HomeMy WebLinkAboutApp-Permit-ComplianceNo. #b�'�S' l,,4C - L—VTT — I (_ — a a 371 FEE Q
COMMONWEALM Of MASS C14USETTS c
Board of Health, YXWYMiQ QTI-t , MA.
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APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Ap ication for a Permit to Construct(
Repair (✓Upgrade ( ) Abandon( - 0 Complete System ❑ Individual Components
cation �0
Owner's Name
Swolh
Map/Parcel# 066 -cob
Address
a 1 a m
Lot#
Telephone#
Installer's Name
; Designer's Name
n
Addressa50i
Address 7
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Telephone# Mb.
Telephone# �-,30-
_ Qy
Type of Building(�
\°IeSG ���o.` Lot.size e �0L Y71 sq. ft.
Dwelling - No. of Bedrooms a Garbage grinder ( )
Other - Type of Building No. of persons Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow (min. required) '3 gpd Calculated design flow Design flow provided _ gpd
Plan: Date J)Cl 1 �` , �_ Number of sheets Revision Date
Title
Description of Soil(s)
Soil Evaluator Form No.
DESCRIPTION OF REPAIRS OR
Name of Soil Evaluator
Date of Evaluation
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees tt t to place the sys eration until a Certificate of Compliance has been issued by the Board of Health.
Signed,/ G -.o e _� Date 1-2/�/���`'
ap
COMMONWEALTH Of MASSACHUSETTS �'�
�Vlb
Board of Health,MA.
CERTIFICATE OF COMPLIANCE
Description of Work: ❑ Individual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired Upgraded ( ), Abandoned ( )
by:
atl �i has been installed A c'// VW, wi provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No./;. Z-2- , dated Approved Design Flow--" (gpd)
�
Installer' -
Designer: 0, 0-0 Cs't'K4 N) I 63 . Inspector: / !� f Date:
The issuance of this permit shall not be construed as a guaran ee that the system will function as designed. 3
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No. - O C - i �. t� UIA- Oo v Sevi c , Vc. s . FEE Z C2:
COMMONWEALTH Of MASSACHUSETTS ck-if ( 317 --
Board of Health, YAO=M01111.1
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ).. Repair�) Upgrade( ) Abandon( ) an individual sewage disposal system
at D(Z`} C lIC1`-,41CCc,`� G as described in the application for
Disposal System Construction Permit No. % 17 7 , d ted
Provided: Construction shall be completed within three -rens of the date of this permit. l local condi ions must be met.
Farm 1255 Rev. 5196 A.M. Sulkin Co. Charlestown, MA Date -" Board of Health i
�
No.:BOHDGIS-6628
Commonwealth of Massachusetts Fee
ass.00
Board of Health, Yarmouth, MA j
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT I
Application for a Permit to:Upgrade-Individual Component(s) ',
Location: 68 CONSTANCE AVE,WEST YARMOUTH, MA 02673 Owner:
SMITH MARION
Map/Parcel#: 086.68 68 CONSTANCE AVE
WEST YARMOUTH,MA 02673
Phone:
Septic System Installer Designer
CAPE COD SEPTIC J.O'LOUGHLIN,INC.
350 ROUTE 28 WEST YARMOUTH, MA 714 MAIN STREET
02673 YARMOUTHPORT,MA 02675 '
Phone: 508-362-4942
5087752825 '
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Type of Building:Dwelling Lot Size:27,878.00 Sq.Ft.
Dwelling-No.of Bedrooms:2 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Fixtures: �
. �
P►an Date:07/31/2015 Number of Sheets: 1 �
Cafeteria: �
p Title:SEWAGE PLAN 68 CONSTANCE AVENiJE Revision Date:08/14/2015
Design Flow(min.required):220 gpd Calculated desiga flow:220 gpd Design flow provided:360.29 gpd
Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:07/15/2015
MICHAEL O'LOUGHLIN,SE
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-EXISTTNG 1000 GAL SEPTIC TANK,DBOX,10
HIGH CAPACITY INFILTRATOR H-20 iJNITS W/OUT STONE IN TRENCH CONFIGURATION:2 TRENCHES 31.25'X 2.83'X 11"
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�lace in ooeration unUl a Certificate of Comoliance has been issued bv the Board of Health.
Signed Date
Inspections I
Y �
� Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
DI5POSAL SYSTEM CONSTRUCTION PERMIT $55.00
�
Permission is herby granted to;
CAPE COD SEPTIC SERVICES,350 ROUTE 28,WEST YARMOUTH, MA 02673
To perform:Upgrade an individual sewage disposal system.
Owner: SMITH MARION
68 CONSTANCE AVE
WEST YARMOUTH,MA 02673
Location:68 CONSTANCE AVE,WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.: BOHDC-15-6628,Dated:December 23,2015
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, DBOX, 10 HIGH CAPACITY
INFILTRATOR H-20 UNITS W/OUT STONE IN TRENCH CONFIGURATION:2 TRENCHES 31.25'X 2.83'X 11"
2.ZONE II MAXIMUM 2 BEDROOMS
�V �����
�
Bruce G. Mur ,M H, R.S., CHO/Amy L.von Hone, R.S.,CHO
ealth Director/Assistant Health Director
The issuance of this permit shall not be construed as a guarantee that the system wiil function as designed.
t
�
i
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
CERTIFICATE OF COMPLIANCE ass.00 ;
i
;
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Description of Wark:Individual Component(s) ';
�
The undersigned hereby certify that the Sewage Disposal System; Upgraded �
by:CAPE COD SEPTIC SERVICES ,
at:68 CONSTANCE AVE,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.: BOHDC-15-6628,dated Ol/19/2016.
Installer:CAPE COD SEPTIC SERVICES
Address:350 ROUTE 28 WEST YARMOUTH,MA Inspector:AMY VON HONE,R.S. '
02673
Designer:J.O'LOUGHLIN,INC.
Conditions
1.SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK,DBOX,10 HIGH
CAPACITY INFILTRATOR H-20 UNITS W/OUT STONE IN TRENCH CONFIGURATION:2
TRENCHES 31Z5'X 2.83'X 11"
2.ZONE II MAXIMUM 2 BEDROOMS �� '
Bruce G. Murp�iy,MPH, R.S., CHO/Amy L.von Hone, R.S.,CHO
�� Health Director/Assistant Health Director
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
BO H_Disposal_Construction_CofC.rpt
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