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HomeMy WebLinkAboutApp-Permit-Compliance/6 --IfD/ No. N0 DC COMMONWEALTH OF MASSACHUSETTS Board of Health, L� t' � �" , Aft -37 FEE 7 C� c� TI®N FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT pplication for a Permit to Construct(,) Repair( ) Upgrade (A Abandon(Complete System 0 Individual Components Location 3 Ar 5`% ,J X Cu -o_%" V -SN Owner's Name Map/Parcel# Z —Z Address i 3Z SuS*-� fkjcT p&z % f4I-(JWCoj Lot# 95 Telephone# ( / 7 -� 7 Installer's Name Designer's Name ve-_ Address Address ) Z Telephone Telephone# 5etZ -y -1 7 - 53 k 3 Type of Building 9S 1 o441_*.1P_A1 Lot.Size Dwelling - No. of Bedrooms A - Garbage grinder ( ) Other - Type of Building NIA No. of persons Showers ( ) , Cafeteria ( ) Other Fixtures ^f 1A Design Flow (min. required) 4-46 gpd Calculated design flow 4-'4c, Design flow provided 4� AA_ gpd Plan: Date 3 Z 7 JJ4- Number of sheets -3 Revision Date Tide Frt�&_8� U *sj-" Description of Soils) d - IZ y A. LS L-29 , `3(x' - $%_i ac S.".A Soil Evaluator Form No. ''- Name of Soil Evaluator Re_lr �Ak-*- ` Date of Evaluation V5 t l,A- $rI - iSi('Z DESCRIPTION OF REPAIRS OR ALTERATIONS Jy z n 1 . ii Ay�'l�" Qk5,:K- G Sf — v�,Stal1 i5aa C --tic. 9-r' acscs Cf E - �5" APs The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further a not /to! plac a system in operation until a Certificate of Comphance has been issued by the Board of Health. Signed Date Z_( COMMONWEALTH LTH OE MASSACHUSETTS Board of Health, �! c-{ r `11\ o' u _k-4% ; MA CERTIFICATE Of COMPLIANCE Description of Work: U Individual Component(s) O`C-mplete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired ( ), Upgraded.•}6andoned ( ) ,'��at has been installedYm f ccordanze withT he� application No. -'� / , dated _ _ Installer F 4�r� t ft %tel •ovisions of 310 CMR 15.00 (Title 5) and th roved design plans/as-built plans relating to �. Approved Design Flow `7 (gpd) Designer: PE—i CM M4 InspectoDate: The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. 1..)OI Dc ^ir,-y `1 S S - - ` D%{l�% t� . S Pel i, m � 6..0 W M • FEE J . aU /, � z © / COMMONWEALT14 Of M ASSAC14USETTS chi 4 eyLV Board of Health,MA. DISPOSAL SYSTEM[ CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( at- �lz>o e /c CZfP L',�Arz:;>6 Upgrad�bandon ( ) an individual sewage disposal system Q Disposal System Construction Permit Nodated as described in the application for Provided: Construction shall be completed within tktree-ye rrs of the date of this per t. All local conditions must be met. j Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date y - � � � � Board of Health 17/1 No.:BOHDGIS-4458 ' Commonwealth of Massachusetts Fee 555.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to:Upgrade-Complete System Location: 34 SIOUX RD,WEST YARMOUTH, MA 02673 Owner: MAGOWN JAYNE TRS Map/Parcel#: 024.75 THE VP WEST YARMOUTH REALT'Y TRUST 132 SUMMER ST NORWELL,MA 02061 Phone: Septic System Installer Designer DAN A.SPEAKMAN ENGINEERING WORKS,INC. 15 SPEAK WAY HARWICH, MA 02645 12 WEST CROSSFIELD ROAD Phone: FORESTDALE,MA 02644 508-477-5313 Type of Building:Dwelling Lot Size: 16,117.00 Acres Dwelling-No.of Bedrooms:4 Garbage Grinder: ' Other Type of Building: No.of persons: Showers: Other Fixtures: Plan Date:03/27/2014 Number of Sheets:3 Csfeteria• Tit1e:PROPOSED SEPTIC SYSTEM UPGRADE PLAN 34 SIOiJX ROAD Revision Date: Design Flow(min.required):440 gpd Calculated design flow:440 gpd Design flow provided:444 gpd 4 Description of Soi1s:SEE PLAN �I 4 ' Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:03/13/2014 � PETER MCENTEE,PE � ' DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL WATERPROOFED SEPTIC i TANK, 1000 GAL WATERPROOFED PUMP CHAMBER,DBOX,25 ARC 36 iJNITS W/OUT STONE:25'X 14.3'X 7" i The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of j 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 � i i ( i I � i I j ; Commonwealth of Massachusetts Board of Health, Yarmouth, MA Fee DISPOSAL SYSTEM CONSTRUCTION PERMIT $55.00 , Permission is herby granted to; DAN A. SPEAKMAN CONSTRUCTION, 15 SPEAK WAY, HARWICH, MA 02645 i To perform:Upgrade an individual sewage disposal system. Owner: MAGOWN JAYNE TRS THE VP WEST YARMOUTH REALTY TRUST 132 SUMIviER ST NORWELL,MA 02061 Location:34 SIOUX RD,WEST YARMOUTH,MA 02673 Disposal System Construction Permit No.: BOHDGIS-4458,Dated: September 15,2015 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 WATERPROOFED SEPTIC TANK, 1000 GAL WATERPROOFED PUMP CHAMBER, DBOX,25 ARC 36 UNITS W/OUT STONE:25'X 14.3'X 7" 2. ELECTRICAL PERMIT REQUIRED FOR PUMP SYSTEM 3. BOH TO INSPECT SOIL REMOVAL 4. MFC VARIANCE APPROVALS:a. GROUNDWATER SEPARATION b.TANLKPUMP CHAMBER PIPE INVERTS TO GROUNDWATER 1j /// V � Bruce G. Murphy, PH, R.S., CHO/Amy L.von Hone, R.S.,CHO . He 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