HomeMy WebLinkAboutApp-Permit-ComplianceNo. �Irt iJ�-IS--� Boo-- i "o 326 7 FEE SS> 0 G
/�-Z-75 C®MINI® I.TII OF NISSC1IiTSTTS'
l )L4gMo QT}! MA.
Board o Health, CfX4 P1
a0
PPI.ICATI®N FOR DISPOSAL SYSTEM[ CONSTRUCTION PERMIT w I U uw 547,
Application for a Permit to Construct64 Repair( ) Upgrade( ) Abandon( ) - Wtomplete System ❑ Individual Components
Location 13
Owner's Name
Map/Parcel#P3
Address
Lot#
Telephone#
Installer's NameDesigner's
Named "
Address_
Address �3 ve
Telephone# �-o _
Telephone#
Type of Building RIE S {{i 4 1 r e Lotsize sq. ft.
Dwelling - No. of Bedrooms Garbage grinder 4�0
Other - Type of Building No. of persons Showers( ), Cafeteria ( )
Other Fixtures
Design Flow (min. required) // gpd Calculated design flow 3J o Design flow provided 3 4S gpd
Plan: Date -? •-3 0 -- %S" Number of sheets Revision Date
Title
Description of Soil(s) o "7-o // ' s� // 'm .2 �� ern Sy "0-5,11 So
Soil Evaluator Form No. ` �3.f-�g Name of Soil Evaluator �Q,,!_a c o SA L vn,-Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS
Ll_ %t) ^ r', -T a-,,, L/_ 20 �n,�.4 <-o o r
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 lacea system in operation until a Certificate of Compliance has been issued by the Board of Health.
I
Signed � hl ,t A )r-, -� 4 � til'/ Date A) o Vj eL5-
No. E" .S� t J FEE 5 :r; c� o
1 � COMMON LTIT Of M ASSACHUSE TS S
Board of Health, YAl2 .0UTV , MA.
CERTIFICATE OF COMPLIANCE
Description of Work: ❑ Individual Component(s) 9161mplete System
The undersigned hereby certify that the Sewage Disposal System; Constructed (yy, Repaired ( ), Upgraded ( ), Abandoned ( )
by: )646`L/ bt.-
�6 . ,' , 7e
has been insta ed tri a cord�ice Wrtl t provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. dated //'_ 3,- `/< Approved Design Flow �? (gpd)
Installer n 1
Designer: rF �+.. ��, l (".��r�t; �6�,"!a° �¢, `w,..e3E f. k= Inspector: .. � � � Date:
The issuance of this permit shall not be iebnstrued as a gua,eet the system will function as designed.
No. ✓ �S� i tt" l '; ^ _ FEE
Board of Health, Vl amo , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct(pi' Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system
at /3l��f� �,^� t-�1= r,c 1 ! j 1%r/ c�4t t:: 4>fi as described in the application for
Disposal System Construction Permit No. % ��, dated
Provided: Construction shall be completed within of the date of this permit, All local condi 'ons must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown, MA Date �+r/ Board of 1 -Tea th
No.:BOHDC-15-6019
� Commonwealth of Massachusetts Fee
$55.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Complete System
Location: 0 WILLOW ST,WEST YARMOUTH, MA 02673 Owner:
YARM CAMP GROUND ASSOC INC
Map/Parcel#: 083.2 C/O LEE W ERICKSON
455 QUINAPDXET ST
TEFFERSON,MA 01522-1461
Phone:
Septic System Installer Designer
B.C.K.GENERAL DOWN CAPE ENGINEERING,INC.
97 TOWN BROOK ROAD WEST 939 ROUTE 6A
YARMOUTH, MA 02673 YARMOUTHPORT,MA 02675
Phone: 50-362-4541
5087780444
Type of Building:Dwelling Lot Size:872,507.00 Sq.Ft.
Dwelling-No.of Bedrooms:2 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Fixtures:
Plan Date:03/30/2015 Number of Sheets: 1 Cafeteria•
Tit1e:TITLE 5 SITE PLAN 13 PARK CIRCLE Revision Date:
� Design Flow(min.required):220 gpd Calculated design flow:220 gpd Design tlow provided:345 gpd
Description of Soi1s:SEE PLAN
Soit Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:03/26/2015
DANIEL GONSALVES,SE
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,4-
500 GAL H-20 PRECAST CHAMBERS W/2'STONE:38'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 olace in oneration until a Certificate of Comnliance has been issued bv the Board of Heakh.
Signed Date
Inspections
i
I •
I
i
'� E Commonwealth of Massachusetts
Board of Health, Yarmouth, l�lti Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT 855.00
Permission is herby granted to;
B.C.K. GENERAL CONTRACTOR,97 TOWN BROOK ROAD,WEST YARMOUTH, MA 02673
To perform:Upgrade an individual sewage disposal system.
Owner: YARM CAMP GROiJND ASSOC INC
C!O LEE W ERICKSON
455 QUINAPDXET ST
JEFFERSON,MA 01522-1461
Location:WILLOW ST,WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.: BOHDGIS-6019,Dated:November 30,2015
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-PROPOSED 1500 GAL SEPTIC TANK, DBOX,4-500 GAL H-20 PRECAST
CHAMBERS W/2'STONE:38'X 8.83'X 2'
2. BOH TO INSPECT SOIL REMOVAL
3. PROPERTY WITHIN BARNSTABLE ZONE II
V �
Bruce G. rp y, 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.