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Home My WebLink AboutApp-Permit-ComplianceNo. Bat-(DG-IS-�S (S FEE 4 fir % COMMONWEALTH Of MASSACHUSETTS Board of Health, y�r1ZN10 Uilk , MA. APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) - ❑ Complete System ❑ Individual Components Location affs � Owner's Name A k Map/Parcel# Address 5555 Lot# Telephone# - Installer's Name `C Designer's Name ons 1 Address -- 91 'a� �tl. Address 90 q , 1E Telephone# S _nS -a 5 Telephone# A Type of Building \-tesXC Dwelling - No. of Bedrooms Other - Type of Building _ Other Fixtures No. of persons Lotsize 4 21No FF _149tle3l Garbage grinder ( ) Showers (�, Cafeteria Design Flow (min. required) AiTj gpd Calculated design flow J?r 5 ��% Design flow provided i gpd Plan: Date ,G�� 1"� Number of sheets 2D Revision Date Title J" F`c z2s,zCn5Z_e<4es.r Description of Soil(s)�. Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONSVRe (1S�CC��CiTCJI� f1 ty �o ,� The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to no place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date /a/�/ Inspections z J-, t z"C 4 1 s _ No. `7(� (f ti 1,5 q 9 1 ± ' / FEE r� z�`7 COMMONWEALTH Of MASSACHUSETTS obi !c-/� -��—Lh # 12-.39 Board of Health, YAr,-ROODA , MA. CERTIEI�TE Of COMPLIANCE Description of Work: ❑ Individual Component(s) Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired t, Upgraded ( ), Abandoned ( ) by: S LSP Cf _A �x,T`'( C` at has been installed i 'accor ance with e provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. -1 / , dated %f-- / Approved Design Flow - . gpd) Installer Designer: Inspector: t %`{ r li' �i? Date: % __1_3 The issuance of this permit shall not be construed as a guarantee that the system will function as designed. l-, FEE X53 • f?U No. 17d, t) r 1 \) :: - t > - tt �� 1 C.!'=i 1'''G C O ,� :� 4-i� 'j°) l J Zr:`�G•-l!` � C.�� 7 COMMONWEALTH Of MASSACHUSETTS cOz#� rz3y Board of Health, ) A P. MC liTA- , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( Upgrade( ) Abandon( ) an individual sewage disposal system at as described in the application for Disposal System Construction Permit No. /-L` 7 , dated 7 �. Provided: Construction shall be completed within tf the d to Lfthnis ermit. All local conditions must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown, MA Dates"' (-Board of Health %,/ No.:BOHDGIS-4818 Commonwealth of Massachusetts Fee ` $55.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERNIIT Application for a Permit to:Upgrade-Complete System Location: 555 ROUTE 6A,YARMOUTH, MA 02675 Owner: RIVERO JACQUELINE LEE Map/Parcel#: 124.111.1 555 ROUTE 6A YARMOUTH PORT,MA 02675-1915 Phone: Septic System Installer Designer CAPE COD SEPTIC MEYER&SONS,INC. 350 ROUTE 28 WEST YARMOUTH, MA P.O.BOX 981 02673 EAST SANDWICH,MA 02537 Phone: 508-360-3311 5087752825 Type of Building:Dwelling Lot Size: 1,432,253.00 Sq.Ft Dwelting-No.of Bedrooms:4 Garbage Grinder: Other Type of Building: No.of persoes: Showers: Other Fia�tures: Plan Date: 10/OS/2015 Number of Sheets:2 Cafeteria: . Tit1e:SEPTIC SYSTEM REPAIR PLAN 555 ROUTE 6A Revision Date: Design Flow(min.required):440 gpd Calculated design flow:440 gpd Design flow provided:525.03 gpd Description of Soi1s:SEE PLAN Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:08/19/2015 DARREN MEYER,R.S. DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK,H-20 DBOX, . 24 HIGH CAPACITY H-20 INFILTRATORS W/OUT STONE:37.5'X 11.32'X 11" 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 S55.00 Permission is herby granted to; CAPE COD SEPTIC SERVICES,350 ROUTE 28,WEST YARMOUTH, MA 02673 To perform:Upgrade an individual sewage disposal system. Owner: RIVERO JACQUELINE LEE 555 ROUTE 6A YARMOUTH PORT,MA 02675-1915 Location:555 ROUTE 6A,YARMOUTH,MA 02675 Disposal System Construction Permit No.: BOHDC-15-4818,Dated:November 03,2015 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, H-20 DBOX,24 HIGH CAPACITY H-20 INFILTRATORS W/OUT STONE: 37.5'X 11.32'X 11" 2. BOH TO INSPECT SOIL REMOVAL 3. PRIVATE WELL SERVICING HOOP HOUSE-MAIN DWELLING ON TOWN WATER Bruce G. h ,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. i I Commonwealth of Massachusetts Board of Health, Yarmouth, MA Fee CERTIFICATE OF COMPLIANCE $55.00 Description of Work:Complete System The undersigned hereby certify that the Sewage Disposal System; Upgraded by:CAPE COD SEPTIC SERVICES at:555 ROUTE 6A,YARMOUTH,MA 02675 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-15-4818,dated 11/13/2015. Installer:CAPE COD SEPTIC SERVICES Address:350 ROUTE 28 WEST YARMOUTH,MA Inspector:AMY VON HONE,R.S. 02673 Designer:MEYER&SONS,INC. Conditions 1.SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK,H-20 DBOX,24 HIGH CAPACITY H-20 INFILTRATORS W/OUT STONE:37.5'X 11.32'X 11" 2.BOH TO INSPECT SOIL REMOVAL 3.PRIVATE WELL SERVICING HOOP HOUSE-MAIN DWE LING ON TOW WATER i Bruce G. rp y, 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