HomeMy WebLinkAboutApp-Permit-ComplianceN '.��G' 1 Sr (oI �� FEE
COMMONWEALTH OF MASSACHUSETTS d4=2s:5p
Board of Health,/A-fLly1OU , AVIA.
APPLICATION F®P, ISI P®SAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon() - ❑ Complete System Yl'Ix�dividual Components
Location
50
Owner's Name /t't� ke SC p 1 l
Map/Parcel#
�,
Address
Lot#
Telephone#
Installer's Name C CO& 6ep, fC 45 el(e)/)
Designer's Name
Address
{!_(J• j��� wyfell p?,(,t/jr
Address
Telephone#®�
2t{L� — Gfl % •�%'�;
Telephone#
Type of Building ' i Q 5 Lot Size sq. ft.
Dwelling - No. of Bedrooms Garbage grinder( )
Other - Type of Building No. of persons Showers ( ) , Cafeteria ( )
Other Fixtures
Design Flow (min. required) gpd Calculated design flow
Plan: Date Number of sheets
Title
Description of Soil(s)
Soil Evaluator Form No.
DESCRIPTION OF REPAIRS OR ALTERATIONS
Name of Soil Evaluator
Design flow provided gpd
Revision Date
Date of Evaluation
The undersigned ees to install the bove described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees t t to ce the eration until a Certificate of Compliance has been issued by the Board of Health.
Signed �j Date % 2' �d. a✓�
Inspections
No. 6`J, FE' ���
COMMONWEALTH LTH ®F MASSACHUSETTS b� v 5
Board of Health, b�
CERTIFICATE Of COMPLIANCE
"`Descripfion of Work: Individual Component(s) 0 Complete System
The undersi ned hereby ce tify that the Sewage Disposal System; Constructed ( ), Repaired (Upgraded ( ),Abandoned ( )
by:.Q •° - �c'jl1r s 10.SlJp� i�Cl(1
at
has been installed in a cord ce wi i the piovisions of 310' CMR 15.00 (Title 5) and the a proved design plans/as-built plans relating to
application No. dated Approved Design Flow (gpd)
Installer
Designer: Inspector:
Date:Z
The issuance of thispermit shall not be construed as a guarr e'e that the system will function as designed.
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COMMONWEALTH LTH ®F M ASSAC14USETTS � �v
Board of Health, /- /�} l�_, AVIA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair (v) Upgrade ( ) Abandon ( ) an individual sewage disposal system
at•- so ��' f (� (F� as described in the application for
isposal Sysf pstruction Permit No.
i =.� v , dated
Provided: Construction shall be completed within the date of is permit. All local conditip s must be met.
Form 1255 Rev.5(96 A.M. Sulkin Co. Chadestawn, MAv Date/—) "�� 5 Board of H lfh V } -i \
i a
1�To.:BOHDC-15-6155
Commonwealth of Massachusetts Fee
$55.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Repair-minor-Individual Component(s)
Location: 50 HILLCREST RD,WEST YARMOUTH, MA 02673 Owner:
DRISCOLL MICHAEL A
Map/Parcel#: 151.58 FIORENZA JANET
13 LINKSIDE COURT
ISLE OF PALMS,SC 29451
Phone:
Septic System Installer Designer
BEFORE SUNSET LLC DOWN CAPE ENGINEERING,INC.
P.O. BOX 1466 HARWICH, MA 02645 939 ROUTE 6A
Phone: YARMOUTHPORT,MA 02675
��4�22229$ 508-362-4541 '
Type of Building:Dwelling Lot Size: 15,682.00 Sq.Ft.
Dweiling-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building: No.of persons: Showers: '
Other Fixtures:
Plan Date: 12/11/1985 Number of Sheets: 1 Cafeteria•
Tit1e:SIT'E PLAN LOT 34 LONGFELLOW&HILLCREST Revision Date:
Design Flow(min.required):330 gpd Calculated design flow:330 gpd Design flow provided:427 gpd
Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-MINOR REPAIR-REPLACE DBOX AND RISER TO
EXISTING 1000 GAL SEPTIC TANK AND 6'X 8'LEACH PIT
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 nlace in ooeration until a Certificate of Comoliance has been issued bv the Board of Heakh.
Signed Date
Inspections
�w
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00
Permission is herby granted to;
BEFORE SUNSET LLC, P.O. BOX 1466, HARWICH, MA 02645
To perform:Repair-minor an individual sewage disposal system.
Owner: DRISCOLL MICHAEL A
FIORENZA JANET
13 LINKSIDE COURT
ISLE OF PALMS,SC 29451
Location:50 HILLCREST RD,WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.:BOHDC-15-6155,Dated:December 10,2015
Provided:Construction shall be completed within six months of the date of this permit. All local conditions must be met.
CONDITIONS:
1.SEPTIC DISPOSAL-MINOR REPAIR-REPLACE DBOX AND RISER TO EXISTING 1000 GAL SEPTIC TANK
AND 6'X 8' LEACH PIT
_ VY
Bruce G. Mu hy, 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
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; Repair-minor
by:BEFORE SiJNSET LLC
at:50 HILLCREST RD,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-15-6155,dated 12/10/2015.
Installer:BEFORE SLJNSET LLC
Address:P.O.BOX 1466 HARWICH,MA 02645 Inspector:AMY VON HONE,R.S.
Designer:DOWN CAPE ENGINEERING,INC.
Conditions
l.SEPTIC DISPOSAL-MINOR REPAIR-REPLACE DBOX AND RISER TO EXISTING 1000
GAL SEPTIC TANK AND 6'X 8' LEACH PIT
;.
Bruce G hy, PH, 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