HomeMy WebLinkAboutApp-Permit-ComplianceNo.' � �`i� ` FEE
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'A CO ® I.TI1®F 1` AS .t���lJ� MS r�
Board of Health, MA.
IV
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) - ❑ Complete System kudividual Components
Location
;�L00 UtV16rJ'3Tt
—,-V'7-
Owner's Name 11 ARy J-000 C®Iva1iJT
Map/Parcel#
Q
Address 14r/ ^7{Ejs14CEW-60Dr? E�C.0
Lot#
Telephone#
Installer's Name E
D 1�
Designer's Name n f
Address
�
�� P
Address
Telephone#
Telephone#
Type of Building P- a t w -W T 144-, Lot Size
Dwelling - No. of Bedrooms
Other - Type of Building No. of persons
Other Fixtures
Design Flow (min. required)
Plan: Date
Title
Description of Soil(s) _
Soil Evaluator Form No,
gpd Calculated design flow
Number of sheets
Name of Soil Evaluator
sq. ft.
Garbage grinder( )
Showers ( ), Cafeteria ( )
Design flow provided
Revision Date
Date of Evaluation
gpd
DESCRIPTION OF REPAIRS OR ALTERATIONS 5e4u 'T,4NK
Rcpr,acC Uuig Mcw TWOLI 10 IPLT
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 t lace th system in operatio until a Certificate of Compliance has been issued by the Board of Health.
Signed Date
,/ Lo yVry
Inspections
Y No. ?4� i� t t - 00 -7 FEE �? J 00
-7 COMMON�I.T14 ®f M ASSACHUSETTS �wz �f go ��Z
Board of Health, yf�li +0 � 1 , MA. 6G ! fid r�, 1
CERTIFICATE Of C®MPI.INCE
Description of Work: Individual Component(s) ❑ Complete System I f >
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired (V Upgraded ( ), Abandoned ( )
by: CA1P6ZrUtDE
at -200 UN I oi.J S T ea!�
t.:=� I -- /� �/7�) 7 f.
has been installed in accordance with Che rovisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. �i /b 7 , dated � P'f -f . Approved Design Flow (gpd)
Installer LAAC-L.-M E &VrERP4(Sgs
Designer: Ae.lk Inspector: Date: 1 l r
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
No.? (.) H ,t.' C I q _.(b l t )
C
COMMONWEALTH LTH Of MASSACHUSETTS
Board of Health, �' Ti( tf , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
FEE D
Permission is hereby granted to; Construct( ) Repair(A) Upgrade( ) Abandon( ) an individual sewage disposal system
at r�00 L ljloxj S Xt--T' as described in the application for
Disposal System Construction Permit No. //- 14 7 , dated
Provide -.d: Construction shall be completed with�e years of the date of this permit. All local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown, MA Date �� Board of Health
i
,
No.:BOHDC-]4-0076
Commonwealth of Massachusetts Fee
$55.00
Board of Health, Yarmouth, MA.
' APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
�
� Application for a Permit to:Repair-minor-Individual Component(s)
Location: 200 UNION ST,YARMOUTH, MA 02675 Owner
Map/Parcel#: 106.69 Name:
CONANT MARY A
Address:
200 UNION ST YARMOUTH PORT, MA
02675-1942
Phone:
Septic System Installer
Name:
CAPEWIDE ENTERPRISES LLC
Address:
153 COMMERCIAL STREET
MASHPEE, MA 02649
Phone:
5084778877
Type otBuilding:Dwelling Lot Siu:0.48 sq.ft.
Dwelling-No.of Bedrooms: Garbage Grinder:
Other Type of Building: No.of persons: Showers: Cafeteria:
Other Fixtures:
Plan Date: Number of Sheets:
Title: Revision Dah:
Design Flow(min.required): gpd Calwlated design flow: gpd Design flow provided: gpd
DescripNon of Soils:
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEAL LEAKING SEPTIC TANK,INSTALL SANITARY TEES,AS
NEEDED,REPLACE LINE FROM SEPTIC TANK TO LEACH PIT PER INSPECTION REPORT
The undersigned agrees to install the above described Indivitlual Sewage Disposal System in aetoMance wkh the provisions
of TITLE 5 and further aprees no!to Dlace In operation until a Certifieate of Compliance has been issuetl by the Board of Health.
Signed Date
Inspections
'
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA. Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00
i
�
� Permission is herby granted to;RICH CAPEN Address: 153 COMMERCIAL STREET
MASHPEE, MA 02649
To perform: Repair-minor an individual sewage disposal system.
Owner. CONANT MARY A
200 UNION ST
YARMOUTH PORT,MA 02675-1942
Location:200 iJNION ST,YARMOUTH,MA 02675
Disposal System Construction Permit No.: BOHDC-140076,Dated: August Ol,2014
Provided: Construction shall be completed within six months of the date of this permit. All loca]conditions must be met.
CondiHons
Seal leaking septic tank, install sanitary tees, as needed, replace line benveen septic tank and leach pit
per inspectfon report
� ���!
Bruce G. u y, MPH, R.S., CHO/Amy L.von Hone, R.S., CHO
� Health Director/Assistant Health Diredor
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.