HomeMy WebLinkAboutApp-Permit-Compliance-tvz(,t16-1a6-C
No. ice/ THE COMMONWEALTH OF MASSACHUSETTS FEE
BOARD OF HEALTH C14-ZWI
ti4oe? OF
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct ( ) Repair 6)ej Upgrade ( ) Abandon ( ) - ,<Complete System ❑ Individual Components
0' ,��1Ai4 4 y 4z*- !
/ o
Location
Map/Parcel #
h,-0, l S D6n181.1H'T EXCM
C4
Telephone #
/ P701j,g Se,,7
Owner's Name
Address
o TXhone
#
Designer'sNya�m�ey
Address
Telephone #
Type of Building: 1" I A A61,41,
Dwelling — No. of Bedrooms .3
Other — Type of Building No. of persons
Other fixtures
Lot Size Sq. feet
Garbage Grinder ( )
Showers ( ), Cafeteria
Design Flow (min. required) 0 gpd Calculated design flow -35b gpd Design flow provided 33Z gpd
Plan: Date k - §::--/5' Number of sheets 2-- Revision Date /t/D,sc/
Je-
Description of.Soil(s) d-- 6qj� I
Soil Evaluator Form No. Name of Soil Evaluator
DESCRIPTION OF REPAIRS OR ALTERATIONS
1A/l-AA / 5-Dd 7.4✓4 /- le- A, -r c -t - S" Z t
Date 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 not to pla the tem in operation until a Certificate of Compliance has been issued by the Board of Health.
7
Signed Date'''`
Inspections
FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96
No. C I THE COMMONWEALTH OF MASSACHUSETTS ^ FEE
D hf D C -I S.`qq,3-7 � /l,, �,, f ` BOARD OF HEALTH U
CERTIFICATE OF COMPLIANCE
Description of Work: ❑ Individual Component(s) Complete System 0� `
The undersignedherebycertify that the Sewage Disposal System; Constructed ( ), Repaired (A, Upgraded ( ), Abandoned
by: % �C° t�? i �� S ZTONIF (Z[ GZ*-r a— C/-1'VATNN + S '-n C-- W C ,
at Z :W211, Q — S�4�7? ✓
has been installed in accordance with the provisions of 310 CMR 15.00 Title
plans relating to application No. dated
Installer ��✓� 7� -��i S
Designer: -�'✓ '��/y-� Inspecto
The issuance of this certificate shall not be construed as a
FORM 3 - CERTIFICATE OF COMPLIANCE
5) and the approved design plans/as-built
Approved Design Flow (gpd)
,guara'ntee that the system will function as designed.
DEP APPROVED FORM 5/96
No,
�( THE COMMONWEALTH OF MASSACHUSETTS
60+ +Dc -15-45 37 �/�/ ids- /
�Gt BOARD OF HEALTH
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to Construct ( Repair (X) Up rade ( ) Abandon ( ) an individual sewage
disposal system at g-� G as described
in the application for Disposal System Construction Permit No. G dated COLIM,�
Provided: Constructions all be cleted within three years of the date of this permit
/Alllo al conditions must be met.
Date IL o pBoard of Health 1
FORM 2 - DSCP _ DEP APPROVED FORM 5/96
FORM 1255 (REV 5/96) H HOBBSB WARREN TM PUBLISHERS - BOSTON
�
No.:BOHDC-15-4437
; Commonwealth of Massachusetts � Fee
� 555.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION T
�
; Application for a Permit to:Upgrade-Complete System
Location: 3 TAM-O-SHANTER WAY, SOUTH YARMOUTH, MA Owner:
02664 THOMPSON MARY ANNE
Map/Parcel#: 090.108 3 TAM-O-SHANTER WAY
SOUTH YARMOUTH,MA 02664-2049
Phone:
Septic System Installer Designer
DONE RIGHT MEYER&SONS.INC.
P.O. BOX 669 SANDWICH, MA 02563 P.O.BOX 981
Phone: EAST SANDWICH,MA 02537
508-362-2922
Type of Building:Dwelling Lot Size: 13,068.00 Acres
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building: No.of persons: S6owers:
Other Fixtures:
Plan Date:08/OS/2015 Number of Sheets•2
� Cafeteria:
Tit1e:PROPOSED SEPTIC SYSTEM UPGRADE PLAN 3 TAM-O-SHANTER Revision Date:
WAY
Design Flow(min.required):330 gpd Calculated design flow:330 gpd Design flow provided:350 gpd
Description of Soi1s:SEE PLAN
� Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:07/28/2015
DARREN MEYER,R.S.
� DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX, 16
HIGH CAPACITY H-20 INFILTRATOR LJNITS W/OUT STONE:25'X 11.32'X 11"
The undersigned agrees to instail the above described Individual Sewage Disposal System in accordance wkh the provisions of
TITLE 5 and further aarees not to olace in ooeration until a Certificate of Comoliance has been issued bv the Bosrd of Health.
Signed Date
Inspections
�
� .
j
3 Commonwealth of Massachusetts
; •
� Board of Health, Yarmouth, MA Fee
� DISPOSAL SYSTEM CONSTRUCTION PERMIT �55.00
;
i
1
I
' Permission is hereby granted to;
�
,
DONE RIGHT EXCAVATION &SEPTIC SERVICES INC., P.O. BOX 669, SANDWICH, MA 02563
To perform: Upgrade an individual sewage disposal system.
Owner: THOMPSON MARY ANNE
3 TAM-O-SHANTER WAY
SOUTH YARMOUTH,MA 02664-2049
Location: 3 TAM-O-SHANTER WAY, SOUTH YARMOUTH,MA 02664
Disposal System Construction Permit No.: BOHDC-15-4437 ,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 SEPTIC TANK, DBOX, 16 HIGH CAPACITY H-20
INFILTRATOR UNITS W/OUT STONE:25'X 11.32'X 11"
���
; Bruce G. Murph , M , R.S., CHO/Amy L. von Hone, R.S., CHO
� H Ith Director/Assistant Health Director
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
;
�
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
CERTIFICATE OF COMPLIANCE $55.00
Description of Work:Complete System
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:DONE RIGHT EXCAVATION& SEPTIC SERVICES INC.
at:3 TAM-O-SHANTER WAY,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-15-4437,dated 09/15/2015.
�' Installer:DONE RIGHT EXCAVATION&SEPTIC SERVICES
A13Qress:P.O.BOX 669 SANDWICH,MA 02563 Inspector:AMY VON HONE,R.S.
,
Designer:MEYER& SONS,INC.
I
I
� ��G"'
� Bruce G. Murph , M , R.S., CHO/Amy L.von one, 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.
i
�
�
�
�
BOH_Disposal_Construction_CofC.rpt