HomeMy WebLinkAboutApp-Permit-ComplianceNo.0 tQ D� ' �7 5� v V br/ FEE 4 �J. 0 d
It COMMONWEALTH OF MASS C14USETTS ok43397�
Board of Health, —r1jy "®I�ji% 'Am.
APPLICATION FOR. DISPOSAL SYSTEM CONSTRUCTION PERM, IT
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System ❑ Individual Components
Location RUAI
Owner's Name 6044Re — M C( V67 AI
Map/Parcel# !
Address i
Lot#
Telephone#
Installer's Name
Designers Name �dle7� �� �N4l lXJ
Address �l Gf�Lllt G JT
7V- Address _ iYADA
Telephone# 7 7
Telephone# 569-36'J--4541
Type of Building Lot Size �I Q ��i � sq. ft.
Dwelling - No. of Bedrooms Garbage grinder( )
Other - Type of Building No. of persons Showers( ), Cafeteria ( )
Other Fixtures
Design Flow (min. required) 330 gpd Calculated design flow
Plan: Date le A0, 15 Number of sheets j
Title
Design flow provided �qS�— gpd
Revision Date
Description ofSoil (s) SAA27 Q vZLi `r rcS6-E 1 4,w
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation 4 -i;L3 -1 5
DESCRIPTION OF REPAIRS OR ALTERATIONS XA)S'-Ag.L, tial 1 Sat) f V Pauq S03,,rG 'i iiwi:: � 1
c3 14 PIEZZ <4
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 in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed / Date rf'' 5 —10 15
No. 1,13"15fU li ,/ FEE If
o�
Board of Health, PaM Qij , MA.CIA
CERTIFICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) Id-60—plete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), U
at Jj
has been installe n;Uorda ce cal the " provisions of 310, CMR 15.00 (Title 5) and the approved
application No. dated /rte Approved Design Flow (gpd)
Installer= -W t
Designer:t16u)w cmis Inspector:
Date:
The issuance of this permit shall not be construed as a guaranj#6 that the system will function as designed.
COMMONWEALTH OF MASSACHUSETTS
Board of Health,�Ql��jj1 MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
plans/as-built plans relating to
FEE�0
()to 339-11
Permission is hereby granted to; Construct( ) Repair( ) Upgrade( ) -Abandon( ) an indi-Adual sewage disposal system
at as described in the application for
Disposal System Construction Permit No.=.,,,��--_ , dated
Provided: Construction shall be com et d w� ttl1in� Q-V~'s of the date of this permit,) All local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown, MA Date ` % oa of Health
i
I
No.:BOHDC-15-5611
• Commonwealth of Massachusetts F�
ass.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT '
Application for a Permit to:Upgrade-Complete System '
�
Location: 160 RUN POND RD, SOUTH YARMOUTH, MA 02664 Owner: �
MCGOVERN CHARLES E
Map/Parcel#: 026.100 MCGOVERN MARY H
160 RUN POND RD
SOUTH YARMOUTH,MA 02664
Phone:
Septic System Installer Designer
CAPEWIDE DOWN CAPE ENGINEERING
153 COMMERCIAL STREET 939 ROUTE 6A
MASHPEE, MA 02649 YARMOUTHPORT,MA 02675
Phone: 508-362-4541
5084778877
Type of Building:Dwelling Lot Size:7,841.00 Sq.Ft.
Dwelling-No.of Bedrooms:3 Garbage Grinder: .
Other Type of Building• No.of persons: Showers: ',
Other Fu�tures:
Plaa Date: 10/19/2015 Number of Sheets: 1 Cafeteria•
Tit1e:TITLE 5 SITE PLAN 169 RiJN POND ROAD Revision Date:
' Design Flow(min.required):330 gpd Calculated design flow:330 gpd Design flow provided:349 gpd
Description of Soi1s:SEE PLAN
' Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:09/23/2015
DAIVIEL GONSALVES,SE
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL POLY SEPTIC TANK.
DBOX,16 HIGH CAPACITY INFILTRATOR UNITS W/OUT STONE:25'X 11.32'X 0.92'
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
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,
� 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:Upgrade an individual sewage disposal system.
Owner: MCGOVERN CHARLES E
MCGOVERN MARY H
� 160 RUN POND RD
SOUTH YARMOUTH,MA 02664
Location: 160 RL1N POND RD,SOUTH YARMOUTH,MA 02664
Disposal System Construction Permit No.: BOHDC-15-5611 ,Dated:November 09,2015
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 POLY SEPTIC TANK. DBOX, 16 HIGH CAPACITY
INFILTRATOR UNITS W/OUT STONE:25'X 11.32'X 0.92'
CJy G5"`t'�
Bruce G. Murph H, R.S., CHO/Amy L.von Hone, R.S., CHO
H th Director/Assistant Health Director
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
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i
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
CERTIFICATE OF COMPLIANCE ass.00
Description of Work:Complete System
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:CAPEWIDE ENTERPRISES,LLC
at: 160 RUN POND RD,SOUTH YARMOUTH,MA 02664
� Has been installed in accordance with the provisions of 310 CMR 15.00(Title 5)and the approved
i design plans or as-built plans relating to application No.: BOHDC-15-5611,dated 11/24/2015.
Installer:CAPEWIDE ENTERPRISES,LLC
� Address:153 COMNIERCIAL STREET MASHPEE,MA Inspector:AMY VON HONE,R.S.
02649
Designer:DOWN CAPE ENGINEERING
Conditions
1.SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL POLY SEPTIC TANK DBOX, 16 HIGH
CAPACITY INFILTRATOR UNITS W/OUT STONE:25'X 11.32'X '
��`
Bruce G. Murphy, 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.
BO H_Disposal_Construction_CofC.rpt
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