HomeMy WebLinkAboutApp-Permit-ComplianceNo. ftt(DC-f5-4P I �j,� �Ir-0 -'jFEE -5-5-1 ®'O
COMMONWEALTH OF MASSACHUSETTS CL4zb-117
Board of Health, )6agmo un , MA.
APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade (d Abandon( ) - C�/Complete System ❑ Individual Components
Location
Owner's Name
Map/Parcel# -31 jedk-ceL
Address --i r -
Lot#
Telephone# was _ 00
Installer's Name '
Designer's Name
Address CI
Address p
Telephone# S
Telephone# �� fJS 1JD
Type of Building 95 t a -� Lot Size I l,�n_ sq. ft.
Dwelling - No. of Bedrooms a -Joe Garbage grinder (gyp
Other - Type of Building
Other Fixtures
No. of persons Showers ( ), Cafeteria (
Design Flow (min. required) gpd Calculated design flow - Design flow provided � gpd
Plan: Date 9 21V Number of sheets
Title
Revision Date
Description of Soils) O %� �o �r�S44Z& iZ3 �B d i V -P-- �U4 .eJ,, -9 =444—
Soil Evaluator Form No. Name of Soil Evaluator R v.J Cd r,T, tLLC._ Date of Evaluation 3 --�..
DESCRIPTION OF REPAIRS OR ALTERATIONS
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to not to pla, 'e the srem in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed
Inspections
Date %D— s S—
No. i�T�� jFEE S'S. Cid
COMMONWEALTH ®FSSAC��S� TSS c.�t.-� X57
Board of Health, AkM61):M , MA.
CERTIFIC Of COMPLIANCE
Description of Work:
El Componenf(s) Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed (Repaired Upgraded (d/) Abandoned ( )
Ii,
by:
at
has been installed in ----
accordance with the /p�ro«sions of 310 CMR 15.00 (Title 5) and the approved
application No. 1 �----2- � , dated i!/ 6 Approved Design Flow e�/ jj;�/ (gpd)
Installer�kD4;!</ -1QA n k'' 14UA0kMl, LIN .-
Designer: 12 ip o C', � 1 L p +mac Inspector:
plans/as-built plans relating to
Date:j1/ 7- —/
The issuance of this permit shall not be construed as a gua>oftee that the system will function as designed.
No. FEE -5
COMMONWEALTH OF MASSACHUSETTS ck ifm�
Board of Health, ne now MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct(j, ' Repair( ) Upgradeo Abandon( ) an individual sewage disposal system
at J has described in the application for
i
Disposal System Construction Permit No.A�,�, dated
Provided: Construction shall be com�ted withl of the date of this permit. local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown, MA Date � Board ofrHealtli ttt...
No.:BOHDC-15-4501 �
• Commonwealth of Massachusetts as o0
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application For a Permit to:Upgrade-Complete System
Location: 38 JERUSHA LN,WEST YARMOUTH, MA 02673 �'oe�� �_
I{ANDARAS CHRISTOPI-�R
C/O MONKEVICZ SCOTT
Map/Parcel#:063.40 5g,�ERTON ST
BROCKTON,MA 02302
Phone:
Designer !
Septic System Installer
B.C.K.GENERAL RONALD J.CADILLAC.PLS.RS.PC
97 TOWN BROOK ROAD WEST P.O.BOX 258 �
YARMOUTH,MA 02673 WEST YARMOUTH,MA 02673 .
Phone: 508-775-9700
Type oi Building:Dwelling Lot Siu: 14,375.00 Acres
Dwelliog-No.of Bedrooms:4 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Fiatures:
Plao Date:09/24/2015 Number of Sheets: 1 Cafeteria:
Titlr.SITE PLAN 8 JERUSHA LANE Revisioo Date:
Design Flow(mio.required):440 gpd Calculated design flow:440 gpd Design flow provided:461 gpd
Descriplion of Soi1s:SEE PLAN
Soil Evaluaror Form No.: Name of Soil Evaluator: Date of Evaluation:OS/13/2015
RONALD J.CADILLAC,RS
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR•PROPOSED 1500 GAL SEPTIC TANK,DBOX,2-
'CRtiNCHES OF 8 ARC 36HC UNITS W/OUT STONE:40'X 2.89'X 0.89'
The undersigned agreea to inafall the above tleseribed Individual Sewage Disposal System in accordance with the provisions of
TITLE 5 and fuRher aarees not to olace in ooerotion untll a Cert�cate of Comolianca has heen Issued hv the Board M Neatth.
Signed Date
Inspections
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA F�
DISPOSAL SYSTEM CONSTRUCTION PERMIT ass.ao
Permission is herby granted to;
B.C.K.GENERAL CONTRACTOR,97 TOWN BROOK ROAD,WEST YARMOUTH, MA 02673
To perform: Upgrade an individual sewage disposal system.
Owner. KANDARAS CHI2ISTOPHER
C/O MONKEVICZ SCOTT
58 MERTON ST
BROCKTON,MA 02302
�� �CrKSk� ��.f
Location:34-HA9�FB�WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.: BOHDC-15-4501 ,Dated:October 06,2015
Provided: Construction shall be completed within six months of the date of this permit. All local conditions must be me[.
CONDITIONS:
1. SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK, DBOX,2-TRENCHES OF 8 ARC
36HC UNITS W/OUT STONE:40'X 2.89'X 0.89'
2. MFC VARIANCES APPROVAL:a. GROUNDWATER SEPARATION b. GROUNDWATE ADJUSTMENT
�
Bruce G. Mu ,MPH, R.S., CHO/Amy L.von Hone, R.S.,CHO
ealth Director/Assistant Heafth Diredor
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
CERTIFICATE OF COMPLIANCE 555.00
Description of Work: Complete System
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by: B.C.K. GENERAL CONTRACTOR
at: 38 JERUSHA RD, WEST YARMOUTH, MA 02673
Has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5)and the approved
design plans or as-built plans relating to application No.: BOHDGIS-4501, dated 11/18/2015.
Installer: B.C.K. GENERAL CONTRACTOR
Address:97 TOWN BROOK ROAD WEST Inspector: AMY VON HONE,R.S.
YARMOUTH, MA 02673
Designer: RONALD J. CADILLAC,PLS,RS,PC
Conditions
1. SEPTIC DISPOSAL -REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,2 -TRENCHES
OF 8 ARC 36HC UNITS W/OUT STONE: 40' X 2.89' X 0.89'
2. MFC VARIANCES APPROVAL: a. GROUNDWATER SEPARATION b. GROUNDWATE
ADNSTMENT
�( V�/�
Bruce G. Murph r PH, R.S., CHO/Amy L. von Hone, R.S., CHO
Health Director/Assistant Health Director
The issuance of t6is permit shall not be construed as a guarantee t6at the system will function as designed.
BOH_Disposa I_Construction_CofC.rpt