HomeMy WebLinkAboutApp-Permit-ComplianceCOMMONWEALTH Of MASSACHUSETTS
j Board of Health, % f MA.
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APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
-.Application for a Permit to Construct( ) Repair( ) Upgrade//Abandon( ) -/complete System ❑ Individual Components
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Owner's Name -7 We, - 041,
Map/Parcel#
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Address C/4"'j
Lot#
Telephone#
Installer's Nam
Designer's Nam �V/0
Address
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Address
Telephone# f
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Telephone# D5, - 17,73 _ a 12;7
Type of Building
Dwelling - No. of Bedrooms
Other - Type of Building _
Lot Size el, >- 7,�Wt sq -ft•-
Garbage grinder ( )
No. of persons Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow (min. required) gpd Calculated design flow Design flow provided gpd
Plan: Date !l/ LI Number of sheets Revision Date
Title
Description of Soil(s)
Soil Evaluator Form No.
Name of Soil Evaluator
DESCRIPTION OF REPAIRS OR ALTERATIONS �•
of �• - - ,• � �._ .
Date of Evaluation
The undersigned agr es to install a above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agree n to place,a tem in operation until a Certificate of ompliance has been issued by the Board of Health.
Signed Date !'
No.
60W17cr16
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G COMMONWEALTH OF SSACHUSETT*101
Board of Health��f�t►'101iTal 1►rA. "� f�
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CERTIFICATE Of COMPLIANCE z.
Description of Work: ❑ Individual Component(s) tTComplete System D'
The undersigned hereby �certify that the Sewage Disposal System; Constructed f1j, Repaired ( ), Upgraded r), Abandoned ( )
by: t 4,f aim t
at r?ttL. �Al Rb:
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has been installed t accord n e wit t e ro-v7 ons of/310 CMR 15.00 (Title 5) and th a roved design plans/as-built plans relating to
application No. % G' > dated - �(o Approved Design Flo w-�(gjd)%
Installer / ��� 1,4e ,1 S%C G C U e 4�V 3
Designers %2s'il//>i / . 1W 5iiyQ X-5 Inspector: Date:
The issuance of this permit shall not be construed as a guaranthat the system will function as designed.
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COMMONWEALTH OF MASSACHUSETTS
Board of Health, Y M00114 , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is herebygranted to; Construct( ) Repair( ) Upgrade) Abandon( ) an individual sewage disposal system
at _6T 2"< e®• I as described in the application for
Disposal System Construction Permit No. %. d �f , dated
P e j�L /
Provided: Construction shall be com Teted within of the date of this permit .All local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown, MA Date Board of Health
No.:BOHDC-16-7854
` Commonwealth of Massachusetts Fee
E55.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERNIIT
Application for a Permit to:Upgrade-Complete System
Location: 45 LOWER BROOK RD, SOUTH YARMOUTH, MA 02664 Owner:
MALONE JAMES J
Map/Parcel#: 058.199 MALONE MARY B
45 LOWER BROOK RD
SOUTH YARMOUTH,MA 02664
Phone:
Septic System Installer Designer
CARDINAL DAVID B.MASON,R.S.
32 RIDGETOP ROAD COTUIT, MA 4 GLACIER PATH
02635 EAST SANDWICH,MA 02537
Phone: 508-833-2177
5084201295
Type of Building:Dwelling Lot Size: 11,761.00 Sq.Ft
Dwelling-No.of Bedrooms:2 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Fixtures:
Plan Date: 11/20/2015 Number of Sheets: 1 '
Cafeteria:
Tit1e:SITE AND SEWAGE PLAN 45 LOWER BROOK ROAD Revision Date:
� Design Flow(min.required):220 gpd Calculated design flow:220 gpd Design flow provided:349 gpd
Description of Soi1s:SEE PLAN
�
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:09/10/2015
DAVID B.MASON,R.S.
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,2-
500 GAL PRECAST CHAMBERS W/4'STONE:25'X 12.83'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 ooeration until a Certificate of Comoliance has been issued bv the Board of Heakh.
Signed Date
Inspections
�
�
Commonwealth of Massachusetts
' Board of Health, Yarmouth, MA Fee
�
DISPOSAL SYSTEM CONSTRUCTION PERMIT 555.00
Permission is herby granted to;
CARDINAL CONSTRUCTION,32 RIDGETOP ROAD, COTUIT, MA 02635
To perform:Upgrade an individual sewage disposal system.
Owner: MALONE JAMES J
MALONE MARY B
45 LOWER BROOK RD
SOUTH YARMOUTH,MA 02664
Location:45 LOWER BROOK RD,SOUTH YARMOUTH,MA 02664
Disposal System Construction Permit No.: BOHDC-16-7854,Dated:January 08,2016
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, DBOX,2-500 GAL PRECAST
CHAMBERS W/4'STONE:25'X 12.83'X 2'
2.ZONE II MAXIMUM 2 BEDROOMS
� �
Bruce G. M 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.