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HomeMy WebLinkAboutApp-Permit-ComplianceCOMMONWEALTH Of MASSACHUSETTS Board of Health, 1 , MA. TI � �PLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION E RMI1 FEE "133M I p ication for a Permit to Construct( ) Repair( ) UpgradeL,�Abandon( ) - -R Complete System ❑ Individual Components Location CqL3 W 1 j J Q)Lfj 6r"\l P -04+b Owner's Name G l(J iv Map/Parcel# 3a t Address j a©� t-Hlb,tlt}�5 �� =7✓t �'r Lot# Telephone# Installer's Name c j5jWt Lte Designer's Name 'SC C— ,&)G1 Address i S Sr � Address g E� Telephone# T Telephone# 50S -2-19 .- 0 Type of Building Dwelling - No. of Bedrooms Other - Type of Building I No. of persons Lot Size t r fwd fi sq. ft. Garbage grinder ( ) Showers ( ), Cafeteria ( ) Other Fixtures Design Flow (min. required) y gpd Calculated design flow Design flow provided q44 gpd Plan: Date 8 - V7 - u1.0 ( Number of sheets Revision Date Title AS W t 1.) S C. ee Lxj Qg&4 PO" Description of Soils) &0 ill. " Sp -g& Q .36" Z 5G -:r- PC-+Fj Soil Evaluator Form No. Name of Soil Evaluator M. P1966-w7igLe Date of Evaluation DESCRIPTION OF REPAIRS ORALTERATIONS 37L)5 06W t 5(X� 9,44L.QU H-0 56pric', `i�faclK -ro fj&u> eoV m las) Aac. 4(n Pr.AAZte, 4i4Auea'r,6,X, tk) & jztQ,,b C40r- C -j 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 lace the syste in operation until a Certificate of Compliance has been issued by the Board of Health. Signed agrees to Date & - 2e5 '.)4 f.,K Inspections No. FEE u COMMONWEALT14 OF MASSACHUSETTS Board of Health, f .®VTI+ , MA. CERTIPcm TE Of COMPLIANCE P Descri tion of Work: L1 Individual Component(s) plete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( )> Upgraded ), Abandoned ( ) by: Afr=wtbe LL -Q. at A3 wlostrCw Q124q OAa has been installed in actor a c`e with the ro��sions of 3 CMR 15.00 (Title 5) and th proved design plans/as-built plans relating to application No. %� — dated � -2 % Approved Design Flow �(gPd) Installer Designer::TC- Inspector: T-1 6�; & � Date: The issuance of this permit shall not be construed as a guarantee tthat the system will function as designed. FEE W'00 4 z- - COMMONWEALTH Of MASSACHUSETTS Board of Health, YAM 0 trl* , MA. DISPOSAL SYSTEM CONSTRUCTION PEPMIT Permission is hereby granted to- Construct( ) Repair( ) Upgrade(�,,.�bandon ( ) an individual sewage disposal system at 3 W l �JSL ow y -P ookllj as described in the application for Disposal System Construction Permit No. �� �' ; dated Provided: Construction shall be completed within three years f the date of this,per 't: l local con di 'Qns must be met. _%, Form 1255 Rev. 5/96�A.M. Sulk�in� Co. Charlestown, MA /j Date / pard oL�41— Health ZW�il✓f'" No.:BOHDGIS-4104 Commonwealth of Massachusetts Fee � ass.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to:Upgrade-Complete System Location: 23 WINSLOW GRAY RD,WEST YARMOUTH, MA 02673 Owner: BRENNAN GARY M Map/Parcel#: 032.16 520 PHINNEY'S LN CENTERVILLE,MA 02632 Phone: Septic System Installer Designer CAPEWIDE JC ENGINEERING.INC. 153 COMMERCIAL STREET 2854 CRANBERRY HIGHWAY MASHPEE, MA 02649 EAST WAREHAM,MA 02538 Phone: 508-273-0377 : Type of Building:Dwelling Lot Size: 18,731.00 Acres ' Dwelling-No.of Bedrooms:4 Garbage Grinder: Other Type of Building: No.of persons: Showers: Other Fixtures: Plan Date:08/17/2015 Number of Sheets: 1 Cafeteria• Tit1e:PROPOSED SEPTIC SYSTEM UPGRADE 23 WINSLOW GRAY ROAD Revision Date: : Design Flow(min.required):440 gpd Calculated design flow:440 gpd Design flow provided:444 gpd Description of Soi1s:SEE PLAN Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:07/09/2015 MICHAEL PIMENTAL,EIT , k ; DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,25 ! ARC 36 UrtITS W/OUT STONE:25'X 14.4'X 7" � ; 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 i Commonwealth of Massachusetts Board of Health, Yarmouth, MA Fee � DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00 Permission is hereby granted to; CAPEWIDE ENTERPRISES, LLC, 153 COMMERCIAL STREET, MASHPEE, MA 02649 To perform: Upgrade an individual sewage disposal system. Owner: BRENNAN GARY M 520 PHINNEY'S LN CENTERVILLE,MA 02632 Location: 23 WINSLOW GRAY RD, WEST YARMOUTH, MA 02673 ' Disposal System Construction Permit No.: BOHDC-15-4104 ,Dated: August 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, DBOX, 25 ARC 36 UNITS W/OUT STONE: 25'X 14.4'X 7° 2. BOH TO INSPECT SOIL REMOVAL 3. PLUMBING PERMIT REQUIRED 4. MFC VARIANCE APPROVAL: a. GROUNDWATER ; { f � : ; , f , Bruce G. Murp , H, R.S., CHO/Am 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. � i