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Home My WebLink AboutApp-Permit-ComplianceNo �j�I F%C�IID 7 FEE ss`�r0D ' Board of Health, 4,A- M00T + MA. 04 APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Al.plication for a Permit to Construct( ) Repair( ) Upgrad�-bandon ( ❑ Complete System -Crlln�ividual Components Location rNQ Owner's Name Map/Parcel# plaCW ssAddress' ' ,10 qJ+V--UA anna-pnmA Lot# Telephone# Installer's Name \nil U—C Designer's Name Dan A rx-T Address`s SOML" DM m�� Address 1 G Telephone# t Telephone# C` - kA Type of Building &,CTI\ Dwelling - No. of Bedrooms Other - Type of Building _ Other Fixtures No. of persons Lot Sizeala "T�l sq. ft. Garbage grinder ( } Showers ( ), Cafeteria ( ) Design Flow (min. required) y- 4 0 gpd Calculated design flow Design flow provided �, C� gpd Plan: Date Number of sheets 1 Revision Date O1 �, f � 1:O r Title !� I±f a XrLYl WV IPYD\`��a Gk -V W►xJ�111;�ek i NVS 5014 h -1 uV"-VQvA_N Description ofSoil(s)- Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersi ed agrees to install the ove escribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and furthe ,es not to plac e s to operation until a Certificate of Compliance has been issued by the Board of Health. -ss Signed 141 Date ` Inspections )Xi-, No.ry i FEE C®�'MON ILT14 Of NIASSAC-hUATTS V Board of ljlealtla, o ( 114A.�( �' r C, CERTIFICATE Of COMPLIANCE lsF Description of Work: WIndidual Component(s) ❑ Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded�Abandoned (• ) by: YY\0,4^, IE ` c CA 1 � E iln^ kUZ - at aq TAP \ <, C,, T)v \\/P '4 (°a 1u y , has been installedWVV611daW& wit'i?tWprovisions of 310 CMR 15.00 (Title 5) and the 11 ap roved application No. r dated —ZZ — . Approved Design Flow (gpd) Installer 1.) (,A- Y-,\C',npc`,k,� Vyy^A: Y`\ IP% design plans/as-built plans relating to Designer: 0j,,��n, )%OP _Inspector: - Date: The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No.013C C®MMONWtALTII . MASSACHUSETTS' Board of Health, Y &0,ffi®u-r::8MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT FEE %.0lz Ut-*tA3180 Permission is hereby granted to; Construct( ) Repair( ) Upgrad@,(�Abandon ( ) an individual sewage disposal system at as described in the application for Disposal System Construction Permit No. ��nyy��'.., �0 tt , dated �,Q' Z Provided: Construction shall be completed wit in three yep ars 'of the date of this pe All local con ' 'ons must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown, MA Date Board of Health t � No.:BOHDGI6-7878 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: 29 MELISSA DR,WEST YARMOUTH, MA 02673 Owner: BEALE HENRY A Map/Parcel#: 086.55 BEALE MAUREEN C 121 WEST YARMOUTH RD WEST YARMOUTH,MA 02673 Phone: Septic System Installer Designer SPEAKMAN DAN A.SPEAKMAN CONSTRUCTION 15 SPEAK WAY HARWICH, MA 02645 15 SPEAK WAY Phone: NORTH HARWICH,MA 02645 5084325565 508-432-5565 Type of Building:Dwelling Lot Size:21,344.00 Sq.Ft. Dwelling-No.of Bedrooms:4 Garbage Grinder: ' Other Type of Building: No.of persons: Showers: Other Fixtures: Plan Date: 11/24/2015 Number of Sheets: 1 Cafeteria• TitIe:SITE PLAN OF PROPOSED CONSTRUCTION 29 MELISSA DRIVE Revision Date:O1/OS/2016 • Design Flow(min.required):440 gpd Calculated design flow:440 gpd Design tlow provided:452.6 gpd Description of Soi1s:SEE PLAN ' Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation: 11/OS/2015 DAVID B.MASON,R.S. DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-EXISTING 1500 GAL SEPTIC TANK,PROPOSED DBOX,4 3050 INFILTRATOR LTNITS W/STONE 4'SIDES,1'ENDS:38.84'X 11'X 1.85' 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 6een issued bv the Board of Health. Signed Date Inspections Commonwealth of Massachusetts � Board of Health, Yarmouth, MA Fee . DISPOSAL SYSTEM CONSTRUCTION PERMIT $55.00 Permission is herby granted to; SPEAKMAN EXCAVATING LLC, 15 SPEAK WAY, HARWICH, MA 02645 To perform:Upgrade an individual sewage disposal system. Owner: BEALE HENRY A BEALE MAUREEN C 121 WEST YARMOUTH RD WEST YARMOUTH,MA 02673 Location:29 MELISSA DR,WEST YARMOUTH,MA 02673 Disposal System Construction Permit No.: BOHDGI6-7878,Dated:January 12,2016 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-EXISTING 1500 GAL SEPTIC TANK, PROPOSED DBOX,4 3050 INFILTRATOR UNITS W/STONE 4'SIDES, 1'ENDS: 38.84'X 11'X 1.85' 2.ZONE II MAXIMUM 4 BEDROOMS 3. MFC VARIANCE APPROVAL: a. DRAINAGE WETLAND SETBACK �C./� Bruce G. M hy, PH, 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.