HomeMy WebLinkAboutApp-Permit-ComplianceMQ
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No.:BOHDGIS-0861
� Commonwealth of Massachusetts Fee
555.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMTT
Application for a Permit to:Upgrade-Complete System
Location: 17 HOPE RD, SOUTH YARMOUTH, MA 02664 Owner:
MICARIPETER
Map/Percel#: 033237 MICARI PAIRTCIA
22 BARBARA RD
TOLLAND,CT 06084-3534
Phone:
Septic System Installer Designer
ELLIS BROTHERS DOWN CAPE ENGINEERING,INC.
23 ENTERPRISE ROAD 939 ROUTE 6A ,
YARMOUTHPORT, MA 02675 yqgMOUTHPORT,MA 02675
Phone: (508)362-4541
Type of Building:Dwelling Lot Size:026 Acres
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Fixtures:
Plan Date:Ol/OS/2015 Number of Sheets: l Cafeteria:
Tit1e:TIT1.E 5 SITE PLAN 17 HOPE ROAD Revision Dah:
Design Flow(min.required):330 gpd Calculated design Flow:330 gpd Design Flow provided:335 gpd
Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name ot Soil Evaluator: Date of Evaluation: 12/03/2014
, � DANIEL GONSALVES,SE
DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR- I500 GAL SEPTIC TANK/500 GAL PUMP CHAMBER COMBINATION,
. DBOX,24 QUiCK 4 STANDARD LOW PROFILE INFILTRATOR UNITS W/OUT STONE:32'X 83'X 0.28'
The undersigned agrees to install the above described Individual Sewage Disposal System in aecortlanee wkh the provisions of
71TLE 5 and further aarees not to olaee in ooeration until a CeRifieate of Comoliance has heen issued bv the 8oartl of Health.
Signed Date
Inspections �
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT ass.00
Permission is herby granted to;
ELLIS BROTHERS CONSTRUCTION,23 ENTERPRISE ROAD, YARMOUTHPORT, MA 02675
To perform: Upgrade an individual sewage disposal system.
Owner. MICARIPETER
MICARI PATRICIA
22 BARBARA RD
TOLLAND,CT 06084-3534
Location: 17 HOPE RD, SOUTH YARMOUTH,MA 02664
Disposal System Construction Permit No.: BOHDC-15-0861 ,Dated: January 22,2015
Provided: Construction shall be completed within six months of the date of this permit. All local conditions must be met.
Conditions
l. BOH TO INSPECT SOIL REMOVAL
2. MFC VARIANCE: 1. GROUNDWATER SEPARATION
3. REPAIR-1500 GAL SEPTIC TANK/S00 GAL PUMP CHAMBER COMBINATION, DBOX, 24 QUICK
4 STANDARD LOW PROFILE INFILTRATOR UNITS W/OUT STONE: 32'X 8.3'X 0.28'
/
Bruce G. urp y, 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.
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: ELL1S BROTHERS CONSTRUCTION
at: 17 HOPE RD,SOUTH YARMOUTH, MA 02664
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.: BOHDG1S0861,dated 03/03/2015.
Installer:ELLIS BROTHERS CONSTRUCTION
Address23 ENTERPRISE ROAD YARMOUTHPORT, Inspector:AMY VON HONE,R.S.
MA 02675
Designer. DOWN CAPE ENGINEERING, INC.
Conditions
1.BOH TO INSPECT SOIL REMOVAL
2.MFC VARIANCE: 1.GROUNDWATER SEPARATION
3.REPAIR- 1500 GAL SEPTIC TANK/500 GAL PUMP CHAMBER COMBINATION,DBOX,24
QUICK 4 STANDARD LOW PROFILE INFILTRATOR UNITS W/ T.S ONE: 32'X 8.3' X 0.28'
,/��O Cer /C O�P �
Bruce G. Murphy,.d"v1PH,R.S., CHO/Amy L. von Hone, R.S.,CHO
�� Health Director/AssistantHealth Diredor
The issuance of this permit shall not be consMued as a guarantee that the system will function as designed.
BOH_Disposal_Construdion_CofC.rpt