HomeMy WebLinkAboutApp-Permit-ComplianceNo. N ��'��•�(S� 4* -J FEE `r' 5400
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COMMONWEALTH TSI ®F MASSAC14USETTS 1 • � ✓
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Board of Health, ` A - M OUT -If MA.
A'MICATI®N F®P, DISPOSAL SYSTEM[ CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade(-KAbandon() - E Complete System ❑ Individual Components
Location
Owner's Name
Map/Parcel# �� 17
Address I "1 t2 l
Lot#
Telephone# 5 0g -z-9 =�
Installer's Name hnoDesigner's
Name
Address 14 -r?0-hERey(
ddress
Telephone # -
Telephone# 60 9 r - k -
Type of Building Lot Size sq. ft.
Dwelling - No. of Bedrooms = %i� Garbage grinder( )
Other - Type of Building No. of persons Showers ( ) , Cafeteria ( )
Other Fixtures :?:, D
Design Flow (min. required) gpd Calculated design flow. �7 Design flow provided
Plan: Date �� ✓� 2. Number of sheets - Revision Date
Title
Description of Soil(s) _
Soil Evaluator Form No.
Name of Soil Evaluator
Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS 16 0 QCL` 1A I QCt RIO CLk Q X3) 6 00 C�
gpd
Theundersi ees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further afire o n t lace the to in o r tion until a Certificate of Com .fiance has been issued by the Board of Health.
Signed Date
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No. f3 "(°S'"i FEE 545, 00
2 COMMONWEALTH LTH ®F MASSACHUSETTS
Board of Health, e472.M O i,Tt'ri MA.
CERTIFICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) P161niplete System
The undersi ned reby certify that the Sewage Disposal System; Constructed ( ), Repaired ( )> Upgraded L4-,�(bandoned ( )
by:
at 21 !� �( i, _�a'l a7. %ti 4 di ce u-1 FN
has been installA'Q d -a4 ` w' hhrg�ons of 310 CMR 15.00 (Title 5) and the roved design plans/as-built plans relating to
to acc r t e wtC
applicati-on Vo_ Z!2,,, dated / h -z �7Approved Design Flow (gpd)
Installer ( t1 / ^
Designee: Q I ' ! �' 1`r Inspector: (.. Date:
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
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No. Z} 31 C 1,6 —ST1 C �" � C � ®� FEE
COMMONWEALTH OF MASSACHUSETTS
Board of Health,MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permissio is hereby granted to; Construct( ) Repair( ) Upgrade( ) Aband n( ) an individual sewage disposal system
at i lw I i11 �1 } as described in the application for
Disposal System Construction Permit No., dated
Provided: Construction shall be compl ted within thw-a;o== =-ofthe date of this 7gnit. All local cond Vons must be met.
,^ I i
Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date /Z "<S ' f Board of Health`D � �
' No.:BOHDC-15-5950
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: 19 THATCHER RD, SOUTH YARMOUTH, MA 02664 Owner:
UMSCHLAG JA1vIS
Map/Parcel#: 033.376 1871 MAIN ST
WEST BARNSTABLE,MA 02668-1120
Phone:
Septic System Installer Designer
B&B EXCAVATION FLAHERTY ENVIRONMENTAL SERVICES
14 TEABERRY LANE FORESTDALE, P.O.BOX 81
MA 02644 YARMOUTHPORT,MA 02675
Phone: 508-362-1657
5084770653
Type of Building:Dwelling Lot Size:7,841.00 Sq.Ft.
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building:DUPLEX No.of persons: Showers:
Other Fixtures:
Plan Date: 11/22/2015 Number of Sheets:2 Cafeteria:
Title:SITE AND SEWAGE PLAN OR 19/21 THATCHER ROAD Revision Date: 12/07/2015
. ' Design Flow(min.required):330 gpd Calculated design flow:330 gpd Design flow provided:348 gpd
Description of Soi1s:SEE PLAN
, ' Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation: 11/10/2015
DAVID FLAHERTY,R.S.
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL TWO COMPARTMENT
TANK,DBOX,2-500 GAL PRECAST CHAMBERS W/4'STONE:2S 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 nf Comoliance has been issued bv the Board of Health.
Signed Date
Inspections ,
I
� �
� � Commonwealth of Massachusetts
�
; :
' . Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT $55.00
Permission is herby granted to;
B&B EXCAVATION, 14 TEABERRY LANE, FORESTDALE, MA 02644
To perform:Upgrade an individual sewage disposal system.
Owner: UMSCHLAG JATIIS
1871 MAIN ST
WEST BARNSTABLE,MA 02668-1120
Location: 19&21 THATCHER RD,SOUTH YARMOUTH,MA 02664
Disposal System Construction Permit No.:BOHDC-15-5950,Dated:December 08,2015
' 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 TWO COMPARTMENT TANK, DBOX,2-500 GAL
PRECAST CHAMBERS W/4'STONE:25'X 12.83'X 2'
2. BOH TO INSPECT SOIL REMOVAL
3. MFC VARIANCE APPROVALS:a. GROUNDWATER SEPARATION b. GROUNDWATER ADJUSTMENT
Bruce G. MyrglSy, PH, R.S., CHO/Amy L.von Hone, R.S., CHO
���ealth 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 555.00
Description of Work:Complete System
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:B&B EXCAVATION
at: 19&21 THATCHER 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-15-5950,dated 12/17/2015.
Installer:B&B EXCAVATION
Address:l4 TEABERRY LANE FORESTDALE,MA Inspector:AMY VON HONE,R.S.
02644
Designer:FLAHERTY ENVIRONMENTAL SERVICES
Conditions
1.SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL TWO COMPARTMENT TANK,DBOX,
16 HIGH CAPACITY INFILTRATORS W/OUT STONE:25'X 11.33'X 11"
2.BOH TO INSPECT SOIL REMOVAL
3.MFC VARIANCE APPROVAL: a.GROUNDWATER SEPA ON
c.�
Bruce G. phy,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