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Home My WebLink AboutApp-Permit-ComplianceNo. �C.I�T� _I FEE do NIMI®NWE4I.TII ®S BCH SETTS Board of Health, YAAMOl)� ;.1a-_1VAP11CA1ION FOR DISPOSAL SYSTEM[ CONSTRUCTION PERMIT Application for a Permit to ConstructX Repair( ) Upgrade Abandon() - XComplete System ❑ Individual Components Location �A py AvAr Owner's Name �+ . f , Al JQ <^W V& p Map/Parcel#p� Q- �% Address Lai* 251-D& :4�8 Q` Telephone# Installer's Name,QA14Aj G. jk t V$ 1-1 JAGes grier's Nam Address LTeLlephone# — - Donald W. Moncevicz, P.E. Civil Engineer 40 Pond Street U/nct Lnnn:c RAA A9L27A Address vjw ° � 131 v i��1D e92 Telephone# rO — 014A.A 15;Ow)Jf-t-a>c,.t - - --. ----- ---- - Type of Building Rews10jVAtrZ4" Lot Size sq. ft. Dwelling - No. of Bedrooms t0jWVj W ,3 19&_t11WAh OEStC N . Garbage grinder "© Other -Type of Building No. of persons Showers ( ) , Cafeteria ( ) Other Fixtures Design Flow (min. required) BJa gpcl Calculated design flow 330 GAL.. Design flow provided .3-4-7 gpd Plan: Date bAlrG J4%ZW /S Number of sheets Revision Date Title J Description of Soil(s) _SAKO /'i.,4M Soil Evaluator Form No. Name of Soil Evaluator DESCRIPTION OF REPAIRS OR ALTERATIONS to Date of Evaluation May !1 ;t01.5" The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further alto Plot to place the�!m �jQ�ation until a Certificate f Compliance has been issud by the Board of Health. Si ned X1-4—, C .6ZT_ Date �B �bT� . Inspections No.(��VC..;i.,�"7C:5 // FEE COMMONWEALTH OF M ASSACRUSETTS -Board of Health, YA1i2MWN , MA. f CERTIFICATE Of COMPLIANCE Description of Work: ❑ Individual Component(s) [Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed Repaired ( ), Upgraded ()4, Abandoned O at Al r, A v(j * �MANrS has been insta led iri c ordaar e witRr a provisions of )10 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. 11 dated rY .ZL /fi. Approved Design Flow (gpd) ,� Installer e'!+l PS 11'�t$.a► l� -.` Designer: j,01to M f+''/1d31`iC&I/I Inspector: ' L �' Date: `e/ The issuance of this permit shall not be construed as a guar4atee that the system will function as designed. I,;10 C00C.:CO.O-0 X000 C 0 0 0 O C O J O O CJ.00.O o 00000000000 O C C..00aC 00.0 00 C C 00 CC CO CO!i.V 00 O 00 Q 0 C O 0').000000 C 0 0000000000,?00000C No. L3Ci'� o- l i(ei ECIC. FEE 5 eQe'� I / COMMONWEALTH LTH ®E MASSACHUSETTS Board of Health, y N'loyn-� 1111M. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is herebygranted to; Construct( Repair( ) Upgrade(l Abandon( ) an individual sewage disposal system at as described in the application for Disposal System Construction Permit No. Provided: Construction shall be compfet Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown. MA Date No.:BOHDC-16-7836 � Commonwealth of Massachusetts Fee $55.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to:Upgrade-Complete System Location: 0 WILLOW ST,WEST YARMOUTH, MA 02673 Owner: YARM CAMP GROUND ASSOC INC Map/Parcel#: 083.2 C/O LEE W ERICKSON 455 QUINAPDXET ST JEFFERSON,MA 01522-1461 Phone: Septic System Installer Designer B.C.K.GENERAL DONALD MONCEVICZ,P.E. 97 TOWN BROOK ROAD WEST 40 POND STREET YARMOUTH, MA 02673 WEST DENNIS,MA 02670 Phone: 508-394-0509 5087780444 Type of Building:Dwelling Lot Size:872,507.00 Sq.Ft. Dwelling-No.of Bedrooms:2 Garbage Grinder: Other Type of Building: No.of persons: Showers: Other Fixtures: Plan Date: 12/14/2015 Number of S6eets: 1 Cafeteria• Tit1e:PROPOSED SANITARY SYSTEM UPGRADE 11 LEAFY AVENUE Revision Date: • Design Flow(min.required):220 gpd Calculated design flow:220 gpd Design flow provided:357 gpd Description of Soi1s:SEE PLAN � Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation: 11/09/2015 DONALD MONCEVICZ,P.E. DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,9 CULTEC C4 DRAIN PANELS W/OUT STONE:24'X 12'X 3° 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 ulace 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 $55.00 Permission is herby granted to; ', B.C.K. GENERAL CONTRACTOR, 97 TOWN BROOK ROAD,WEST YARMOUTH, MA 02673 To perform:Upgrade an individual sewage disposal system. Owner: YARM CAMP GROiJND ASSOC INC C/O LEE W ERICKSON 455 QUINAPDXET ST JEFFERSON,MA 01522-1461 Location: WILLOW ST,WEST YARMOUTH,MA 02673 Disposal System Construction Permit No.: BOHDC-16-7836,Dated:January 22,2016 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, DBOX,9 CULTEC C4 DRAIN PANELS W/OUT STONE:24'X 12'X 3" 2. PLUMBING PERMIT REQUIRED 3.ZONE II MAXIMUM 2 BEDROOM WITHOUT FURTHER REVIEW �v C� Bruce G. Murphy PH, R.S., CHO/Amy L.von Hone, R.S., CHO ,e th Director/Assistant Health Director The issuance of this permit shall not be construed as a guarantee that the system will function as designed.