HomeMy WebLinkAboutApp-Permit-ComplianceCOMMONWFALTH OF MASSACHUSETTS
Board of Health, YAR-M0Q1' 4 , MA.
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APPLICA TION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) UpgradeV--Abandon- O"Complete System ❑ Individual Components
Location
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Owner's Name .;.r �/y �'c•��
Map/Parcel#
Address 75f/ I-ICIS 6-7*',071e4
Lot#
Telephone*r 93;c _ 7 Y�
Installer's Nam
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Designer's Name Cv -re et}
Address 5 2
Address'? a. /-z 6' S' .�
Telephone#
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Telephone# rjp 5, e - ,;:$ FI?V
Type of Building
Dwelling - No. of Bedrooms
Other - Type of Building _
Other Fixtures
Lot Size sq. ft.
Garbage grinder ( )
No. of persons Showers ( ), Cafeteria ( )
Design Flow.(min. required) gpd Calculated design flow S -9d Design flow provided U gpd
Plan: DateVu ,94--Q3 Number of sheets A Revision Date
Title
Description of Soil (s)
Soil Evaluator Form No.
DESCRIPTION OF
Name of Soil Evaluator
OR ALTERATIONS 2LU
-2
Date of Evaluation
W
The undersigned ees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further afire s to of t ace the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date
g �G°3CC�C�O�IC�D
o Inspections
HEALTH DEPT.
No. % r FEE
COMMONWEALT14®f MASSACHUSETTS
Board of Health, MA.��f
CERTIFICATE OF COMPLIANCE
Description of Work: ❑ Individual Component(s) Complete System '
The undersigned hereby ce .y that the Senage Disposal System; Constructed ( ), Repaired (Upgraded (Abandoned ( )
by: 4 ,, C. r�4C C,,T i c�/t
at ,r7 Z
has been installe in actor ante wit `the pi:ovisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application NNo% dated `.;, i3 ' % _� Approved Design Flow 3 2 v (gpd)
Installer (_ 'l � �_+ r 6d ,1,.S 7X c C �� G✓C fi % �� �O�t`ll/
Designer: .0 0 - % Inspector: L ` Ii �-'t/ rfi%r Date:
t
The issuance of this permit shall not be construed as a guaranthat the system will function as designed.
No. f2 <-e..� '" -� � eDIAjq L- v FEE ? _
COMMONWEALT14 OF MASSACHUSETTS 1 Z.4j
Board of Health, ! 61-W 10 UTA , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
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Permission is hereby granted to; Construct( ) Repair( ) Upgrade(kj Abandon( ) an individual sewage disposal system
G
at ! f `"� ��' V leo as described in the application for
Disposal System Construction Permit No. , dated
Provided: Construction shall be completed within thf4ajx-*rs of the date of this permit. All local conditions must be met.
Board of Health i
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown, MA Date �_. ✓
r
No.:BOHDGIS-2131
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: 99 STUDLEY RD, SOUTH YARMOUTH, MA 02664 Owner:
SANDSTRAND FLORENCE H
Map/Parcel#: 079.141 134 SAINT PAULS AVE
STATEN ISLAND,NY 10301
Phone:
Septic System Installer Designer
CARDINAL ECO-TECH RAPID RESPONSE f
32 RIDGETOP ROAD COTUIT, MA P.O.BOX 1265
02635 WEST CHATHAM,MA 02669 '
Phone: (5081364-0894
Type of Building:Dwelling Lot Size: 16,988.40 Acres
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Fixtures:
Plan Date:09/12/2014 Number of Sheets:2 Cafeteria•
Tit1e:SEWAGE DISPOSAL SYSTEM 99 STIJDLEY ROAD Revision Date:
Design Flow(min.required):330 gpd Calculated design tlow:330 gpd Design flow provided:330 gpd
Description of Soi1s:SEE PLAN ;
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:09/10/2014 i
DAVID COUGHANOWR,R.S.
DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-1500 GAL SEPTIC TANK,H-20 DBOX,2-500 GAL PRECAST
CHAMBERS W/STONE 3.5'ENDS,3.83'SIDES:24'X 12.5'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.
Signed Date
Inspections
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� Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT 555.00
Permission is herby granted to;
CARDINAL CONSTRUCTION,32 RIDGETOP ROAD, COTUIT, MA 02635
To perform:Upgrade an individual sewage disposal system.
Owner: SANDSTRAND FLORENCE H
134 SAINT PAULS AVE
STATEN ISLAND,NY 10301
Location:99 STUDLEY RD, SOUTH YARMOUTH,MA 02664 '
Disposal System Construction Permit No.: BOHDC-15-2131 ,Dated:May 13,2015
Provided:Construction shall be completed within six months of the date of this permit. All local conditions must be met.
Conditions
1. REPAIR-I500 GAL SEPTIC TANK, H-20 DBOX, 2-S00 GAL PRECAST CHAMBERS W/STONE
3.S'ENDS, 3.83'SIDES:24'X 12.S'X 2'
2. PLUMBING PERMIT REQUIRED '
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Bruce G. rp , 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 S55.00
Description of Work:Complete System
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:CARDINAL CONSTRUCTION
at:99 STUDLEY RD, SOUTH YARMOUTH,MA 02664
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-15-2131,dated OS/18/2015.
Installer:CARDINAL CONSTRUCTION '
Address:32 RIDGETOP ROAD COTUIT,MA 02635 Inspector:AMY VON HONE,R.S.
Designer:ECO-TECH RAPID RESPONSE
Conditions
1.REPAIR- 1500 GAL SEPTIC TANK,H-20 DBOX,2-500 GAL PRECAST CHAMBERS W/
STONE 3.5'ENDS,3.83' SIDES:24'X 12.5'X 2' '
2.PLUMBING PERMIT REQUIRED
��
Bruce G. Murp ,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 guarant e that the system will function as designed.
BO H_Disposal_Construction_CofC.rpt