HomeMy WebLinkAboutApp-Permit-ComplianceNo. BO 4DC-1 S-- `t' l _5S /l G�"(.C� � �� FEE Sy, 00
LUYIMUNWLAL114 U1 M SNALHUSLTTS
/0oard of Health, 7 AR-Mej iJ , MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( grade( Abandon( ) - 2.666-66mSystem ❑ Individual Components
Location
UmvlI
Owner's Name -ToWp Arj {
Map/Parcel#
q %j 1
Address ea 1 00 A
Ar3t(IG 5k T1110
Lot#
Telephone#
G 41 GA&O , = fr
Installer's Name is h,4 -t igL-L C,ve
esigner's Name L i A
P w l0
Address (,j
1?0J c Z 7 A ( r Ca j�,7
Address 'Qv o K to I
i3 It i k( I , V'i` O Z& 31
Telephone#
Sv g . T1 g7 _ 171 e7
Telephone# g t? M & -- JS'[ 5
Type of Building L. S - Lot Size 0, 53 A C S
Dwelling - No. of Bedrooms `Z Garbage grinder ( )
Other -Type of Building No. of persons Showers( ), Cafeteria ( )
Other Fixtures
i
Design Flow (min. required) 'ZZ 0 gpd Calculated design flow Design flow provided 5 s gpd
Plan: Date f!i ) 0 1 Number of sheets ( Revision Date
Title PP o to 2 i S �--
Description of Soil (s) E- __f \ Le A �6 -D C i tA. b+�J -
Soil Evaluator Form No. Name of Soil Evaluator Li ^d'Q Pt o�a Date of Evaluation `1 � Z°I � t �
DESCRIPTION OF REPAIRS OR ALTERATIONS JjNj5rAL& t4-c� I 5#a d4f— S QN-W4 176 —(a 07,0
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to of to place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed N, t�` td.r — Date _� o �'
COMMONWEALTH LTR O F MASSACHUSETTW
Board of Health, l A9 -MIO Ji t"
CERTIFICATE OF COMPLIANCE --4.'-
Description of Work: ❑ Individual Comporient(s) LComplete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired (Upgraded (Abandoned (
by: i`%i c > ,+N tc� 01Q, `,4 i ", r` L G - � t✓ V r? C_ , L4
has been installein_accor ce with th
l5
application No. / "��� dated _
fi
Installer A4 s i 61 CA r,
is of CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
is
Design Flow ;>y pd)
Designer: D t ^8 d ,i rte; Inspector:/116(. - L-/ ��� � Date:
The issuance of this permit shall not be construed as a guar ee that the system will function as designed.
''��"e ii7 FEE
-
Na Au pL �i:PnL
COMMON LTR Of MASSACHUSETTS
Board of Health, Y2 2&M 0 Q_M MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby ranted to; Construct Re air(, r u de ) Abandon an individual sewage disposal stem
at y �P r'. s"'� '� T." �\' 'oq � `/ �� f""' as described in the application for
Disposal System Construction Permit No. �_, dated
Provided: Construction shall be completed within tree yearsfate of this perpt All
�local
/conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown, MA Date `� Board of Health ��K t1/�E'�
. ;
No.:BOHDC-15-4965 '
� Commonwealth of Massachusetts Fee �
$55.00 ti
Board of Health, Yarmouth, MA ;
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT ;
Application for a Permit to:Upgrade-Complete System '
i
Location: 5 PAR 3 DR, SOUTH YARMOUTH, MA 02664 Owner: !
JONES JOSEPHINE C(LIFE EST)
Map/Parcel#: 091.31 C/O BANK OF AMERICA
30 NORTH LASALLE SUITE 2330
CHICAGO,IL 60602
Phone:
SepHc System Installer Designer
ALL CAPE SEPTIC OCEANSIDE SEPTIC
618 ROUTE 28, UNIT 3 WEST P.O.BOX 201
YARMOUTH, MA 02673 BREWSTER,MA 02631
Phone: 508-896-1513
5087714200
Type of Building:Dwelling Lot Size:22,216.00 Sq.Ft. >
Dwelling-No.of Bedrooms:2 Garbage Grinder: �
Ot6er Type of Building: No.of persons: Showers: �
Other Fixtures:
Plan Date:08/OS/2015 Number of S6eets: 1 Cafeteria• '
Title:PROPOSED SEWAGE DISPOSAL SYSTEM 5 PAR THREE DRIVE Revision Date: i
;
' Design Flow(min.required):220 gpd Calculated design flow:220 gpd Design flow provided:355 gpd
Description of Soi1s:SEE PLAN
` Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:07/29/2015
LINDA PINTO,PE ,
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK,H-20 DBOX,
20 ARC 36HC CHAMBERS W/OUT STONE:25'X 11.5'X 0.89' ,
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance wkh the provisions of
TITLE 5 and further aarees not to olace in ooeration until a Certificate of Comoliance has heen issued bv the Board of Health.
Signed Date
i
Inspecfions �
1
+ f
Commonwealth of Massachusetts
� Board of Health, Yarmouth, � Fee ;
DISPOSAL SYSTEM CONSTRUCTION PERMIT 555.00
Permission is herby granted to;
ALL CAPE SEPTIC,618 ROUTE 28, UNIT 3,WEST YARMOUTH,MA 02673 '
To perform:Upgrade an individual sewage disposal system.
Owner: JONES JOSEPHINE C(LIFE EST)
C/O BANK OF AMERICA
30 NORTH LASALLE SUITE 2330
CHICAGO,IL 60602
Location:5 PAR 3 DR,SOUTH YARMOUTH,MA 02664
Disposal System Construction Permit No.: BOHDC-15-4965,Dated:November 04,2015
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-PROPOSED 1500 GAL SEPTIC TANK, H-20 DBOX,20 ARC 36HC ,
CHAMBERS W/OUT STONE:25'X 11.5'X 0.89'
2. ENGINEER TO INSPECT AND CERTIFY PER PLAN NOTE
3. MFC VARIANCE APPROVAL:a. DEPTH VARIANCE
4.ZONE II MAXIMUM 2 BEDROOMS '
� ;
U �
Bruce G. Mu y,MPH, 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 will function as designed.
s
i
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
CERTIFICATE OF COMPLIANCE $55.00
Description of Work:Complete System
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:ALL CAPE SEPTIC
at:5 PAR 3 DR,SOUTH YARMOUTH,MA 02664
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-15-4965,dated 11/19/2015.
Installer:ALL CAPE SEPTIC
Address:618 ROUTE 28,UNIT 3 WEST YARMOUTH, Inspector:AMY VON HONE,R.S.
MA 026'73
Designer:OCEANSIDE SEPTIC
Conditions
1.SEPTIC DISPOSAL-REPAIIt-PROPOSED 1500 GAL SEPTIC TANK,H-20 DBOX,20 ARC
36HC CHAMBERS W/OUT STONE:25'X 11.5'X 0.89'
2.ENGINEER TO INSPECT AND CERTIFY PER PLAN NOTE
3.MFC VARIANCE APPROVAL: a.DEPTH VARIANCE
4.ZONE II MAXIMUM 2 BEDROOMS f0��
�
Bruce G. Murph ,M H, 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 guarante hat the system will function as designed. '
BO H_Disposal_Construction_CofC.rpt
�