HomeMy WebLinkAboutApp-Permit-ComplianceT
T—V -eG"G4 J, C., — I a S
No. Z THE COMMONWEALTH OF MASSACHUSETTS FEE
j+J)c-I"57-1-1 BOARD O� F HEALTH &A-4zo-'?
l'2%-1 OF
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct ( ) Repair (/116 Upgrade ( ) Abandon ( ) -.Complete System [-]Individual Components
Location
�' zv
Map/Parcel #
In all s NameIn all s Name �L
dress
Telephone #
Type of Building: S -7
Dwelling — No. of Bedrooms
Other — Type of Building
Other fixtures
,,T /LZner's Name
Address
I ���i9 /. Blepho #
��,6as//
Telephone #
Lot Size��" 3Sq. feet
Garbage Grinder ( )
�r
le_ /c�No. of persons Showers ( ), Cafeteria ( )
Design Flow (min. required) 3g_ gpd Calculated design flow 3,0 gpd Design flow provided 3sz gpd
Plan: Date 77 D —i 5 Number of sheets Z-- Revision Date
Title
Description of Soil(s)¢'�
Soil Evaluator Form No.
Name of Soil Evaluator
OF REPAIRS OR ALTERATIONS_
/ S7 ;o -74-:PzeL CZ
Date of
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of
TITLE 5 and further a es not Woo ystem in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date
Inspections
FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96
No. THE COMMONWEALTH OF MASSACHUSETTS/ /WE
BOARD OF HEALTH �J'I �.
CERTIFICATE OF COMPLIANCE ; t/ may'
� r�c
Description of Work: ❑ Individual Component(s) Complete SystemC
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired/), Upgraded ( ), Abandoned ( ���"�
by: /� /� �i S SON / r G(CA �d�-'r-7dNi- T
at
has been installed in accordance with the provisions of 310 C R15
5) and the approved design plans/as-built
plans relating to application No. I �' ( ci L dated Approved Design Flow _35U - (gpd)
Installer 13,�'T it _� n t 1 , 'I__ -
Designer: / "4
'! ioZ, ` 4� Inspector 6Z42ZX WDate X
The issuance of this certificate shall not be construed as a gugi(anteii that the system will function as designed.
FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96
No.i T_ I't_l THE COMMONWEALTH OF MASSACHUSETTS FEE --s
"G^(s-4435 '!rZ 4,-114 BOARD OF HEALTH
DISPOSAL SYSTEM CONSTRUCTION P VU,
Permission is hereby granted to Con truct ( ) Repair Upgrade ( ) Aband an individual sewage
disposal system at /psi I A —/w A-" Az�e_ as described
in the application for Disposal System Construction Permit No. 1� i dated' 7
Provided: Construction shall be completed within three years of the date of this permit.All local conditions must be met.
Date 5�7'--' �Z — I � Board of Health S 6,
FORM 2 - DSCP
FORM 1255 (REV 5/96)
DEP APPROVED FORM 5/96
H&W HOBBSB WARRENTM PUBLISHERS - BOSTON
� No.:BOHDGIS-4438
Commonwealth of Massachusetts Fee
" ass.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Complete System
Location: 105 STATION AVE, SOUTH YARMOUTH, MA 02664 Owner:
GRIMES ROBERT W
Map/Parcel#: 069.20 105 STATION AVE
SOUTH YARMOUTH,MA 02664
Phone:
Septic System Installer Designer
DONE RIGHT MEYER&SONS.INC.
P.O. BOX 669 SANDWICH, MA 02563 P.O.BOX 981
Phone: EAST SANDWICH,MA 02537
508-360-3311
Type of Building:Dwelling Lot Size: 15,246.00 Acres
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Ot6er Type of Building: No.of persons: Showers:
Other Fixtures:
f
Plan Date:07/10/2015 Number of Sheets:2 Cafeteria•
Title:SEPTIC SYSTEM REPAIR PLAN 105 STATION AVENUE Revision Date: •
Desi n Flow min.re uired :330 d Calculated desi n flow:330 d Desi n flow rovided:350 d �
g � 9 ) gP g gP g P gP �
� Description of Soils:SEE PLAN j
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:07/Ol/2015 �
DARREN MEYER,R.S.
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTTC TANK,H-20 DBOX, f
16 HIGH CAPACITY INFILTRATORS W/OUT STONE:25'X 11.32'X 11"
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance wkh 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
�
;
R
E
�
�
f
r
e
Commonwealth of Massachusetts
i
� Board of Health, Yarmouth, MA Fe6
j DISPOSAL SYSTEM CONSTRUCTION PERMIT 555.00
Permission is herby granted to;
' DONE RIGHT EXCAVATION&SEPTIC SERVICES INC., P.O. BOX 669, SANDWICH, MA 02563
To erform:U rade an individual sewa e dis osal s stem.
P Pg
g P Y
Owner: GRIMES ROBERT W
105 STATION AVE
SOUTH YARMOUTH,MA 02664
Location: 105 STATION AVE,SOUTH YARMOUTH,MA 02664
Disposal System Construction Permit No.: BOHDC-15-4438,Dated: September 15,2015
Provided: Construction shall be completed within six months of the date of this permit. All local wnditions must be met.
CONDITIONS:
1. SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK, H-20 DBOX, 16 HIGH CAPACITY
INFILTRATORS W/OUT STONE:25'X 11.32'X 11"
Bruce G. Mu hy, MPH, R.S., CHO/Am L.von Hone, R.S.,CHO
ealth 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
i
M
�