HomeMy WebLinkAboutApp-Permit-ComplianceNo. 0 N C.—f 0 LI) � f �, dO `®C✓a IA ck4 V4
FEE
COMMONWEALTH LTH ®f MASSACHUSETTS
Board of Health, &aMO MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) UpgradeeT--Abandon() - ❑ Complete System �vidual Components
Location 2L
Owner's Name ]' D ae.L, nn -5 % � T
Map/Parcel# S
Address �. h�
A 11)" 1�al,
Lot#
Telephone# 9c> $-
Lt to
Installer's Name
Designer's Name r >�S
S u 2 Viz ` h
Address -� G��
Address
Telephone#Telephone#
r 36
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Type of Building ° Lot Size /1,,f sq. ft.
Dwelling - No. of Bedrooms 3 Garbage grinder( )
Other - Type of Building No. of persons Showers ( ) , Cafeteria ( )
Other Fixtures y
Design Flow (min. required) d) gpd Calculated design flow Design flow provided S gpd
Plan: Date 111 4 /1H, Nutter her of sheets n n Revision Date
Title X44
Description of Soil(s) _
Soil Evaluator Form No.
.i
Name of Soil Evaluator
DESCRIPTION OFREPAIRS OR ALTERATIONS s�-P d"y N
of Evaluation �/ "/
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to 1 e n on until a Certificate f Compliance has been issued b the Board of Health.
ln' no p ce o/ P _ Y
Signed Date Z/
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Inspections
M.
No. ~'t9 f FEE
COMMONWEALTH OF MASSACHUSETTS
Board of Health, i?491 O U774- , MA.
CERTIFICATE Of COMPLIANCE
Description of Work: a1ndividual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded.(_) Abandoned ( )
by: i:`. { E ` /J
at_t
has been installedin ac ofdanz?e wit'bi the ro-6sioris of 310 CMR 15.00 (Title 5) and the roved design plans/as-built plans relating to
application No. 6 101 Approved Design Flow 3 (gpd)
Installer �^�,
Designer: ~ii' .� f 1 0 (J 1_ i Inspector: (I t.-'�" 1 Date:
The issuance of this permit shall not be construed as a guaran that the system will function as designed.
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No. FEEl}
COMMONWEALTH Of MASSACIIUSETTS 44ZY79
Board of Health, Y%A-J=ffio OTW , MA.
j DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is herebyl granted to; Construct( ) Repair( ) Upgrade(� Abandon( ) an individual sewage disposal system
at CT t1 P 1 0.9 C4 tA/,05 ,4 5 /"M. � 7
a- as described in the application for
J _
Disposal System Construction Permit No. /15;- % , dated 6 "
Provided: Construction shall be complete with{/i-nn tkaars o the date of this aL�
ermitAll local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date �+ �� Board of Health
, i
No.:BOHDGIS-2351
' Commonwealth of Massachusetts Fee
555.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Individual Component(s)
Location: 22 SHEFFIELD RD,WEST YARMOUTH, MA 02673 Owner:
MONTEIRO IDALINA M
Map/Parcel#: 076.52 22 SHEFFIELD RD
WEST YARMOUTH,MA 02673
Phone: '
Septic System Installer Designer '
ELLIS BROTHERS EAS SURVEY,INC.
23 ENTERPRISE ROAD P.O.BOX 1729
YARMOUTHPORT, MA 02675 SANDWICH,MA 02563
Phone: (5081888-3619 I
Type of Building:Dwelling Lot Size: 12,197.00 Acres
Dwelling-No.of Bedrooms:3 Garbage Grinder: �
Other Type of Building: No.of persons: Showers: i
�
E
Other Fixtures: �
Plan Date: 11/24/2014 Number of Sheets:2 Cafeteria•
Title:SIT'E&SEWAGE REPAIR PLAN 22 SHEFFIELD ROAD Revision Date: ,
Design Flow(roin.required):330 gpd Calculated design flow:330 gpd Design flow provided:353 gpd
Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation: 11/13/2014
EDWARD STONE,PLS
, i
DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-EXISTING 1000 GAL SEPTIC TANK,DBOX,2-500 GAL PRECAST
CHAMBERS W/4'STONE:25'X 13'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 ooeration until a Certificate of Comoliance has been issued bv the Board of Health.
i
Signed Date �
Inspections ;
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: Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00
Permission is herby granted to;
ELLIS BROTHERS CONSTRUCTION,23 ENTERPRISE ROAD,YARMOUTHPORT, MA 02675
To perform:Upgrade an individual sewage disposal system.
Owner: MONTEIRO IDALINA M
22 SHEFFIELD RD
WEST YARMOUTH,MA 02673
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Location:22 SHEFFIELD RD,WEST YARMOUTH,MA 02673
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Disposal System Construction Permit No.: BOHDC-15-2351 ,Dated:June 08,2015 '
Provided: Construction shall be completed within six months of the date of this permit. All local conditions must be met.
Conditions
1. REPAIR-EXISTING 1000 GAL SEPTIC TANK, DBOX, 2-S00 GAL PRECAST CHAMBERS W/4' �
STONE:25'X 13'X 2'
2. ZONE II MAXIMUM 3 BEDROOMS
Bruce G. urp 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.
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� Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
CERTIFICATE OF COMPLIANCE $55.00
Description of Work:Individual Component(s)
� The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:ELLIS BROTHERS CONSTRUCTION
at:22 SHEFFIELD 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-15-2351,dated 07/23/2015.
Installer:ELLIS BROTHERS CONSTRUCTION
Address:23 ENTERPRISE ROAD YARMOUTHPORT, Inspector:AMY VON HONE,R.S.
MA 02675
Designer:EAS SURVEY,INC.
Conditions
1.REPAIR-EXISTING 1000 GAL SEPTIC TANK,DBOX,2-500 GAL PRECAST CHAMBERS
W/4' STONE:25'X 13'X 2'
2.ZONE II MAXIMUM 3 BEDROOMS � !I ,/�����
C..(:(�.
Bruce G. Mu y, 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.
BOH_Disposal_Construction_CofC.rpt
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