HomeMy WebLinkAboutApp-Permit-ComplianceNo. 6o i --v C-- (S'4 1/�� FEE % O . 00
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Board of Health, -
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to ConstructV Repair( ) Upgrade( ) Abandon( ) - Complete System ❑ Individual Components
Location _3.f -i J Wft
S Owner's Name
Map/Parcel#/07 CZ
Address 15-oa59
Lot#
Telephone#s-,o p S'� - /lJ 3 0
Installer's Name
Designer's Name o W`
Address ►-��
Address .9
Telephone# fzir 0749-r j//f
Telephone#
Type of Building 5 1 PA A�"- - LotSize 6.3� sq. ft.
Dwelling - No. of Bedrooms )= 2 1,41-0Garbage grinder (y),Z
Other - Type of Building No. of persons Showers ( ) , Cafeteria ( )
Other Fixtures
Design Flow (min. required) /10 gpd Calculated design flow _ Al Yo Design flow provided s.S� gpd
Plan: Date '� -/0 —45— Number of sheets Revision Date
Title
Description of Soil(s) o /,F- A..5- LT, ,ate = / G j�
i a -
Soil Evaluator Form No. Name of Soil Evaluator E j2 .ST" 157- Date of Evaluation _ f r1 -- Z Z —0.3
DESCRIPTION OF REPAIRS OR ALTERATIONS 4j-,
G S, A. a'f Q R -P C.i i C'
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to,not to place the em in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date 'l -��
Inspections
COMMONWEALTH 01 NIASSACII
Board of Health, ifl=.1M0U71i♦ , AIA.
CERTIFICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed (j/}�, Repaired ( ), Upgraded ( ), Abandoned ( )
by:
at
has been instal PedMrrda'hce Ath tQhe provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. to3 dated -7 - 7`/ Approved Design Flows d)
Installer c- t;
Designeq, r 4 "11, � , t ��.o l� � � � � r Inspector: e4!� �� // l�.i�� Date:
The issuance of this permit shall not be const -tied as a guarant�t�hat the system will function as designed.
No. —0151 FEE t2,. 0 c-}.
COMMONWEALTH Of MASSACHUSETTS
Board of Health, Y L1R1V W77f , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct (y �)f Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system
at ' (ANiZ 'i r-,PJ�. �" lAk"irA:',e 5. V as described in the application for
Disposal System Construction Permit No. dated 7- 7-14;;
;
Provided: Construction shall be complet' eii&-Tti ?of the date of this permit. l local ti. ns must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Go. Chadeslown, MA Date 7 Board of Health
f f
No.:BOHDGIS-0191
Commonwealth of Massachusetts Fee ,
$110.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:New Construction-Complete System
Location: 35 WEST GREAT WESTERN RD,YARMOUTH, MA 02675 Owner:
MOORE JAMES S
Map/Parcel#: 109.77.2 15 GOELETTA DR
EAST FALMOUTH,MA 02536
Phone:
Septic System Installer Designer
B.C.K.GENERAL DOWN CAPE ENGINEERING.INC.
97 TOWN BROOK ROAD WEST 939 ROUTE 6A
YARMOUTH, MA 02673 YARMOUTHPORT,MA 02675
Phone: 508-362-4541
Type of Building:Dwelling Lot Size:43,560.00 Acres
Dwelling-No.of Bedrooms:4 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Ot6er Fixtures:
Plan Date:04/10/2015 Number of Sheets: 1 Cafeteria•
Tit1e:TITLE 5 SITE PLAN 35 WEST GREAT WESTERN ROAD Revision Date:
Design Flow(min.required):440 gpd Calculated design flow:440 gpd Design flow provided:455 gpd
Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation: 10/22/2003
EDWARD STONE,PLS .
DESCRIPTION OF REPAIRS OR ALTERATIONS:NEW-PROPOSED 1500 GAL SEPTIC TANK,DBOX,3-500 GAL PRECAST
CHAMBERS W/4'STONE:33.5'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 Health.
Signed Date
Inspections
Commonwealth of Massachusetts
:
Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT 5110.00
Permission is herby granted to;
B.C.K. GENERAL CONTRACTOR, 97 TOWN BROOK ROAD,WEST YARMOUTH, MA 02673
To perform:New Construction an individual sewage disposal system.
Owner: MOORE JAMES S
15 GOELETTA DR
EAST FALMOUTH,MA 02536
Location:35 WEST GREAT WESTERN RD,YARMOUTH,MA 02675
Disposal System Construction Permit No.: BOHDC-15-0191 ,Dated:July 07,2015
Provided: Construction shall be completed within six months of the date of this permit. All local conditions must be met.
Conditions
1.NEW-PROPOSED 1 S00 GAL SEPTIC TANK, DBOX, 3-S00 GAL PRECAST CHAMBERS W/4'
STONE: 33.S'X 12.83'X 2'
2. ZONE II MAXIMUM 4 BEDROOMS
3. FOUNDATION VARIANCEAPPROVED(1.25)
�C-
Bruce G. Mur hy,MPH, 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 $710.00
Description of Work:Complete System
The undersigned hereby certify that the Sewage Disposal System; New Construction
by:B.C.K.GENERAL CONTRACTOR
at:35 WEST GREAT WESTERN RD,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-15-0191,dated 09/04/2015.
Installer:B.C.K.GENERAL CONTRACTOR
Address:97 TOWN BROOK ROAD WEST Inspector:AMY VON HONE,R.S.
YARMOUTH MA 02673
Designer:D0�1VN CAPE ENGINEERING,INC.
Conditions
1.NEW-PROPOSED 1500 GAL SEPTIC TANK,DBOX,3-500 GAL PRECAST CHAMBERS W/
4'STONE:33.5'X 12.83'X 2'
2.ZONE II MAXIMUM 4 BEDROOMS
3.FOUNDATION VARIANCE APPROVED(1.25')
Bruce G. Murph ,M H, 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 guarante that the system will function as designed.
BO H_Disposal_Construction_CofC.rpt