HomeMy WebLinkAboutApp-Permit-ComplianceNo" 8014DC-15 THE COMMONWEALTH OF MASSACHUSETTS FEE
l� BOARD F HEALTH 3X
yP1
OF �, HEALTH LWT
APPLICATION FOR DISPOSAZ SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct ( ) Repair( ) Upgrade 4_-)—A -Bandon ( ) =�plete System ❑ Individual Components
SyN I rr-acoo L Oo cto
[ Mat ion
Map/Parcel #
C%WMC
67 Su)irr 8 W Z eQ s, ya. -
/
Down (r, ,,, . Te A, I ne er" (n 9
q3 qf� I n s am m j
Telephone #
Type of Building: jt�� %( (rQ Lot Size U>
Dwelling — No. of Bedrooms Garbage Grinder ( )
Other — Type of Building No. of persons Showers ( ), Cafeteria ( )
Other fixtures
Design Flow (min. required) -220 gpd Calculated design flow gpd Design flow provided gpd
Plan: Date 12 Number of sheets Revision Date
Title
Description of Soil(s)
jig (I Q7—
Soil Evaluator Form No. Name of Soil Evaluator 12�ge of Evaluation `G
DESCRIPTION OF REPAIRS OR ALTERATIONS
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of
TITLE 5 and furer rees not to place a Sys 1 operation until a Certificate of Compliance has been issued by the Board of Health.
Signed ) ) Date 21 )_0 Ill-.(
Inspections
FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96
L"- i No. &004 DC -15'd132.- TH COMMONWEALTH OF MASSACHUSETTS "'�` FEE
BOARD OF HEALTH// ft-7WC RTIFICATE OF COMPLIANCE /res's
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System
vie-, 0,04`
Description of Work: E] Individual Component(s) g-C'mnplete S y
�, olc
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( )Upgraded (�-j''�bandoned ( )
by: -� )CCI\J(-A �tU n
at &,-7 S \,,a,f i rT i ( DLJ V :T_ 6)0-0
has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design'pl nss/as-built,
plans r�Ja ' to application No. ✓ dated .�—.2 -7—/Approved Design FlowJ�=SIL( Pd)
Installer
Designer: J rn Inspector Date r
The issuance of this certificate shall not be construed as a guarantee that the system will function as designed.
FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96
No. () c aS-i«ZTHE OMMONWEALTH OF MASSACHUSETTS FEE ;SS ,L
BOARD OF HEALTH-7("�
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to Construct ( ) Repair ) Upgrade (--'f—Abandon ( ) an individual sewage
disposal system at i 1' i l(�(��� ��)�(� as described
in the application for Disposal System Construction Permit No. A; dated
Provided: Construction shall be completed within-94;oo-yQars.of the date o is perm/_ocal,conditions must be met.
Date 2 ` Bard of Health
FORM 2 - DSCP DEP APPROVED FORM 5/96
FORM 1255 (REV 5/96) H&W HOBBSB WARRENrM PUBLISHERS - BOSTON G/
No.:BOHDC-IS-2132
, Cammonwealth of Massachasetts ss o0
Board of Health, Yarmouth, MA
� APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
iI
jApplicetion for a Permit to:Upgrade-Comptete System
� I.,ocation:67 SIMFT BROOK Rp, S6UTH YARMOUI'Fi,MA 62664 Owner:
OHARA V&RA S TR
� Map/Parcel#: 067.236 VERA S OHARA 1RUST
' 61 SWiFT BROOK KD
Ii
SO YARMOUTH,MA 02664
Phone:
Septic System installer Desigoer
B&B EXCAVATION DqWN CAPE ENGINEERING.INC.
14 7EA8ERRY LANE FORESTDALE, 939 ROUTE 6A
MA 02644 YARMOUTHPOItT,1VIA 02675
Pho�: {508}3b2-454t
Tppe of Building.Dwelling Lut Siu:0.31 Acres �
6welting-No.of Bodropms:2 Garbage Grinder:
Other Type of Buildiog: No.of persons: Showars:
Other Finturas:
Plan Date: 12/23/2014 Number of 5heets: 1 Caftter�:
Tit1e:TITLE S SI'IF,PLAN 67 SWIFT BROOK ROAD Revision Date:
Design Flow(min.required}:220 gpd Calcutated desfgn Oow:220 gpd Design tiow provided:240 gpcl
pescription of SoiIs:SEE PLAN
Soii Evaluator Form No.; Name of Soii EvsieaMr: Date oP Evtlaation:0 611 8120 1 4
� DAMEL GONSALVES,SE
DESCRIPTTON pF REYAIRS OR ALTERATIONS:REPAIR- I500 GAL SEPTIC TANK,FBOX,11 H[GH CAPACITY INFILTRATORS
WiOUT STpNE
The uedeaigned agrees W i�roq11 tha above deacribed Imlividua!$ewage Disposal Systern in actordance with tha provtsbm of
TIttE 6 ana further eareas not to olace in ooerotion unFil a Certificate df Comoliance has heen Isaued bv the 8ogrd of Heatth.
Signed Date
Inspections
Cammonwealth of Massachusetts
° Baard of Health, Yarmauth, MA. F�
� DISPOSAL SYSTEM CONSTRUCTIQN PERMIT sss.00
a
�
� Permission is herby grantecl to;
� B&B EXCAVATlON, 14 TERBERRY IRNE,FORESTDALE,MA 02644
i
�
�, To perform:Upgrade an individual sewage disposai system.
� Owner: OI�TARAVERAS'TR
i VERA S OIIARA TRU5'I
ib7 SWIFT BROOK RD
i SQ YARMOUTH,MA 02664
Location:67 SWIFT BROOK RI?,SQUTH YARMOUTH,MA 02664
Disposal System Construcrion Permit No.:BQHDC-1S1132,Dated:February 23,2QI5
Provided:Construction shall be completed wi[hin six months of[he date of this perrnit. All local canditions must be met.
Conditions
I. BtJH T(?INSPECT SOIL REMOYr2L PRIt?R Tt?INSTALLRTIQN
2. REPAIR-I500 GAL SEPTIC TANK, DBpX, 11 HIGH CAPACIT3'INFILTRATORS W/OUT STONE
3. PLUMBING PERMIT REQUIRED
4. MFC VARZ�tNCES: 1. WETLAND SF,TBACK2. PROPERTY LINEAND FOtINDATI4NSETBACK
S. ZONE II-MAXIMUM2 BEDROOMS !
i�
i
Bruce G. u hy, MPH, R.S., CHO/A y L.von Hone, R.S., CHO
Heshh Ctirector/Assistant Heafth Directar
The issuance of this permit shall not be construed as a guarantee that the system will Functian as designed.
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