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HomeMy WebLinkAboutApp-Permit-ComplianceNo. 6th ff D C q 5- 5`) `i i FEE �1(04,.0d �7-3 COMMONWEALTH Of MASSACHUSETTS Board of Health, �'�j�,�l� , MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( Repair( ) Upgrade( ) Abandon( - O'Complete System ❑ Individual Components Location 7 `�;,�) S Owner's Name j -r-a A e- 7 L /'0 li Map/Parcel# 1 7 G Address Yo 4 f Pl Lot# Telephone#Gi U(o 8, Installer's Name LL C G C Designer's Name 0A n%/- ( ®iA j„A Address %7- Y Address ��� S�} f/✓b d r9 Telephone#D _ Zlli� Telephone# p Type of Building ze S Lot Size sq. ft. Dwelling - No, of Bedrooms T Garbage grinder ( } Other -Type of Building No. of persons Showers ( ), Cafeteria ( ) Other Fixtures Design Flow (min, required) `ftp gpd Calculated design flow Design flow provided ivy gpd Plait: Date 3 % r F5 11 Number of sheets % Revision Date Title % ,, 1 rim 55 [ /7�6 /J Description of Soil (s) Low S�tlm r�-CIrl exa vx, C:Otsd-L Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation e z 1 7 � DESCRIPTION OF REPAIRS OR ALTERATIONS 4Svn The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to no top ace the syste m operation until a Certificate of om liance has been issued by the Board of Health. Signed /qt G4� 61 9' tet.. Date f / /c Inspections I lZ / /,I -,, L T ,C Y 6 No. 60 6i'r' — 15" S ( • 1 1,i � l� f �[�E `6r Ito. 00 COMMONWEALTH OF MASSACHUSETTS I 0M Board of Health, Przm©L�m MA, CERTIFICATE Of COMPLIANCE Description of Work: ❑ Individual Component(s) Hirlmplete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ,Repaired ( ), Upgraded ( ), Abandoned ( ) by: at has been installeErnn accordaricewfth d application No. dated Installer M i c" c'L A) op i N 6_ of 39.CMR 15.00 (Title 5) and th a proved design plans/as-built plans relating to . Approved Design F ow (gpd) Designer: Inspector: ( Cs Date: The issuance of this permit shall not be construed as a guarantee that the system will function as designed. 7-� COMMONWEALTH OF MASSACHUSETTS Board c f Health, �i F� j[Z( j_, MA. DISPOSAL SYSTEM 'CONSTRUCTION PERMIT FEE 4 Permission is hereby granted to; Construct( Repair( ) Upgrade ( ) Abandon ( ) an individual sewage disposal system at `� �� �� °' /-�-r� as described in the application for Disposal System Construction Permit No. ice" , dated /fir 3� Provided: Construction shall be completed within tbxzaA&eafs o the date of thisperm' . All local condi 'ons must be met. 40 Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown, MA i Date .:1V _/ Board of Health J(� ( ` No.:BOHDGIS-5949 Commonwealth of Massachusetts Fee 5110.00 , Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to:New Coustruction-Complete System � � Location: 57 LEWIS BAY RD,WEST YARMOUTH, MA 02673 Owner: ' POLI FRANCIS C Map/Parcel#: 017.68 404 PINE CREEK AVE I FAIRFIELD,CT 06824 ; i Phone: Septic System Installer Designer ALL CAPE SEPTIC LLC DOWN CAPE ENGINEERING.INC. ' 618 ROUTE 28, UNIT 3 WEST 939 ROUTE 6A ' YARMOUTH, MA 02673 YARMOUTHPORT,MA 02675 Phone: 508-362-4541 5087714200 i Type of Building:Dwelling Lot Size:37,026.00 Sq.Ft. Dwelling-No.of Bedrooms:4 Garbage Grinder: Other Type of Building: No.of persons: Showers: Other Fiatures: Plan Date:03/18/2015 Number of Sheets: 1 Cafeteria: , Tit1e:TITLE 5 SITE PLAN 57 LEWIS BAY ROAD Revision Date: Design Flow(minaequired):440 gpd Calculated design flow:440 gpd Design flow provided:444 gpd Description of Soils:SEE PLAN Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation: 12/17/2014 DANIEL GONSALVES,SE DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-NEW CONSTRUCTION-PROPOSED 1500 GAL SEPTIC ' TANK,DBOX,40'X 15'X 6°LEACH FIELD 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 CeRificate 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; , ALL CAPE SEPTIC LLC,618 ROUTE 28, UNIT 3,WEST YARMOUTH, MA 02673 To perform:New Construction an individual sewage disposal system. Owner: POLI FRANCIS C 404 PINE CREEK AVE FAIRFIELD,CT 06824 Location: 57 LEWIS BAY RD,WEST YARMOUTH,MA 02673 Disposal System Construction Permit No.: BOHDC-15-5949,Dated:November 30,2015 Provided: Construction shall be completed within six months of the date of this permit. All local conditions must be met. CONDITIONS: 1. SEPTIC DISPOSAL-NEW CONSTRUCTION-PROPOSED 1500 GAL SEPTIC TANK, DBOX,40'X 15'X 6" LEACH FIELD 2. BOH TO INSPECT SOIL REMOVAL 3.WATER LINE TO BE SLEEVED V l�7 ' Bruce G. Mu - y,M H, 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.