HomeMy WebLinkAboutApp-Permit-ComplianceNo. L71: 1' D 0-115-6 95,_7 FEE ' 55 00
COMMONWEALTH LTH ®f MASSACHUSETTS
Y. Board of Health, RLDf�Tl•{' , MA.
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APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade04 Abandon( ) -Complete System ❑ Individual Components
Location
o�✓ .,
Owner's Name G'/1�9i ���/��-•
Map/Parcel#1
15
Address C Seo � 00 j,/ S�
Lot#
Telephone# 517 A'401
Installer's Name
Designer's Designer's Namea�uit✓
Address
Address-�r�/�`�/%�;✓i�
242i 1¢% r
Telephone#-
--
Telephone#D
Type of Building
Dwelling - No. of Bedroo
Other - Type of Building
Other Fixtures
of persons
Lot Size C5c;7c7 sq. ft.
Garbage grinder No
Showers ( ), Cafeteria ( )
Design Flow (min. required) C5 gpd Calculated design flow Design flow provided 35'j' gpd
Plan: Date Number of sheets 9 Revisiovi Date
Title '-a ., d' 5-
Description of Soil(s) �'
Soil Evaluator Form No. Name of i valuator (57 Date of Evaluation 1 2- " 1
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
further agrees to Irp e the em ' e at'o until a Certificate of Compliance •^has been issued by the Board of Health.
Signed Date /✓
a
' Inspections
No. 15-065Z' COMMONWEALTH OF MASSACHUSETTS FEE 155-0O
�' r1 ak4 2-L{ 3 Z
Board of Health, YA,f2 o ury , AIA.
CERTIFICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) omplete System
The undersigned h/ereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded ({�, Abandoned( )
by: �-.L.T '/;.,s' mss" - e- a—A':..x � rA�-y.-�t:.a' r
at
has been installe to _h c r�yaWc'Fwtt e p o Bions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. / � C%O dated / "�. /s�. Approved Design Flow (gpd)
Installer s✓t ?� . '%m.
Designer: D,", h' C� lJl� a=- �9/1. - Inspector: � ' ` Date:
The issuance of this. permit shall not be astrued as a gua antee that the system will function as designed.
No. t"r C `��_ �t/ e -LU S e ear r�T- LS FEE
COMMONWEALT14 Of MASSAC14USETTS
,/ %', Board of Health, TAP D 074 , MA.
y� �) T D
EI � Nm -
DISPOSAL ®SAL S ll�% ST CONSTRUCTION PERMIT
Permission is hereby,granted to; Construct( ) Repairs) Upgrade �,.4 Abandon( ) an individual sewage disposal system
at
as described in the application for
Disposal, System Construction Permit No. /5 -a,,? , date$!
No.:BOHDC-15-0852
' Commonwealth of Massachusetts F�
ass.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Complete System
Location: 19 CAPT NICKERSON RD,SOUTH YARMOUTH, MA Owner:
02664 WALKERJANEC
Map/Parcel#: 078.117 C/O WILLIAM CRAIG WALKER
566 HALE ST BOX 36
PRIDES CROSSING,MA 01965
Phone:
SepHc System Installer Designer
ELLIS BROTHERS DOWN CAPE ENGINEERING,INC.
23 ENTERPRISE ROAD 939 ROUTE 6A
YARMOUTHPORT, MA 02675 yp]ZMOUTHPORT,MA 02675
Phone:
(508)362-4541
Type of Building:Dwelling Lot Size:0.26 Acres
Dwelling-No.of Bedrooms:2 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Fiatures:
Plan Date: ll/12/2014 Number of Sheets: 1
Cafeteria:
Tit1e:TIT1,E 5 SITE PLAN 19 CAPTAIIV NICKERSON ROAD Revision Date:
Design Flow(mio.required):220 gpd Calculahd design Oow:220 gpd Design tlow provided:349 gpd
Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation: 11/12/2014
ARNE OJALA,PE
DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-NEW 1500 GAL SEPTIC TANK,DBOX, l6 HIGH CAPAC[TY
INFILIRATORS W/OUT STONE:2 ROWS OF 5 I1IVITS,t ROW OF 6l1NITS
. The untlersignetl agrees to install the above described Individual Sewage Disposal System in accortlance wkh the provbions of
TITLE 5 and further aarees not to olace in ooeration untll a Cerlifkafe of Comoliance has been issued hv the Board of Heal[h.
Signed Date
Inspections
, Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT sss•oo
Permission is herby granted to;
ELLIS BROTHERS CONSTRUCTION,23 ENTERPRISE ROAD,YARMOUTHPORT, MA 02675
To perform:Upgrade an individual sewage disposal system.
Owner: WAI,KER JANE C
C/O WILLIAM CRAIG WALKER
566 HALE ST BOX 36
PRIDES CROSSING,MA 01965
Location: 19 CAPT NICKERSON RD, SOUTH YARMOUTH,MA 02664
Disposal System Construction Permit No.: BOHDGIS-0852 ,Dated:January 20,2015
Provided:Construction shall be completed within six mon[hs of[he date of this permit. All local conditions must be met.
Conditions
1. REPAIR-NEW I500 GAL SEPTIC TANK, DBOX, 16 HIGH CAPACITY INFILTRATORS W/OUT
STONE:2 ROWS OF 5 UNITS. 1 ROW OF 6 UNITS �
Bruc�G. IOlurphy, MPH, R.S., CHO/Amy L. von Hone, R.S., CHO
/ Health Diredor/Assistant Health Director
The issuance of this permit shall not be construed as a guarantee that the system will funMion as desigoed.
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fg@
CERTIFICATE OF COMPLIANCE ass.00
Description of Work Compkte System
The undersigned hereby certify that the Sewage Disposal Systern; Upgraded
by:ELLIS BROTHERS CONSTRUCTION
at: 19 CAPT NICKERSON RD,SOUTIi YARMOUTH,MA 02664
Has been installed in accordance with the provisions of 316 CMR I SAd(Title 5}and the approved
design plans or as-built plans relating Yo appiication Na: BOHDC-15-4552>dated Q3123120Y5.
Installer:ELLIS BROTHERS CONSTRUCTION
Address:23 ENTF.RPRISE ROAI�YARMOUTHPORT, Inspector:AMY VON HONE,R.S.
MA 02675
Designer:DOWN CRPE ENGINEETtING,INC.
Conditions
1.REPAIR-NEW 1500 GAL SEPTIC TANK,DBOX,16 HIGH CAPACITY INFILTRATORS
WJOUT STONE:2 ROWS OF 5 UNITS,l ROW OF b UNiTS , y.-��r�e
C t,�.
Bruce G. rphy, MPH, R.S., CHO/Amy L.von Hone, R.S., CHO
� Heatth Dire�tor t AssistaM Heatth Directar
The issaance of this permit shall not be construed as a gnarantee that the system wiit fuoctian as desi�ned.
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