HomeMy WebLinkAboutApp-Permit-ComplianceNo. C701*(]C•-1S4Sg1 �LDTY;� —Ko -00_Z _0 FEE Q
L COMMONWEALTH Of MASSACHUSETTS c�-��z:�zS'
Board of Health, _I RV D Qni , MA.
APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) - ❑ Complete System ❑ Individual Components
Location V3 /,vi /56.v
i1p
Owner's Name
Map/Parcel# __�7g — 104
Address syr
Lot#
Telephone#
Installer's Name 4,1(0%N4,---
QCX )
Designer's Name
Address 3Z
AO. A
Address o -&-V
Telephone# �2G — / Z
Telephone#
Type of Building r ! %��Crt - F4.� % /'�bilK-J `t2-- Lot,Size sq. ft.
Dwelling - No. of Bedrooms S Garbage grinder (,,�)J
Other -Type of Building No. of persons Showers ( ) , Cafeteria ( )
Other Fixtures Q
Design Flow (min. required) 0 gpd Calculated design flow Design flow provided ` gpd
Plan: Date Number of sheets / Revision Date
Title
Description of Soils)
Soil Evaluator Form No.
Name of Soil Evaluator
Date of Evaluation
OF REPAIRS OR ALTERATIONS 15'00 �!V/ A.c)
?, / 4 V 4 L ", / l i Z-0 •moi / rt-. 7-/) Z
The undersigned ees t .install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agre to t toia e the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed - t Date i %a / "
Inspections
No. 0141lC. —/S-'"'f't9 9d FEE � 55-.0 0
C®M[M[®NWFAI,TII Of NISSCIIUSETTS Nee D
44, 12.7
Board of Health, MA. 0r -
CERTIFICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) 0&mplete System
The undersigned hereby certifX that the Sewage Disposal System; Constructed Repaired ( ), Upgraded ( ), Abandoned
e
by: r �* 1�' AC
at '� �'%, 1,101 A-70.
has been i t< d in a nce with the pro 'sions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
U, t - 0 5r 10 /w rl,, d
application No,. 0 ! -�" gated Vii! b l5 Approved Design Flow (gpd)
Installer -_ _ . �t lZ.!> /A d (�j•� �7`t t � 7�� �•v 40, S uTy_ CAS F1209i ,, ,
Designer: Al. Inspector: �°'�-.r Date:
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
No. 60H —1!5" 891 C4+r401r4A- .. L_VOM, FEE 4S -00
r` a
COMMONWEALTH LTH ®I MASSACHUSETTS �`'�12'7S_
Board of Health, �ftOY 160T_ + , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct (6'f Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system
at� �'!- /4So•� �' as described in the application for
6014VC. PJ t' y
Disposal System Construction Permit No. 0i IS -c� 3 �, , dated
d i
Provided: Construction shall be completed within three years of the date of this permit. All local conditions mu$,P be met.
6 j1, ,Jfi
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestovn, MA Date . G!/, 61/,5 Board of Health c.0'L' ,4) �/� � tr i+,(
No.:BOHDGIS-4891
' Commonwealth of Massachusetts F�
ass.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERNIIT
Application for a Permit to:Upgrade-Complete System
Location:43 WILSON RD,WEST YARMOUTH, MA 02673 Owner:
KVARACEIN JOSEPH A JR
Map/Parcel#: 058.106 KVARACEIN HELEN R
81 WORTHINGTON AVE
SHREWSBURY,MA 01072
Phone:
Septic System Installer Designer
CARDINAL STEPHEN HAAS,PE
32 RIDGETOP ROAD COTUIT, MA P.O.BOX 16
02635 SOUTH DENNIS,MA 02660
Phone: 508-362-8132
Type of Building:Dwelling Lot Size:9,583.00 Acres
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Fixtures:
Plan Date:02/19/2015 Number of Sheets: 1 Cafeteria•
Tit1e:SEPTIC SYSTEM DESIGN 43 WILSON ROAD Revision Date:
Design Flow(min.required):330 gpd Calculated design flow:330 gpd Design flow provided:330 gpd
Description of Soils:SEE PLAN ',.
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation: 11/25/2014 '
� STEPHEN HAAS,PE '
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK,H-20 DBOX.,
` 18 HIGH CAPACITY INFILTRATORS W/OUT STONE:37.5'X 9.5'X 11"
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 nlace in ooeration until a Certificate of Comoliance has been issued bv the Board of Heakh.
Signed Date
Inspections
, Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT $55.00
Permission is herby granted to;
CARDINAL CONSTRUCTION,32 RIDGETOP ROAD, COTUIT,MA 02635
To perform:Upgrade an individual sewage disposal system.
Owner: KVARACEIN JOSEPH A JR
KVARACEIN HELEN R
81 WORTHINGTON AVE
SHREWSBURY,MA 01072
Location:43 WILSON RD,WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.: BOHDC-15-4891 ,Dated: October 27,2015
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, H-20 DBOX., 18 HIGH CAPACITY
INFILTRATORS W/OUT STONE:37.5'X 9.5'X 11"
C'�(
Bruce G. rphy,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. '
- �
i
i
.
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
CERTIFICATE OF COMPLIANCE $55.00
Description of Work:Complete System
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:CARDINAL CONSTRUCTION
at:43 WILSON RD,WEST YARMOUTH,MA 02673
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-15-4891,dated 10/19/2015.
Installer:CARDINAL CONSTRUCTION
Address:32 RIDGETOP ROAD COTUIT,MA 02635 Inspector:PHILIP RENAUD
Designer:STEPHEN HAAS,PE
�V ��/
�`1
Bruce G. Mu y, 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 guara ee that the system will function as designed.
BOH_Disposal_Construction_CofC.rpt