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HomeMy WebLinkAboutApp-Permit-ComplianceNo.� ��2✓G�� FEE *P5_5%00 / COMMONWEALTH OF MASSACHUSETTS C" NOY 0 4 215 Board of Health, �.� 'TION FOR DISPOSAL SYSTEM CONSTRUC��O RMI ' Application for a Permit to Construct( ) Repair( -,,"Upgrade( ) Abandon ) ❑ Complete System 0 Indivi ual Components Location t��� �� Owner's Namee. Map/Parcel# Address r_,\„ v Lot# kQ Telephone# 1_�_(7& a !�1 0 � Installer's Name Vl. Designer's Name � J Address \ l VJ Address ts,eG UAi Telephone# .- (� ©(p Telephone# r Type of Building Dwelling - No. of Bedrooms Other - Type of Building No. of persons Other Fixtures Lot Size \;)- e o O sq. ft. Garbage grinder.{ f Showers ( ), Cafeteria ( ) fl Design Flow (min. required) 6( �o( gpd Calculated design flow Design flow provided gpd Plait: Date Number of sheets ( Revision Date Title Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS -Add... CJ k Dox cn1�, J i C7 �SP U 6n`. � C r CJ /�, 7S �2� o 3� c c,.r yt e. 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 the system ' eration until a Certificate of Compliance has been issued by the Board of Health. Signed Date k k Inspections No. &o G� � �sI��/C�1C_," • FEE 00 COMON�LT14 OF MASS C� Board of HealthzMA. CERTIFICATE Off, CO Li��cr, �� o Description of Work: *Individual Component(.) ❑ Complete System Q ��M 5_7 The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired (Upgraded (; ),Abandoned ( ) by: SCOA �rt"-, at C`Sr . 1 _ ccr� /_tk L_p has been'insto dan e t e provisions of 310 CMR 15.00 (Title 5) and the a p •oved design plans/as-built plans relating to application No. /'� :� - dated 1/ Approved Design Flow (gpd) Installer Designer: ]>Awa COVG 4i A.WOIA � Inspector: Date: The issuance of this permit shall not be construed as a guaran a #1 at the system will function as designed. Scoir MFEE 00 COMMONWEALTH Of MASSACHUSETTS Board of Health, �/� Q tMA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair(vY"'Upgrade( ) Abandon( ) an individual sewage disposal system at-�r_�L;,� t S 0 �� �G.sMo� as described in the application for Disposal System Construction Permit No. X,-21 dated %!-f Provided: Construction shall be completed withuears �e date of this per it. All local conditions must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown, MA Date - '' Board of Health / / /l No.:BOHDC-15-5637 ' Commonwealth of Massachusetts Fee $55.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to:Upgrade-Individual Component(s) Location: 58 MADISON AVE, SOUTH YARMOUTH,MA 02664 Owner: CATERINO CAROLE Map/Parcel#: 088.102 79 COVE RD SO DENNIS,MA 02660 Phone: Septic System Installer Designer ECO-TECH RAPID RESPONSE 113 OLD YARMOUTH ROAD HYANNIS, 155 GOERGE RYDER ROAD MA 02601 SOUTH CHATHAM,MA 02633 Phone: 508-364-0894 5082940069 Type of Building:Dwelling Lot Size: 12,632.00 Sq.Ft. Dwelling-No.of Bedrooms:2 Garbage Grinder: Other Type of Building: No.of persons: Showers: Other Fixtures: Plan Date: 10/30/2015 Number of Sheets:2 Cafeteria: Tit1e:SEWAGE DISPOSAL SYSTEM PLAN 58 MADISON AVENUE Revision Date: � Design Flow(min.required):220 gpd Calculated design flow:220 gpd Design flow provided:224.96 gpd Description of Soi1s:SEE PLAN f Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation: 10/29/2015 DAVID COUGHANOWR,R.S. DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK,H-20 DBOX, 1 -500 GAL PRECAST CHAMBER W/STONE 3.75'ENDS,3.83'SIDES: 16'X 12'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 Health. Signed Date Inspections � Commonwealth of Massachusetts Board of Health, Yarmouth, MA F� DISPOSAL SYSTEM CONSTRUCTION PERMIT $ss.00 Permission is herby granted to; ' To perform:Upgrade an individual sewage disposal system. Owner: CATERiNO CAROLE 79 COVE RD SO DENNIS,MA 02660 Location: 58 MADISON AVE, SOUTH YARMOUTH,MA 02664 Disposal System Construction Permit No.: BOHDGIS-5637,Dated:November 19,2015 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 1000 GAL SEPTIC TANK, H-20 DBOX, 1 -500 GAL PRECAST CHAMBER W/STONE 3.75'ENDS,3.83'SIDES: 16'X 12'X 2' ZONE II MAXIMUM 2 BEDROOMS , `, Bruce G. urphy,MPH, 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. ' Commonwealth of Massachusetts Board of Health, Yarmouth, MA Fee CERTIFICATE OF COMPLIANCE 555.00 Description of Work:Individual Component(s) The undersigned hereby certify that the Sewage Disposal System; Upgraded by: at: 58 MADISON AVE,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-15-5637,dated 11/25/2015. Installer: Address:113 OLD YARMOUTH ROAD HYANNIS, Inspector:AMY VON HONE,R.S. MA 02601 Designer:ECO-TECH RAPID RESPONSE Conditions 1.SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK,H-20 DBOX,1 -500 GAL PRECAST CHAMBER W/STONE 3.75'ENDS,3.83'SIDES: 16' X 12'X 2' ZONE II MAXIMUM 2 BEDROOMS V Bruce G. u hy,MPH, 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