HomeMy WebLinkAboutApp-Permit-ComplianceNo. o . — t 13 ..-3;q 4q FEE $ 5 W
COMMONWEALTH OF MASSACHUSETTS - W C� 019 ('p
J�/ /S Board of Health, , MA.
Y TEM CONSTRUCTION PERMIT
APPLICATION FOR DISPOSAL S S
Application for a Permit to Construct( ) Repair( ) Upgrade Abandon( ) - ❑ Complete Syste"dividual Components
Location S ., �p�.
Owner's Name
Map/Parcel# 1433 4,r
Addressd!j(
Lot#
Telephone#
Installer's Name r l f t S ca-�
Designer's Name N11it,
Address fA 3
Address qv S, YJ
Telephone#(0 3
Telephone# $ 0
Type of Building
Dwelling - No. of Bedrooms
Other - Type of Building _
No. of persons
Lot Size
sq. ft.
_ Garbage grinder ( )
Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow (min. required) Z gpd Calculated design flowDesign flow provided gpd
Plan: Date ick lin _� Number of sheets Revision Date
Title
Description of Soil (s) Sr Q-111
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS S
The undersigned agree o tall the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees ton o plac e Tim pe until a Certificate of Compliance hp been issued by the Board of Health.
Signed -"�'� Date
V
Inspections If 7 7
(C tq tl. f I-
I FEEsl
r f c COMMONWEALTH Of MASSACHUSETTS
Board of Health, �%��A!' O 071 , MA.
CERTIFICATE Of COMPLIANCE
Description of Work: Individual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded (°7"AbandotledM(} )
< < r
by:
at
has been inst<tlle m accdrdai ` e wiRh the ro-,7sions of 310 CMR 15.00 (Title 5) and hap o ed design plans/as-built plans relating to
application No. % dated : ' .� Approved Design Flow I (Wpd)
Installer 5CC. ] �> 3e:..D C
Designer: (A "r PE Inspector: Date: "Oi
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
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No. t . -� '1 .i s �"} -`� . FEE 00
COMMONWEAL114 OF MASSACHUSETTS ChZS 1
Board of Health, VAi?.M0 UTA
DISPOSAL. SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgrade Abandon( ) an individual sewage disposal system
at '" �` Vii` / �� .-x t i , f �Fti r- s %i �� /`J , as described in the application for
Disposal System Construction Permit No. / F - 7-
, dated
.. ,;�
Provided: Construction shall be completed within t�ee���� f the date of this perm�t...N11 local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown, MA Date Board of Health ! �`
No.:BOHDGIS-3949
• Commonwealth of Massachusetts Fee '
ass.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Individual Component(s)
Location: 1 ESSEX WAY,YARMOUTH, MA 02675 Owner:
PINTABONE MARY A
Map/Parcel#: 133.48 1 ESSEX WAY
YARMOUTH PORT,MA 02675-1320
Phone:
Septic System Installer Designer
ELLIS BROTHERS PUNK
PO BOX 59 YARMOUTHPORT, MA P.O.BOX 483
02675 SOUTH DENNIS,MA 02660
Phone: 508-564-8379
Type of Building:Dwelling Lot Size: 16,988.00 Acres
Dwelling-No.of Bedrooms:2 Garbage Grinder:
Other Type of Building: No.of persoos: Showers:
Other Fixtures:
Plan Date:07/29/2015 Number of Sheets: 1 Cafeteria•
Tit1e:PROPOSED SEPTIC DESIGN 1 ESSEX WAY Revision Date:
Design Flow(min.required):220 gpd Catculated design flow:220 gpd Design flow provided:352.98 gpd
Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:07/28/2015
, TERRY HAYES,R.S.
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-EXISTING 1500 GAL SEPTIC TANK,DBOX,2-500
, GAL PRECAST CHAMBERS W/4'STONE:25'X 13'X 2'
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 ooeratinn until a Certificate of Comnliance has been issued bv the Board of Health.
Signed Date
Inspections
'
_ Commonwealth of Massachusetts
` Board of Health, Yarmouth, MA F�
DISPOSAL SYSTEM CONSTRUCTION PERMIT ass.00
Permission is herby granted to;
ELLIS BROTHERS CONSTRUCTION, PO BOX 59,YARMOUTHPORT, MA 02675
To perform:Upgrade an individual sewage disposal system.
Owner: PINTABONE MARY A
1 ESSEX WAY
YARMOUTH PORT,MA 02675-1320
Location: 1 ESSEX WAY,YARMOUTH,MA 02675
Disposal System Construction Permit No.: BOHDC-15-3949,Dated: September 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 1500 GAL SEPTIC TANK, DBOX,2-500 GAL PRECAST
CHAMBERS W/4'STONE:25'X 13'X 2'
2. BOH TO INSPECT SOIL REMOVAL
SEPTIC DISPOSAL-REPAIR-EXISTING 1500 GAL SEPTIC TANK, DBOX,2-500 GAL PRECAST CHAMBERS
W/4'STONE:25'X 13'X 2'
Bruce G. Murphy, P , R.S., CHO/Amy L. on Hone, R.S.,CHO
He Director/Assistant Health Director
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
.