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HomeMy WebLinkAboutApp-Permit-ComplianceNo. -60#0c- I �7RSr rV —,; �) />`, x FEE 00 COMMONWEALTH Of MASSACHUSETTS C"34 2-96 Board of Health, _l F'i(2M0Q-R , MA. APPLICATION FOP DISPOSAL SYSTEM CONSTRUCTION PERMIT Application fora Permit to Construct( ) Repair( Upgrade( ) Abandon( ) - ❑ Complete System Individual Components Location g M4.550kHUS& t ' AV 6- Owner's Name VI R COWA DUFF � ' t< .orj Map/Parcel# M d1 -U a� ,, -7 Address g (4AS 4Ct-NL)_�6-Aye , 4w tow -n4 Lot# Telephone# Installer's Name eApC-4j (D6 &j f Ej)AZj6 5 L" Designer's Name Address / 53 (�ZSG�[OtA(_ "&�E� Address Telephone#5-09-4-7-7-,9:9-7-7 Telephone# Type of Building -St DG0?t AC _ Lot Size 15-) -27 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 Design flow provided3 -3 e9 gpd Plan: Date Number of sheets Revision Date Title Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator DESCRIPTION OF REPAIRS OR ALTERATIONS PC- p6orec- b - 9 y X C N "�) Date of Evaluation 2-1 The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to of o pl)jzf the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date "' Z" 02006 Inspections No. 8 �f� l�C-f6 -78 1 f l - 17(1/ EE 5y. 00 COMMONWEALTH OF MASSACHUSETTS Board of Health, -I i'�r(LM(�ljr( , MA. CERTIFICATE OF COMPLIANCE Description of Work: Individual Component(s) ❑ Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired K), Upgraded ( ), Abandoned ( ) by: e1 - Gat 2 M,4<s U56ie-s AVC W E—S-r Y-40A-c®O?-F has been instatef iii acc0a;,OMtFthe provisions of 310 CMR 15.00 (Title 5) and the proved design plans/as-built plans relating to application No. �_, dated / �" / ki Approved Design Flow 3 'i (gpd) Installer 6-46 LA—V. , Designer: "114 Inspector: 4/i . ✓ w Date: The issuance of this permit shall not be construed as a guarantee at the system will function as designed. No. &OKD C (o -7RZ- 64 -PEW I D C- FEE �6 - © C- COMMONWEALTH Of MASSACHUSETTS C&4t 3qz-91C Board c f Health, kL-7a! • , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is herebygranted to; Construct( ) 'Repair(X) Upgrade( ) Abandon( ) an individual sewage disposal system at _1�1 �'s Bill ''T�'� AV97 as described in the application for Disposal System Construction Permit No. /600 , dated Provided: Construction shall be completed wit in t" -Y --ars o f e hate of this permi . All -local conditions must be met. Form 1255 Rev. 5196 A.M. Sulkin Co. Charlestown, MA Date % Board of Health � � . No.:BOHDGI6-7855 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: 8 MASSACHUSETTS AVE,WEST YARMOUTH, MA 02673 Owner: DUFFY VIRGINIA M Map/Parcel#: 022.274 8 MASSACHLTSETTS AVE WEST YARMOUTH,MA 02673 Phone: Septic System Installer Designer CAPEWIDE DAVID B.MASON.R.S. 153 COMMERCIAL STREET 4 GLACIER PATH MASHPEE, MA 02649 EAST SANDWICH,MA 02537 Phone: 508-833-2177 5084778877 Type of Building:Dwelling Lot Size:5,227.00 Sq.Ft. Dwelling-No.of Bedrooms:2 Garbage Grinder: Other Type of Building: No.of persons: Showers: ' Other Fixtures: Plan Date:07/28/2000 Number of Sheets: 1 ' Cafeteria: Tit1e:SITE AND SEWAGE PLAN 8 MASSACHiJSETTS AVENLTE Revision Date: Design Flow(min.required):220 gpd Calculated design flow:220 gpd Design flow provided:338 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-EXISTING H-20 1000 GAL SEPTIC TANK, PROPOSED H-20 DBOX TO EXISTING 4 RECHARGERS W/STONE 3'SIDES,4'ENDS:33'X 8.83'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 nlace in oneration until a Certificate of Comoliance has been issued bv the Board of Health. Signed Date Inspections ' � • . Commonwealth of Massachusetts � Board of Health, Yarmouth, MA Fee DISPOSAL SYSTEM CONSTRUCTION PERMIT 555.00 Permission is herby granted to; CAPEWIDE ENTERPRISES, LLC, 153 COMMERCIAL STREET, MASHPEE, MA 02649 To perform:Repair-minor an individual sewage disposal system. Owner: DUFFY VIRGINIA M 8 MASSACHIJSETTS AVE WEST YARMOUTH,MA 02673 Location: 8 MASSACHUSETTS AVE,WEST YARMOUTH,MA 02673 ' Disposal System Construction Permit No.: BOHDC-16-7855,Dated:January OS,2016 Provided:Construction shall be completed within six months of the date of this permit. All local conditions must be met. CONDITIONS: SEPTIC DISPOSAL-MINOR REPAIR-EXISTING H-20 1000 GAL SEPTIC TANK, PROPOSED H-20 DBOX TO EXISTING 4 RECHARGERS W/STONE 3'SIDES,4'ENDS: 33'X 8.83'X 2' , �i`/ 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. � ; 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:CAPEWIDE ENTERPRISES,LLC at: 8 MASSACHUSETTS AVE, 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-16-7855,dated Ol/12/2016. I Installer:CAPEWIDE ENTERPRISES,LLC Address:153 COMMERCIAL STREET MASHPEE,MA Inspector:AMY VON HONE,R.S. 02649 Designer:DAVID B.MASON,R.S. Conditions SEPTIC DISPOSAL-MINOR REPAIR-EXISTING H-201000 GAL SEPTIC TANK,PROPOSED H-20 DBOX TO EXISTING 4 RECHARGERS W/STONE 3'SID � 'ENDS:33' 8.83'X 2' Bruce G. Mu y, 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. BOH_Disposal_Construction_CofC.rpt i Ii I �