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HomeMy WebLinkAboutApp-Permit-ComplianceN VAP- No J508 QLD � k 15 00d-003 FEE +CJ�.�''c©o COMMON LTH Of M SSACHUSETTS =ti Board of Health, ca �� -rc-+ , ALA. APPLICATION FOR DISPOSAL SYSTEM[ C®N TRUCTI®N PERMIT A plication for a Permit to Construct( ) Repair( ) Upgrade Ab ( andon- ' Complete System ❑ Individual Components Location -1,7 5 i Lt/(5z L, cAi= LAgE Owner's Name H u C -A.0 Map/Parcel# -;t-q %4 Address + "'" O kLe-,4A 5 R-1> 4A,*,cA-qr- 4 Lot# Telephone# Installer's Name CAPE- _ Designer's Name Address , Gl o6kke�_ Address (2ke Telephone# -502 -4 '77 - 9 V 7 Telephone# 5a g- 4-7 7 - 5313 Type of Building 12, ES l b E -?T -t i4l_ Lot.Size O sq. ft. Dwelling - No. of Bedrooms L4` Garbage grinder ( ) Other - Type of Building _ Other Fixtures No. of persons Showers ( ), Cafeteria ( ) Design Flow (mien. required) 4go gpd Calculated design flow Design flow provided 14 %1,5 gpd Plan: Date `>' " 7 -,.lot 5 Number of sheets o-. Revision Date J-7 r ,Xof S Title -7-7 Jt "alz ("-f= L406 Vjc-s 'r %s° amodl l Description of Soil (s) FtA%15- 54rip Soil Evaluator Form No. Name of Soil Evaluator P.M41L�''A i!156 Date of Evaluation I a -17 - AW 4 DESCRIPTION OF REPAIRS OR ALTERATIONS = N S U6Ze Jt t�� C�f-u-� A) I�L&T t �° C=pil C - -t K D-0& -ro al AlzC 36 HD P(d"'ric C4144tA69C LO A FIC—lb 1r-4A6.(7-(C�. . 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 place thesystemin operation until a Cert'if'icate of Compliance has been issued by the Board of Health. Signed Date 11 - 13 -A&5 COMMONWEALTH OF M ASS HUSETT Board of Health, 1� �oh'i , MA. 1� CERTIFICATE Of COMPLIANCE ' ow��,`��� Q �/ Description of Work: Ll Individual Component(s)-0-Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( )> Upgraded-(� } Abandoned( ) at 1 i -V 6 L. '.A has been inst�� it a�cord�nce �_ h� he provigons of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. I< '".i 7 , dated /% l+f � . Approved Design Flow -,ev,;�R,..y(,gpd) ^ Installer &Nrskmsev, Designer: .. &l4-/Q6� �k,& %dzW Zi%(.Inspector:�Z l � 0 f �;1.�,�% ` Date: >� The issuance of this permit shall not be construed as a guaraeVe at the system function as designed. CaO J O i._S1C+%1�1% e OS, .. _� ;?CtC' -`.•r(l t) C1r .... v ..t. G.., u 3.. ^ - - c-Eu�'o-t3err�!�M �-^"`1 -c�'r � :, Ccs :.. J ., -Y'Y.. 6 [-„ Cn, ... (` . �; a + ee, ,) ,). , e, u � r) o U o e -, O G , u r� o J o ., o o � No.oy'DC-- 06 CA--PeFWI.DC- 12.Pglscs FEE t55,00. z- S" 7 COMMON L114 0I F M."ASSACHUSETTS O Board of Health, yAn,Mould , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission isherebygranted to; Construct( ) Repair( ) Upgrade (Abandon( ) an individual sewage disposal system at .� 1 4 -V &-P L.� F 1,A as described in the application for Disposal System Construction Permit No. / " ;) dated - �s �� Provided: Construction shall be completed within years`bf t�e date of this,permit. E local conditions must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date �•/ / - ,l S Board of Health ✓� i I ^ No.:BOHDC-15-5508 ' � Commonwealth of Massachusetts Fee $55.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to:Upgrade-Complete System Location: 77 SILVER LEAF LN,WEST YARMOUTH, MA 02673 Owner: HORGAN MURIEL E Map/Parcel#• 022.147 C/O GLOVER WILLIAM R III � 1555 ORLEANS RD HARWICH,MA 02645 Phone: Septic System Installer Designer CAPEWIDE ENGINEERiNG WORKS.INC. 153 COMMERCIAL STREET 12 WEST CROSSFIELD ROAD MASHPEE, MA 02649 FORESTDALE,MA 02644 Phone: 508-477-5313 5084778877 Type of Building:Dwelling Lot Size:9,148.00 Sq.Ft. Dwelling-No.of Bedrooms:4 Garbage Grinder: Ot6er Type of Building: No.of persons: Showers: i Other F�tures: Plan Date:04/17/2015 Number of Sheets:2 Cafeteria• Tit1e:PROPOSED SEPTIC SYSTEM UPGRADE PLAN 77 SILVER LEAF LANE Revision Date: - Design Flow(min.required):440 gpd Calculated design flow:440 gpd Design flow provided:479.5 gpd Description of Soi1s:SEE PLAN ° Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation: 12/17/2014 DAVID A.CLARK,P.E. i I DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL POLY SEPTIC TANK, i DBOX,27 ADS ARC 36HD iJNITS W/OUT STONE:45'X 8.5'X 7.13" � 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 6v the Board of Heakh. Signed Date Inspections I i � � : Commonwealth of Massachusetts � Board of Health, Yarmouth, MA Fee � DISPOSAL SYSTEM CONSTRUCTION PERMIT $55.00 I I Permission is herby granted to; CAPEWIDE ENTERPRISES, LLC, 153 COMMERCIAL STREET, MASHPEE, MA 02649 To perform:Upgrade an individual sewage disposal system. Owner: HORGAN MURIEL E C/O GLOVER WILLIAM R III 1555 ORLEANS RD � HARWICH,MA 02645 � Location:77 SILVER LEAF LN,WEST YARMOUTH,MA 02673 Disposal System Construction Permit No.: BOHDGIS-5508,Dated:November 09,2015 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 POLY SEPTIC TANK, DBOX,27 ADS ARC 36HD UNITS W/OUT STONE:45'X 8.5'X 7.13" 2. MFC VARIANCE APPROVALS: a. SETBACKS r � �, ' Bruce G. Mur y, PH, 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. � � i i 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:CAPEWIDE ENTERPRISES,LLC at:77 SILVER LEAF LN,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-15-5508,dated 12/23/2015. Installer:CAPEWIDE ENTERPRISES,LLC Address:153 COMMERCIAL STREET MASHPEE,MA Inspector:AMY VON HONE,R.S. 02649 � Designer:ENGINEERING WORKS,INC. ' Conditions ' 1.SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL POLY SEPTIC TANK,DBOX,27 ADS � ARC 36HD UNITS W/OUT STONE:45'X 8.5'X 7.13" 2.MFC VARIANCE APPROVALS:a.SETBACKS . C�����"C ' Bruce G. Murph , PH, R.S., CHO/Amy L.von Hone, R.S.,CHO � j Health Director/Assistant Health Director i � 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 ; ! i I