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Home My WebLink AboutApp-Permit-Compliancer COMMONWEALTH LTH ®f MASSACHUSETTS Board of Health, y%�-MOUTIf , MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade(�bandon()-ed-ClImplete System ❑ Individual Components Location 5c) I'i'vGl p ��`ti{ Owner's Name kvl 1 /'44 'e) Cot 4`I f Map/Parcel# Address Lot# Telephone# S off %2 1,569 Installer's Name l �� Designer's Name AddressIVI lr ri�p ! Address Telephone# So�- 3 (p Telephone# -S 44SL4 Type of Building Dwelling - No. of Bedrooms Other - Type of Building Lot Size / � sq. ft. Garbage grinder ( ) No. of persons Showers ( ), Cafeteria ( ) Other Fixtures Design Flow (min. required) gpd Calculated design flow Design flow provided_ gpd Plan: Date 0 CJ-. a-7 , 1 S Number of sheets Revision Date .If Title Description of Soils) _ W Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS :9 c UPJ 1 1i►�t The undersigned es to ' tall the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to di to i i until a Certificate of Complianceas be n issued by the Board of Health. Signed ��✓ Date � Inspections No. 6oVVDC.-115" U-:' L FEE' , 00 COMMONWEALT14 OF M SS C1IUSETTSJi-4 2-5 Board of Health, YALM0 LM4 , MA. CERTIFICATE OF COMPLIANCE Description of Work: U Individual Component(s) Q -Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded), Abandoned ( ) by: 1MivIS C.-Il5l - at. 41 T44,r b. , S 1) /' . 1,(. 1-.1 _ 4 0�"k has been instaligP,4crorc�at�c wits tf2 rJo sions of 3FIO N& 15.00 (Title 5) and the approved design plans/as-buil4fans relating to application No. dated �% -! i' `� Approved Design Flow (gpd) Installer i.- 3 .S it ; i' 4-- ec,1 0 -Y t Designer: _c ,.� n ! ' it. t+°)�"irector: ,� ` �! /�/� Gr Date: The issuance of this permit shall not be construed as a guaran,�Zethat the system will function as designed. "'iTT.G c. .. c..T3.,J.OJC}'6. C`Cr'-. c��. C`Y. .. .. .. �,� �ncC2 �`J .. ,. ^•G ,cUU7J o.,-�;:��ro o..:'?'!'dc,.POoC•CvOo-C9��•oc;C�. COe^oC'Ooo.C-G.o^iJ.,,O:;rip„_oo�r 0'!?.:-•3podG7, �i'd[ No. 6 0"Dc - S s- G o y' Z FEE 5 : 00 COMMONWEALT14 Of MASSACHUSETTS ck-#z5'16 7. Board of Health, YA M&n3l —IMA. 4.-” 9 DISPOSAL SYSTEM CONSTRUCTION PERMIT r-- Permission is hereby granted to; Construct( ) Repair( ) UpgradOV) Abandon( 1�-�an individual sewage disposal system at So T A S r r 7 n- � 12 k > t'„Z Alt) -rW 00krs described in the application for;, Disposal System Construction Permit No. /_C=-1 dated Z r1'l 60�2 Provided: Construction shall be completed within tt,LP car -of the date of this peri t. All local conditions must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown, MA Date% _1 /'�$oard of Hea th No.:BOHDGIS-6032 Commonwealth of Massachusetts Fee � $55.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERNIIT Application for a Permit to:Upgrade-Complete System Location: 50 TASMANIA DR,YARMOUTH, MA 02675 Owner: GILLIS MARCIA A TR Map/Parcel#: 127.9 MARCIA A GILLIS LVG TRUST 50 TASMANIA DR YARMOUTH PORT,MA 02675 Phone: Septic System Installer Designer ELLIS BROTHERS DOWN CAPE ENGINEERING PO BOX 59 YARMOUTHPORT, MA 939 ROUTE 6A 02675 YARMOUTHPORT,MA 02675 Phone: 508-362-4541 5083626237 Type of Buitding:Dwelling Lot Size: 17,424.00 Sq.Ft. Dwelling-No.of Bedrooms:3 Garbage Grinder: Other Type of Building: No.of persons: Showers: Other Figtures: Plan Date: 10/27/2015 Number of Sheets: 1 Cafeteria: Titie:TITLE 5 SITE PLAN 50 TASMANIA DWVE Revision Date: 12/16/2015 � Design Flow(min.required):330 gpd Calculated design flow:330 gpd Design flow provided:349 gpd Description of Soi1s:SEE PLAN Soil Evaluator Form No.: Name of Soii Evaluator: Date of Evaluation: 10/20/2015 DANIEL GONSALVES,SE DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL H-20 SEPTIC TANK,H-20 DBOX,2-500 GAL PRECAST H-20 CHAMBERS W/4'STONE:25'X 12.83'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 HeaRh. Signed Date Inspections , I • Commonwealth of Massachusetts ! ` Board of Health, Yarmouth, MA Fee DISPOSAL SYSTEM CONSTRUCTION PERMIT 555.00 Permission is herby granted to; ELLIS BROTHERS CONSTRUCTION, PO BOX 59,YARMOUTHPORT, MA 02675 To perform:Upgrade an individual sewage disposal system. Owner: GILLIS MARCIA A TR MARCIA A GILLIS LVG TRUST 50 TASMANIA DR YARMOUTH PORT,MA 02675 Location: 50 TASMANIA DR,YARMOUTH,MA 02675 Disposal System Construction Permit No.: BOHDC-15-6032 ,Dated:December 22,2015 Provided:Construction shall be completed within six months of the date of this permit. All locai conditions must be met. CONDITIONS: 1. SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL H-20 SEPTIC TANK, H-20 DBOX,2-500 GAL PRECAST H-20 CHAMBERS W/4'STONE:25'X 12.83'X 2' 2. BOH TO VERIFY SOILS PRIOR TO INSTALLATION 3. MFC VARIANCE APPROVAL:a. DEPTH OF LEACH FACILITY 4.ZONE II MAXIMUM 3 BEDROOM V � Bruce G. Murp , PH, R.S., CHO/Amy L.von Hone, R.S.,CHO eaith Director/Assistant Health Director The issuance of this permit shall not be construed as a guarantee that the system will function as designed. 1 i i i Commonwealth of Massachusetts ; Board of Health, Yarmouth, MA Fee CERTIFICATE OF COMPLIANCE $55.00 Description of Work: Comptete System The undersigned hereby certify that the Sewage Disposal System; Upgraded by:ELLIS BROTHERS CONSTRUCTION at: 50 TASMANIA DR,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-15-6032,dated Ol/15/2016. Installer:ELLIS BROTHERS CONSTRUCTION Address:PO BOX 59 YARMOUTHPORT,MA 02675 Inspector:AMY VON HONE,R.S. Designer:DOWN CAPE ENGINEERING Conditions 1.SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL H-20 SEPTIC TANK,H-20 DBOX,2- 500 GAL PRECAST H-20 CHAMBERS W/4' STONE:25' X 12.83'X 2' 2.BOH TO VERIFY SOILS PRIOR TO INSTALLATION 3.MFC VARIANCE APPROVAL: a.DEPTH OF LEACH FACILITY 4.ZONE II MAXIMUM 3 BEDROOM V Bruce G. urph , 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. BO H_Disposal_Construction_CofC.rpt