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HomeMy WebLinkAboutApp-Permit-Compliancef No 66WDC-6`5/ 9 FEE *110,00 COMMONWEALT�I ® MASSAX14 ETT c i 0 33 dry= H + Board of Health, A-(2lT ® -tf , MA. g f A APPLICATION FOR DISPOSAL SYSTEM CON TRUCTI©N PERMIT rs A lication fora Permit to Construct(/RRepairO Upgrade( ) Abandon( - Complete System ❑ Individual Components V .ocation /,b A&C . r f Owner's Name •Q 1 Map/Parcel# Z 3 IV Address AVI4-AJ...JAJArJ JM Lot# 10 Telephone# v L! Ys - Installer's Name AU- Ci i- 6011M UIC Designer's Name Cro re4w, Address (o 19 i j j& 2k o , y/4.e,--ko 4-4, Address Telephone# f Telephone# 5-0.? s { - - Z a'j s Type of Building Lr Dwelling - No. of Bedrooms Other - Type of Building _ Lot Size. �29p sq. ft. Garbage grinder ( ) No. of persons Showers ( ), Cafeteria Other Fixtures Design Flow (min. required) 3 3 Q gpd Calculated design flow 1 Design flow provided `331 gpd Plan: Date /� 14 1 S C Number of sheets 1 Revision Date Cl '501 1 Title 1" s'e' 0!2 S e� 15 20,SA � �� 6 Yy- Description of Soils) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS 1 IV STAJ 1500 6131 S_ 14k `W- _ T6 C^N The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees tQ not t place the s tem in operation until a Certificate of Com liance has been issued by the Board of Health. Signed tr.. �;t1LC.I�.ai•- Date t i Inspections No. © "' `��"r FEE . 4110,01 t .� - CO1� MON�I.T14 OF MASSAC14USETTS � L 10 3:3 Board of Health, LIEWMbirTIA, MA. CERTIFICATE Off` COMPLIANCE� t�� R, s� Descri tion of Work: ❑ Individual Com onends) '"Com Tete S stem p p P Y The undersigned hereby certify that the Sewage Disposal System; Constructed 4 -)-,'Repaired ( ), Upgraded ( ), Abandoned( ) by:,. l c ` t� { c L F at Z a>01,)1- 4 ,-.9 C, U , r -ei,f,. YA r J' has'tieiii'irfstall'ed irY,7c nce with the provisions of 310 application No. Z>-- dated %f , TI -- . Installer e--64-A-e •- Av C D) r'd 10 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to tpproved Design Flow 3:�(gpd) Designer: jA 0 ao7epu Inspector: "'' i Date:—J-4,4411/ The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. 1 1+0 G CAS pc- S&-Pn %If Cc C- FEEJ/10,00 IALTII OF MASSACHUSETTS Ck* A5 ---COMMONWT Board of Health, �nl` j(Y1 G Jr 4- MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to - Construct(Vy Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system at afedAc0 ( /� T, r It" ill 1 �t as described in the application for Disposal System Construction Permit No.1gt- Li 2- , dated Provided: Construction shall be competed within three j of the date of this permit. All local conditions must be met. Form 1255 Rev. 5/96 ASulkin Co. Chadestown,MA Date Board of Health %� ��AA No.:BOHDGIS-5948 � Commonwealth of Massachusetts Fee $110.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to:New Construction-Complete System Location: 13 MORGAN RD,WEST YARMOUTH, MA 02673 Owner: MCALPINE ROBERT C Map/Parcel#: 023.46 MCALPINE KATHI,EEN A 91 RAVINE RD MEDFORD,MA 02155 Phone: Septic System Installer Designer ALL CAPE SEPTIC LLC ALL CAPE ENGINEERING LLC 618 ROUTE 28, UNIT 3 WEST 618 ROUTE 28 YARMOUTH, MA 02673 WEST YARMOUTH,MA 02673 Phone: 508-827-7151 5087714200 Type of Building:Dwelling Lot Size:8,276.00 Sq.Ft. Dwelling-No.of Bedrooms:3 Garbage Grinder: Other Type of Building: No.of persons: Showers: Other Fiatures: Plan Date:09/14/2015 Number of Sheets: 1 Cafeteria: Title:PROPOSED SEWGE DISPOSAL PLAN 13 MORGAN ROAD Revision Date:09/30/2015 Design Flow(min.required):330 gpd Calculated design flow:330 gpd Design flow provided:331 gpd Description of Soils:SEE PLAN Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:08/19/2015 LINDA PINTO,PE DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-NEW CONSTRUCTION-PROPOSED 1500 GAL SEPTIC TANK,DBOX H-20,3-500 GAL PRECAST CHAMBERS W/STONE 2'ENDS,2.5'SIDES:9.83'X 29.5'X 2' The undersigned agrees to install the above described Indlvidual 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 Fee DISPOSAL SYSTEM CONSTRUCTION PERMIT $110.00 Permission is herby granted to; ALL CAPE SEPTIC LLC,618 ROUTE 28, UNIT 3,WEST YARMOUTH, MA 02673 To perform:New Construction an individual sewage disposal system. Owner: MCALPINE ROBERT C MCALPINE KATHI.EEN A 91 RAVINE RD MEDFORD,MA 02155 Location: 13 MORGAN RD,WEST YARMOUTH,MA 02673 Disposal System Construction Permit No.: BOHDC-15-5948,Dated:November 30,2015 Provided: Construction shall be wmpleted within six months of the date of this permit. All local conditions must be met. CONDITIONS: 1. SEPTIC DISPOSAL-NEW CONSTRUCTION-PROPOSED 1500 GAL SEPTIC TANK, DBOX H-20,3-500 GAL PRECAST CHAMBERS W/STONE 2'ENDS,2.5'SIDES:9.83'X 29.5'X 2' Bruce G. Murphy, MPH . ., CHO/Amy L.von Hon , R.S., CHO , Health Dir ctor/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 i CERTIFICATE OF COMPLIANCE $110.00 Description of Work:Com lete S stem P Y The undersigned hereby certify that the Sewage Disposal System; New Construction by:ALL CAPE SEPTIC LLC at: 13 MORGAN 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-15-5948,dated 12/21/2015. Installer:ALL CAPE SEPTIC LLC Address:618 ROUTE 28,LJNIT 3 WEST YARMOUTH, Inspector:BRUCE MURPHY,R.S. MA 02673 Designer:ALL CAPE ENGINEERING LLC Conditions 1.SEPTIC DISPOSAL-NEW CONSTRUCTION-PROPOSED 1500 GAL SEPTIC TANK,DBOX H-20,3-500 GAL PRECAST CAAMBERS W/STONE 2'ENDS, . �j�S: 9.83' . 'X 2' l L.� Bruce G. Murp , H, 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