HomeMy WebLinkAboutApp-Permit-ComplianceNo. (3Q17C��SbOZ�
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COMMONWEALTH OF MASSACHUSETTS C�►► '�"ice �'
j el 414S' Board of Health, Y%}M1)"1 MA.
�f4PPLICATION FOR. DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgradq--) Abandon( - ❑ Complete System Individual Components
Location 35 Ga
Owner's Name
Map/Parcel# ? 2
Address S
Lot# 0,2
Telephone#
Installer's NameDesigner's
Name Q
Address
Address I 'Z C j U S 1
Telephone# _ r`
Telephone# �93
Type of Building L)wc- l l,ft!�4 Lot Size /L�,� sq. ft.
Dwelling - No. of Bedrooms Garbage grinder ( }
Other - Type of Building No. of persons Showers ( ), Cafeteria ( }
Other Fixtures
Design Flow (min. required) 336 gpd Calculated design flow •%�I G?% Design flow provided 333 gpd
Plan: Date le)� Number of sheets Z Revision Date /J
Title
Description of Soil (s)
Soil Evaluator Form No.
13
Name of Soil Evaluator
DESCRIPTION OF REPAIRS OR ALTERATIONS Y'—
—I— � — i , — _ , \ ^— , t r ( .
Date of Evaluation
Tundersigned agrees install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
f er -e s to not top ce the system in operation until a Certificate of ompl•ance, has been issued by the Board of Health.
Signed Date 1 _
Inspections
No. bOOTC 1:57-40-2-0 FEE 0
/2&, COMMONWEALTH OF MASSACHUSETTS
Board of Health, YA n'l OLIT E , MA.
CERTIFICATE Of COMPLIANCE
Description of Work: Individual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgrade, Abandoned ( )
by: �� r� ��a �t� fti— fI7� ' lC{�l� �xc#4ir�fi1N(s� C A��?CTi)r2�
at �._ t -A
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has been installed'i accoud_a,r� with �p`roisions of 31 CMR 15.00 (Title 5) and thea proved design plans/as-built plans relating to
application No. ! �� %S�• ,dated _ � Approved Design Flown (gp )
Installer
Designer: Pc"Tl" (11t ANT Inspector:" - t Date:
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
No. VT fI SOly Jou Z,4-
COMMONWIA: .TII OF MASSACHUSETTS
Board of Health, l 8 JM4 , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
FEE
" 15--G f
Permission is hereby granted to; Construct( ) Repair( ) UpgradkA Abandon ( ) an individual sewage disposal system
at 36- 0462SM6264 &Ze as described in the application for
Disposal System Construction Permit No. ��=. 76 , dated
d t - _
Provided: Construction shall be complete withitt�,f the date of this permit. Adl local conditions must be met.
Form 12555/Rev, 5196 A.M�Su`lkin Co. Chadesj�avn,/fir • Date �U j��� Bc ard"o H a the �
(OlA7`iLLrLt �tl.9sJ'/917.1[ C %//rlT /.'cif /\r�i1TJ 7Je
No.:BOHDC-15-6020
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: 35 CONSTANCE AVE,WEST YARMOUTH, MA 02673 Owner:
NEWELL GARY E(EST OF)
Map/Parcel#:086.203 C/O BAYVIEW LOAN SERVICING LLC
4425 PONCE DELEON BLVD
CORAL GABLES,FL 33146
Phone:
Septic System Installer Designer
AMERICAN ENGINEERING WORKS,INC.
27 COUNTY ROAD MASHPEE, MA 12 WEST CROSSFIELD ROAD
02�9 FORESTDALE,MA 02644
Phone:
7748365774 508-477-5313
Type of Building:Dwelling Lot Size: 14,810.00 Sq.Ft.
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Fixtures:
Plan Date: 10/14/2015 Number of Sheets:2
Cafeteria:
Title:PROPOSED SEPTTC SYSTEM UPGRADE PLAN 35 CONSTANCE Revision Date: �
AVENUE C
� Design Flow(min.required):330 gpd Calculated design flow:330 gpd Design flow provided:333 gpd
Description of Soils:SEE PLAN
� Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:09/03/2015
PETER MCENTEE,PE
DESCRIPTION OF REPAIRS OR ALTERATTONS:SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK,DBOX,45'X
10'X 6"LEACH FIELD
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 f
i
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� = Commonweal h f
t o Massachusetts
Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT 355.00
Permission is herby granted to;
AMERICAN EXCAVATING CONTRACTORS,27 COUNTY ROAD, MASHPEE, MA 02649
To perform:Upgrade an individual sewage disposal system.
Owner: NEWELL GARY E(EST OF)
C/O BAYVIEW LOAN SERVICING LLC
4425 PONCE DELEON BLVD
CORAL GABLES,FL 33146
Location:35 CONSTANCE AVE,WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.: BOHDC-15-6020,Dated:November 30,2015
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,45'X 10'X 6"LEACH FIELD
2.ZONE II MAXIMUM 3 BEDROOM
3. MFC VARIANCE APPROVAL:a. DEPTH OF LEACH FIELD
`;_�.�-C
Bruce G. rp y, MPH, R.S., CHO/Amy .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.
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Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
CERTIFICATE OF COMPLIANCE $55.00
Description of Work: Individual Component(s)
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:AMERICAN EXCAVATING CONTRACTORS
at:35 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-15-6020,dated 12/04/2015.
Installer:AMERICAN EXCAVATING CONTRACTORS
Address:27 COtJNTY ROAD MASHPEE,MA 02649 Inspector:BRUCE MURPHY,R.S.
Designer:ENGINEERING WORKS,INC.
Conditions
1.SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK,DBOX,45'X 10' X 6"
LEACH FIELD
2.ZONE II MAXIMUM 3 BEDROOM
3.MFC VARIANCE APPROVAL: a.DEPTH OF AC EL
Bruce G. Murphy,MPH, .S., /Amy L.von Hone, R.S.,CHO
Heal Di ector/Assistant Health Director
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
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BO H_Disposal_Construction_CofC.rpt
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