HomeMy WebLinkAboutApp-Permit-ComplianceNo. P-)0R1QC-15-5q3-7
12
/57- COMMONW ILTH OF MASSACHUSETTS
Board of Health, Yi&W 0 07V MA.
FEE 1,65,00
C4 -41-5-7o
APPLICATIONFOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair GgraD
) Abandon( ) - W -Complete System O Individual Components
Location b 2 V, N E
oC7tc-
Owner's Name
,y.1 19, (e -t /s
Map/Parcel# Z
11-16
Address
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Lot#
Telephone#
Installer's Name
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Designer's Name
C' 4p •e -
Address 5-/
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Address
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Telephone# 5m-, i'a f �
Telephone#
j ed f1rel
Type of Building R -e • r Lot SizePA, sq. ft.
Dwelling - No. of Bedrooms -L Garbage grinder ( )
Other -Type of Building No. of persons Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow (min. required) U gpd Calculated design flow Design flow provided gpd
Plan: Date n Number of sheets Revision Date
Title j-�-, sw
Description of Soils) _
Soil Evaluator Form No.
DESCRIPTION OF REPAIRS OR ALTERATIONS
Name of Soil Evaluator Date of Evaluation
The undersigned agrees to install the above described1ndividual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to not to lade system in operation until a Certificate ofomplia ce has been issued by the Board of Health.
Signed � � Date /% or / f
Inspections
COMMONWEALTH OF MASSACHUS TT
Board of Health, , MA. 0V -- 01 /0 11
CERTIFICATE OF COMPLIANCE W
Description of Work: O Individual Component(s) O Complete System
The undersi ned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired O Upgrade ), Abandoned ( j
by: f''' 4JIv, Ci,1or'�/�`r, �- eKGAVAMOK3
at '� Pcok AW
has been installed iff a o ace 4,11 of 310 CMR 15.00 (Title 5) and thea proved design plans/as-built plans relating to
application ��" dated /L -,/5.-Approved roved Desi n Flow d
PP pP �' (gpd)
Installer 'TEV -{i -11t l.l�Ciey- /,A .t �//$�� � �f� �-
g /� pf Inspector: ~
Designer:
>', F i
The issuance of this permit shall not be construed as a guar a that the system will function as designed. F"
No. D o tk-T)C - 15-5-w) '"�^� I,i fl1 i� G -A V . --- FEE +�
- I COMMONWEALT14 OF MASSACHUSETTS cg, --.w 115-70
Board of Health,M� , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( Upgra ( ) Abandon ( ) an individual sewage disposal system
at " ` ff�/!l t G® /' Ad _ as described in the application for.
Disposal System Construction Permit No. , dated
Provided: Construction shall be compT t'd within xh?yeas oithdate of this permit. l local conditio s must be met.
Form 1255' Rev. 5/96 A.M. Sulkin Co. Chadesfown, MA Date/��7 Boarc of ealth ' 1
No.:BOHDGIS-5937
� 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: 62 VINEBROOK RD, SOUTH YARMOUTH, MA 02664 Owner: '
MURPHY DOROTHY J LIFE EST
Map/Parcel#: 078.146 C/O BARKER THOMAS J
185 CANTERBURY ST APT 2
' WORCESTER,MA 01603
Phone:
� Septic System Installer Designer
TERRY S. WALKER DOWN CAPE ENGINEERING,INC.
511 UPPER COUNTY ROAD SOUTH 939 ROUTE 6A
DENNIS, MA 02660 YARMOUTHPORT,MA 02675
Phone: 508-362-4541
5085095870
Type of Building:Dwelling Lot Size:9,148.00 Sq.Ft.
Dwelling-No.of Bedrooms:2 Garbage Grinder:
Other Type of Building: No.of persons: Showers: i
Other Fixtures:
Plan Date:09/23/2015 Number of Sheets: 1
Cafeteria:
Tit1e:TITLE 5 SITE PLAN 62 VINEBROOK ROAD Revision Date: i
Design Flow(min.required):220 gpd Calculated design f1ow:220 gpd Design ftow provided:336 gpd �
' Description of Soi1s:SEE PLAN '
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:09/16/2015
DANIEL GONSALVES,SE
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,2- ,
500 GAL CHAMBERS W/STONE:30'X 9.83'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 Heakh. ;
Signed Date
Inspections
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� Commonwealth of Massachusetts
Board of Health, Yarmouth� 1�iH Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT $55.00
Permission is herby granted to;
TERRY S.WALKER EXCAVATION,511 UPPER COUNTY ROAD, SOUTH DENNIS, MA 02660
To perform:Upgrade an individual sewage disposal system.
. Owner: MiJRPHY DOROTHY J LIFE EST
C/O BARKER THOMAS J
. 185 CANTERBURY ST APT 2
= WORCESTER,MA 01603
Location:62 VINEBROOK RD,SOUTH YARMOUTH,MA 02664
Disposal System Construction Permit No.: BOHDC-15-5937,Dated:December 04,2015
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,2-500 GAL CHAMBERS W/
STONE:30'X 9.83'X 2'
2.ZONE II MAXIMUM 2 BEDROOM
��
Bruce G. Mu y, 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.
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