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Home My WebLink AboutApp-Permit-ComplianceNo. 801f DC 14-OOX � � �� j ��I�� 1�-o�31n1 a�� 1 � r FEE � SSS OO COMMONWEALTH Of MASSAC14USETTS Board of Health, yA,9MQQ_M , MA. f� l �-r APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrad" Abandon( ) - ❑ Complete System individual Components Location 0 (,(`el.,-e/ j Owner's Name 1 j -Y /,en C9 au 1 Map/Parcel# -7(c 5Jf- 4,4,500- Address q 6 C4,4,50-0- g 2 �Z ��j Lot# Lot# Telephone# Installer's Name �7`I 1 Q p,� C0h s1 Designer's Name DOCg rl Address 2-3 ff Address 1?3 g ,__S;,� Telephone# SC6�3Gd Telephone# $ c'� 3 (� Z_. &j Type of Building Lot Size sq. ft. Dwelling - No. of Bedrooms 3 Garbage grinder ( ) Other -Type of Building No. of persons Showers ( ), Cafeteria ( ) Other Fixtures Design Flow (min. required) 3 3aY. )L gpd Calculated design flow Design flow provided gpd Plan: Date 7,4"-e 11. Z 11-!' Number of sheets 1 Revision Date Title Description of Soil(s) Sae Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS /0-B,S'i, The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to to lace tysys 01* a til a Certificate of Compliance has been issued by the Board of Health. Signed G Date T17 — Inspections No. -fl i c, NPL N -0j c% ( FEE C) O /-4 -R-4) COMMONWEALTH OF MASSACHUSETTS Board of Health, Yk(2, MO UTl+ MA. CERTIFICATE Of COMPLIANCE 1�6 Description of Work: �Ix►dividual Component(s) ❑ Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded), Abandoned ( ) by: /- I 1 11 /CIP- 6 Cc-` at1r(o (V'9 (,'� 6,0 has been installed in accordanc, w,�' he ro ' f 310 CMR 15.00 (Title 5) and th a roved design plans/as-built plans relating to application No. j� _ % �0clafed �/ pp 'Approved Design Flow (gpd) Installer�C - - - — ,GCs'-� 4a�4�-- r Designer: +)e_(_ , Cc74-= f rri a ; rv, Inspector: st,:I ce moi`° , Date: Zot The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. ✓Uf�Jv ly 60�1(� C.l. t, i FEE _ SE .ori /f COMMONWEALTH LTH OF MASSACHUSETTS `4l -* 2_37fn Board of Health, YA (2M0 an* , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ') Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system r at q Cc as described in the application for Disposal System Construction Permit No. '% <(� dated ` Provided: Construction shall b&completed within th•-ee- f the date of this per it. All local conditions must be met. Form 1255 Rev. 5196 A.M. Sulkin Co Chadestown, y1A Date Board of Health d t/ .=��`'� No.:BOHDGI4-0096 Commonwealth of Massachusetts F� sss.00 Board of Health, Yarmouth, MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to:Upgrade-Individual Compouent(s) Location: 96 WEBBERS PATH,WEST YARMOUTH, MA 02673 Owner Map/ParceWi: 076.98 Name: GOULD HELEN A Address: 96 WEBBERS PATH WEST YARMOUTH, MA 02673 Phone: Septic System Installer Name: ELLIS BROTHERS CONSTRUCTION Address: P.O. BOX 59 YARMOUTHPORT, MA 02675 Phone: 5083626237 Type otBuilding:Dwelling Lot Size:028 sq.ft. DwelGng-No.of Bedrooms:3 Garbage Grinder: Other Type of Building: � No.of persoos: Showers: Cafeteria: Other Futures: Plan Date:06/11/2014 Number otSheets: 1 Tit1e:TITLE 5 SITE PLAN OF 96 WEBBER'S PATH Revision Data � Design Flow(min.required):330 gpd Calculated design flow:330 Design flow provided:349 gpd '�.. � i DescripNou of Soi1s:SEE PLANS � II Soil Evaluator Form No.: Name otSoil Evaluator: Date of Evaluatioo:06/11/2014 I, D.4IVIEL GONSALVES ��'� DESCRIPTION OF REPAIRS OR ALTERATIONS:EXIST[NG]000 GAL PLASTIC SEP17C TANK DBOX ' 16 HIGH CAPACITY H-20[NFILTRATORS W/STONE: 25'X 11.3'X 11" The untlersigned agreea to insfall the above descrlbed Individual Sewage Diaposal System in accordance with the provisions of 71TLE 5 and further aprees not to place in operatlon until a Certifieate of Compliance has been issued bv!he Board of Health. Signed Date Inspections i Commonwealth of Massachusetts ' Board of Health, Yarmouth, MA. Fee DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00 , Permission is herby granted to;REID C.ELLIS Address:P.O.BOX 59 YARMOUTHPORT,MA 02675 To perform: Upgrade an individual sewage disposal system. Owmer: GOLJI,D HELEN A � 96 WEBBERS PATH WEST YARMOUTH,MA 02673 Location:96 WEBBERS PATH, WEST YARMOUTH,MA 02673 Disposal System Construction Permit No.: BOHDC-140096,Dated:August 11,2014 Provided: Construction shall be completed wi[hin six months of the date of this permit. All local condi[ions must be met. CondiHons Zone II Maximum 3 Bedrooms ABox and Leaching installation only ' � Bruce G. urphy,MPH, R.S., CHO/Amy L.von Hone, R.S., CHO Health Director/Assistant Health Director � The issuance of this permit s6a11 not be construed as a guarantee t6at the system will function as designed. I � il I . I � !