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Home My WebLink AboutApp-Permit-ComplianceNo. &O WDC -/,5"- 567(5� �" i S �(%c f [/ [ FEE 05-00 -00 Board o Health, ��/� � f y,o, , MA. a�-v-l� _rL0-oo2r0-3.® APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair- Upgrade( ) Abandon( - ❑ Complete System,�vidual Components Location ,q 1 C7 V- ( CXV-MWA Owner's Name KJOMV-%l i f rk Map/Parcel# m Address 0 I rut on ,Df i`- - y arm1, W Lot# Installer's Name�Atj V�`^ LL� Telephone# 50% -L� �S - a3S Designer's Name OCky-N C1, ��n Address 5 - ��vvv�G1�M'Aoa6gS Address` S�a S Telephone# a„ fC'j Telephone# Type of Building K�S) Dwelling - No. of Bedrooms Other - Type of Building _ No. of persons Lot Size sq. ft. _ Garbage grinder ( ) Showers ( ), Cafeteria ( ) Other Fixtures 2 Design Flow (min. required) l 1 n X 3 gpd Calculated design flow\tA01 Design flow provided 3 gpd Plan: Date Title Desc: Soil Evaluator Form No Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS a. 24 [.i / 0_ 1&0 .k The undersigned agrees to installo described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and furthers to t to pla syste operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date i -o 4 01!5 M Inspections � - ®NIM[® IR� ,, . LTH �j,N SSACHUSETTS /, ,„,,�..�' a r Board of Heal k y6gmoc" , MA. t CERTIFICATE OF COMPLIANCE Description of Work: "O Individual Component(s) ❑ Complete System The undersigned hereby certify that the Sewage Disposal System; Constructe ~), Repair at , Upgraded ( ), Abandoned ( has been installed in_ acco^rda'e vidated ro`aisions of 3 0 CMR 15.00 (Title 5) and 1he proved design plans/as-built plans relating to application No. A 64- , dated Approved Design Flower (gpd) �-- Installer -'PAN e V -MN) `- Designer: Inspector: Date: of The issuance of this permit shall not be construed as a guar tee that the system will function as designed. k, 0,t G<' 0 01 J.O O.Or� GU<JO Cn 0", C'. C 0 C 0 C. 000 C,CC-. O C JO D Q C 0 L C. l0<CCU0.1'�,:, 0..+--0j-C 01?4C017 0 V'.JC: U C',O Onu Z:C C: C, C? Ovi;,, No. 6017 UC -6 51 /5'- ~k ' :3 t Adj cc) N) 51-- FEE . %� COMMONWEALTH OF MASSACHUSETTS Board of Health, i-1�lO�i-r" , MA. i DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; /Construct( ) RepaiipK Upgrade( ) Abandon( ) an individual sewage disposal system at "�"�'� %yG7 �//2sU�- as described in the application for Disposal System Construction Permit N .��i� , dated Provided: Construction shall be completed within dw-e years of the date of this permit A-11 local conditions must be met. ,yyt�i rt Form 1255 Rev. 5196 A M Sulkin Co. Chadeslown, MA Date h/ 4',`7Board of Health /11 7 �r> �s/� r/ I' /`_` .�Si'✓!flf.� v `' !�� ,�i'Q6 ''% � . � //.// � �'F�/'%Y' ! 1,. �V . ; No.:BOHDC-15-5515 : Commonwealth of Massachusetts Fee � $55.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to: Upgrade-Individual Component(s) Location: 43 CLINTON DR,YARMOUTH, MA 02675 Owner: , MCPHEE JAMES N Map/Parcel#: 125.167 MCPHEE KATHLEEN R 43 CLINTON DR YARMOUTH PORT,MA 02675 Phone: Septic System Installer Designer DAN A. SPEAKMAN DAN A. SPEAKMAN CONSTRUCTION 15 SPEAK WAY HARWICH, MA 02645 15 SPEAK WAY Phone: NORTH HARWICH,MA 02645 5084325565 508-432-5565 Type of Building:Dwelling Lot Size:30,056.00 Sq.Ft. Dwelling-No.of Bedrooms:3 Garbage Grinder: j Other Type of Building• No.of persons: Showers: � � Other Fixtures: � Plan Date: 10/16/2015 Number of Sheets: 1 � Cafeteria: Tit1e:SITE PLAN OF PROPOSED CONSTRUCTION 43 CLINTON DRIVE Revision Date: 11/17/2015 ; ' Design Flow(min.required):330 gpd Calculated design flow:330 gpd Design flow provided:373 gpd � a Description of Soils:SEE PLAN � Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation: 10/14/2015 DAVID B.MASON,R.S. DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK,PROPOSED DBOX, 10 H-20 3050 INFILTRATOR iJNITS W/OUT STONE:35.55'X 8.5'X 1.86' The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further aarees not to olace in ooeration until a Certificate of Comoliance has been issued bv the Board of Health. Signed Date Inspections � , � Commonwealth of Massachusetts � ` Board of Health, Yarmouth, MA Fee DISPOSAL SYSTEM CONSTRUCTION PERMIT , sss.00 Permission is herby granted to; DAN A.SPEAKMAN CONSTRUCTION, 15 SPEAK WAY, HARWICH, MA 02645 To perform:Upgrade an individual sewage disposal system. Owner: MCPHEE JAMES N MCPHEE KATHLEEN R 43 CLINTON DR YARMOLJTH PORT,MA 02675 ' Location:43 CLINTON DR,YARMOUTH,MA 02675 Disposal System Construction Permit No.: BOHDC-15-5515 ,Dated: November 18,2015 Provided:Construction shall be completed within six months of the date of this permit. All local conditions must be met. � CONDITIONS: 1. SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK, PROPOSED DBOX, 10 H-20 3050 INFILTRATOR UNITS W/OUT STONE: 35.55'X 8.5'X 1.86' ' 2. BOH&ENGINEER TO CERTIFY 4'SUITABLE SOILS BELOW LEACH FIELD PRIOR TO CONSTRUCTION ; i 3. MFC VARIANCE APPROVAL: a. DEPTH OF LEACH FACILITY ! C� �%!�� I � � Bruce G. M hy, PH, R.S.,CHO/Amy L.von Hone, R.S., CHO � Health Director/Assistant Health Director x The issuance of this permit shall not be construed as a guarantee that the system will function as designed. ` � � . i I � : Commonwealth of Massachusetts Board of Health, Yarmouth, � Fee CERTIFICATE OF COMPLIANCE 555.00 Description of Work:Individual Component(s) The undersigned hereby certify that the Sewage Disposal System; Upgraded by:DAN A. SPEAKMAN CONSTRUCTION at:43 CLINTON DR,YARMOUTH,MA 02675 ' Has been installed in accordance with the provisions of 310 CMR 15.00(Title S)and the approved design plans or as-built plans relating to application No.: BOHDC-15-5515,dated 12/Ol/2015. Installer:DAN A. SPEAKMAN CONSTRUCTION Address:l5 SPEAK WAY HARWICH,MA 02645 Inspector:AMY VON HONE,R.S. Designer:DAN A. SPEAKMAN CONSTRUCTION Conditions 1.SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK,PROPOSED DBOX,10 H-20 3050 INFILTRATOR UNITS W/OUT STONE:35.55'X 8.5'X 1.86' 2.BOH&ENGINEER TO CERTIFY 4' SUITABLE SOILS BELOW LEACH FIELD PRIOR TO ' CONSTRUCTION 3.MFC VARIANCE APPROVAL: a.DEPTH OF LEACH FACILITY Bruce G. Murphy, MPH, R.S., CHO/Amy L.von Hone, R.S.,CHO Health Director/Assistant Health Director � The issuance of this permit shali not be construed as a guarantee that the system will function as designed. I BOH_Disposal_Construction_CofC.rpt ! i I