HomeMy WebLinkAboutApp-Permit-ComplianceNo. 6 o H -Dc — 1,5 4 ,3 8 G �� . �f " '�/ `"' � FEE
COMMONWEALTIIOFMASSAC14USETTS
Board of Health, �Pk 1 by� , MA. "5r Aa
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) RepairA Upgrade( ) Abandon( ) - ❑ Complete System,,�vidual Components
Location
Owner's Name A -u L- pa5-
Map/Parcel#
Address D(�.
Lot#
Telephone# 2,B- - 021(o
Installer's Name �� C1 15
Designer's Name��-.� E -
Address Vb I I Nt;
Address Saves- 5.
Telephone# 5bo _41,j ZSR
Telephone# S7)$ -j
Type of Building fkr: Lot Size 2-71010 sq. ft.
Dwelling - No. of Bedrooms Garbage grinder ( )
Other -Type of Building No. of persons Showers ( ), Cafeterias; )
Other Fixtures
6
Design Flow (min. required) 4¢U gpd Calculated design flow !10 Design flow provided gpd
Plan: Date Number of sheets q Revision Date
Title
Description of Soil(s) _
Soil Evaluator Form No.
Nam of f Soil Evaluator 7 (�A-4T> Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS M b V
G.
The unAa;e
es a above described Individual Sewage D
iSystem in accordance with the provisions of TITLE 5 and
further t to la a tem in operation until a Certificate liance has been issued by the Board of Health.
Signed Date
Inspections
No. r.10 WK -ICJ ' f J S FEE
7 COMMONWEALTH Of MASSACHUSETTS ck-* Z�Li
Board of Health, YF4(ZMQU1-i , MA.
CERTIFICATE Of COMPLIANCE
Description of Work: P-Kd-ividual Component(s) ❑ Complete System
The un rsigned hereb certify that the Sewage Disposal System; Constructed ( ), Repaired ), Upgraded ( ), Abandoned ( )
by: i3bpi �� o t.T> S
atiA'n C?>UC-u--
has been install e in acco ance with the pro 'sions of 310 CMR 15.00 (Title 5) and the ap�Pr ed design plans/as-built plans relating to
application No. / " , dated ' 5� - /�. Approved Design Flot �diC��pd)
Installer -0 at ids t,D C, Ci ugg$ C*1 S 2161 ' 100'r
Designer: ��`�tit ECi • Inspector: \ Date:
The issuance of this permit shall not be construed as a tee that the system will function as designed.
No. r70j+t)C 145 " (tel" 8 (0 R17i3(-TZ-,r 641 C5 t PSC FEE 4 5� 00
/,5-- 117 COMMONWEALT14 Of MASSACHUSETTS
Board of Health, f Al2 Iii 0 Q_n+ , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( :.) RepairO Upgrade ( ) Abandon ( ) an individual sewage disposal system
atm UGC _ %-ry Pbn -. as described in the application for
Disposal System Construction Permit No. �, dated % _ c' /7C
!r.P �� p
Provided: Construction shall be completed within+kfee-rem f t e ate of this permit. 1 -local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown,MA Date *" � �-> Board of Health 4"( '�
w No.:BOHDGIS-1586
Commonwealth of Massachusetts Fee
� ;55.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT "
Application for a Permit to:Upgrade-Individual Component(s)
Location: 7 STARBUCK LN,YARMOUTH, MA 02675 Owner:
MCBRIDE PAUL N III
Map/Parcel#: 106.70 7 STARBUCK LN
YARMOUTH PORT,MA 02675-2417
,
Phone:
Septic System Installer Designer i
ROBERT CHILDS INC. SWEETSER ENGINEERING
P.O. BOX 1431 SOUTH DENNIS, MA P.O.BOX 713 �
02660 SOUTH DENNIS,MA 02660
Phone:
(5081385-6900
Type of Building:Dwelling Lot Size:22,215.60 Acres
Dwelling-No.of Bedrooms:4 Garbage Grinder:
i
Other Type of Building: No.of persons: Showers: �
Other Fiatures: jf
I
Plan Date:03/21/2015 Number of Sheets: 1 Cafeteria• �
Tit1e:PROPOSED SEPTTC DESIGN FOR 7 STARBUCK LANE Revision Date: •
Design Flow(min.required):440 gpd Calculated design flow:440 gpd Design flow provided:470.64 gpd �
Description of Soi1s:SEE PLAN �
�
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:03/10/2015
ROBIN WILCOX,PLS
" DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-EXISTING 1500 GAL SEPTIC TANK,DBOX,4 FLOWDIFFUSORS W/
STONE 4'ENDS,4'SIDES,6"BELOW: 12'X 40'X 1.5' �
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 �
�
�
r
Commonwealth of Massachusetts
= Board of Health, Yarmouth, 1�1L� Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00
Permission is herby granted to;
ROBERT CHILDS INC., P.O. BOX 1431,SOUTH DENNIS,MA 02660
To perform:Upgrade an individual sewage disposal system.
Owner: MCBRIDE PAUL N III ;
7 STARBUCK LN '
YARMOUTH PORT,MA 02675-2417
f
Location:7 STARBUCK LN,YARMOUTH,MA 02675
Disposal System Construction Permit No.: BOHDGIS-1586,Dated:Apri109,2015
Provided:Construction shall be completed within six months of the date of this permit. Ali local conditions must be met.
Conditions
1. REPAIR-EXISTING 1 S00 GAL SEPTIC TANK, DBOX, 4 FLOWDIFFUSORS W/STONE 4'ENDS, 4'
SIDES, 6"BELOW.• 12'X 40'X 1.S'
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2. ZONE II MAXIMUM 4 BEDROOM �
�v� .
Bru G. rphy,MPH, R.S., CHO/Amy L.von Hone, R.S.,CHO ;
Health Director/Assistant Health Director �
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The issuance of this permit shall not be construed as a guarantee that the system will function as designed. I
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Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
CERTIFICATE OF COMPLIANCE sss.00
;
Description of Wark:Individual Component(s)
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:ROBERT CHILDS INC.
at:7 STARBUCK LN,YARMOUTH,MA 02675
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-15-1586,dated OS/04/2015.
Installer:ROBERT CHILDS INC.
Address:P.O.BOX 1431 SOUTH DENNIS,MA 02660 Inspector:AMY VON HONE,R.S.
Designer: SWEETSER ENGINEERING
Conditions
1.REPAIR-EXISTING 1500 GAL SEPTIC TANK,DBOX,4 FLOWDIFFUSORS W/STONE 4'
ENDS,4' SIDES,6" BELOW: 12'X 40'X 1.5'
2.ZONE II MAXIMUM 4 BEDROOM
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.
BOH_Disposal_Construction_CofC.rpt
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