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HomeMy WebLinkAboutApp-Permit-ComplianceNo. _ 0 C 1C3—C461 8 LbT9 — 11, J ooDzI !` FEE COMMONWFALT14 Of MASSAC14USETTS ���/��� `�^��, 4����/ Board of Health, i�'�1�"1.1� � PPIL CATI®N FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair (/Upgrade( ) Abandon() - ❑ Complete System individual Components Location W!Mt Owner's Name C ' Map/Parcel# tZ3 C1 3 Address 7 C7 "�6e Lot# Telephone# _ 65-1 - Installer's Name`G f• Designer's Name o Ne Address 2)50 _CeS � bjs C I M61-22 Address 9bq (\S� Telephone#_ % ]�� �" Telephone# Type of Building NOW - Dwelling - No. of Bedrooms Other - Type of Building _ No. of persons Lot Size sq. ft. Garbage grinder( ) Showers ( ), Cafeteria ( ) Other Fixtures Design Flow (min. required) 'n© gpd Calculated design flow TL101— Design flow provided Plan: Date jaw Number of sheets I Revision Date Title Description of Soil(s) _ Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation `DESCRIPTION OFREPAIRS ORALTERATIONS V= -Ib At c &OC-\ gpd The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to ce the system in gerafion til a Certificate of Co pliance has been issued by the Board of Health. Signed - rte— ate �i�� Inspections r7— <� b No. F20'� DC -i 5" C `T 01 COMMONWEALT14 Of MASSACHUSETTS Board of Health, %A P -MO U11i , MA. CERTIFICATE Of COMPLIANCE FEE • 6b Ilo3 Description of Work:[Individual Component(s) El Complete System The undersigned here y certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded (X, Abandoned,( ) by: at C has been installed n acco `dance with the provisions of 310 CMR 15.00 (Title 5) and t W oved design plans/as-built plans relating to application No. � /� / dated -2-27 / Approved Design Flow (gpd) Installer �: t r Designer: t�!C`t.�A1 U',QC'. Inspector: � /C.1/D ��XjIJ� Date: The issuance of this permit shall not be construed as a guarantee system will function as designed. No. �li C.-'-� �`i C • jE��?� YC_ 7 • 10C r FEE �� 00 f r / �>' / COMMONWEALT14 Of MASSACHUSETTS a,#-` 16 Board of Health,ypQ C) 0-1-ry , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( v/"Upgrade ( ) Abandon( ) an individual sewage disposal system at j i Oro& � ��_ as described in the application for Disposal System Construction Permit No. S / , dated 7 _�2 Provided: Construction shall be compfeted within of the date of this permit. local local conditions must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA D to �` / Board f Health 1 Commonwealth of Massachusetts Board of Health, Yarmouth, MA Fee CERTIFICATE OF COMPLIANCE sss.00 Description of Work:Individual Component(s) The undersigned hereby certify that the Sewage Disposal System; Upgraded by:CAPE COD SEPTIC SERVICES at:7 WOODSIDE CIR,YARMOUTH PORT,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-15-0461,dated 08/06/2015. Installer:CAPE COD SEPTIC SERVICES Address350 ROUTE 28 WEST YARMOUTH,MA Inspector:AMY VON HONE,R.S. 02673 Designer:DOWN CAPE ENGINEERING,INC. V� Bruce G. Mur„p3h3hy, PH, R.S., CHO/Amy L.von Hone, R.S., CHO ' Health Director/Assistant Health Director The i n f hi � ' ssua ce o t s permit shall not be construed as a guarantee that the system will function as designed. BO H_Disposal_Construction_CofC.rpt • No.:BOHDC-15-0461 j 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: 7 WOODSIDE CIR,YARMOUTH PORT, MA 02675 Owner: SHAYLOR ROSE M TR Map/Parcel#: 123.93 SHAYLOR REAL ESTATE TRUST 7 WOODSIDE CIR YARMOUTH PORT,MA 02675-1800 Phone: Septic System Installer Designer CAPE COD SEPTIC DOWN CAPE ENGINEERING,INC. 350 ROUTE 28 WEST YARMOUTH, MA 939 ROUTE 6A 02673 YARMOUTHPORT,MA 02675 Phone: 508-362-4541 Type of Building:Dwelling Lot Size:40,075.00 Acres � Dwelling-No.of Bedrooms:3 Garbage Grinder: ', Other Type of Building: No.of persons: Showers: � Other Fixtures: ' Plan Date:06/26/2015 Number of Sheets: 1 Cafeteria: Tit1e:TTTLE 5 SITE PLAN 7 WOODSIDE CIRCLE Revision Date: Design Flow(min.required):330 gpd Calculated design flow:330 gpd Design flow provided:349 gpd Description of Soi1s:SEE PLAN Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:06/25/2015 DANIEL GONSALVES,SE DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK,PROPOSED DBOX AND 2-500 GAL PRECAST CHAMBERS W/4'STONE:25'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 nlace in ooeration until a Certificate of Comoliance has been issued bv the Board of Health. Signed Date Inspections • Commonwealth of Massachusetts i Board of Health, Yarmouth, MA Fee DISPOSAL SYSTEM CONSTRUCTION PERMIT �55.00 Permission is hereby granted to; CAPE COD SEPTIC SERVICES, 350 ROUTE 28,WEST YARMOUTH, MA 02673 To perform: Upgrade an individual sewage disposal system. Owner: SHAYLOR ROSE M TR SHAYLOR REAL ESTATE TRUST 7 WOODSIDE CIR YARMOUTH PORT,MA 02675-1800 Location: 7 WOODSIDE CIR, YARMOUTH PORT, MA 02675 Disposal System Construction Permit No.: BOHDC-15-0461 , Dated: July 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- EXISTING 1000 GAL SEPTIC TANK, PROPOSED DBOX AND 2-500 GAL PRECAST CHAMBERS W/4'STONE:25'X 12.83'X 2' 2. BOH TO INSPECT SOIL REMOVAL V� / Bruce G. Mu 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 g arantee that the system will function as designed. ' , ;