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HomeMy WebLinkAboutApp-Permit-ComplianceNo. '��G-I ✓� 1 1— � � � FEE A C 55 00 l &LID " �5 0()9'9�10MIMI® LTH Of MASSACHUSETTS J-b-t0�-7 Board of Health, yfitM0077i APPLICATION FOR FISP®/Abadon( TEM[ CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( pgrade() -omplete System �dividual Components Location Owner's Name \SSV Sp Map/Parcel# r Address Lot# Installer's Name , Telephone#$ - Designer's Name - W M 2— A Address' iC Address S - �W 1C V1 Telephone# - _ �$ . CJ� STelephone#, - - � Cj rjp�S �ja - Gj q(0 Type of Building _S Dwelling - No. of Bedrooms Other - Type of Building _ Other Fixtures No. of persons Lot Size 19D 1 � � 9 sq. ft. Garbage grinder ( ) Showers ( ), Cafeteria ( ) Design Flow (min. required) gpd Calculated design flow Design flow provided gpd Plan: Date 1 Number of sheets I Revision Date Tide.Y_ 1 01,11 Description of Soil(s) _ Soil Evaluator Form No. Name of Soil Evaluator DESCRIPTION OF REPAIRS OR ALTERATIONS �O C�Cs''l`h� 61J©ee &e4Q Date of Evaluation The undersi ed agrees to ins 2abe described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further esto ttopl an operation until a Certificate of gamplian a has been issued by the Board of Health. Signed r' Date s_ -37 COMM ON LTH OF MASSACHUSETTS,-' Board of Health, Aemoy-Tv _,MA. 3 CERTIFICATE Of COMPLIANCE1- L.�rt� 0 fes% IY Description of Work: ❑ Individual Component(s) 0 Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded {');`Abandoned ( ) by: tJ A S perk7y -r� at ?<, (.'Nb' t k j''1 G has been installed"ih acc dance wi& tLie provisions of 310 CMR 15.00 (Title 5) and the roved design plans/as-built plans relating to application No. / S dated — / S Approved Design Flow / 3 (gpd) Installer --�""�� /'� PCW ' '5P f_- MpSfJ � N S7(L�J�t7 ON Designer: s�) Pat -m(� ,O I sn pectora Date: The issuance of this permit shall not be construed as a guar �eediathe system will function as designed. No. '�t�(�r`%i �JP�t"L(jvi FEE J`�� 00 �>9 COMMONWEALTH Of MASSACHUSETTS � Board of Health, YA EMO U171- , MA. r DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( ) Upgrade (--''`Abandon ( ) an individual sewage disposal system at <�7. '0i 1 to 1O ( 1;�;�Q;'� �.( C� ����1�i �11 as described in the application for Disposal System Construction Permit No. dated .3' Provided: Construction shall be completed within thvee-Cye sic . h& date of this permit—All Coccal conditions must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date - ��� �� Board of Health ) eG�-r No.:BOHDC-15-1462 �i ' Commonwealth of Massachusetts Fee I us.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERNIIT ' Application for a Permit to:Upgrade-Complete System Location: 8 CAPT CROCKER RD,SOUTH YARMOUTH, MA 02664 Owner: FUSSELL,CHRISSY Map/Parcel#: 078.304 FUSSELL,CFfl2ISSY 15 GALLAGHER LN MARSTONS MILLS,MA 02648 Phone: Septic System Installer Designer DAN A. SPEAKMAN DAN A. SPEAKMAN CONSTRUCTION 15 SPEAK WAY HARWICH, MA 02645 15 SPEAK WAY Phone: NORTH HARWICH,MA (508)432-5565 Type otBuilding:Dwelling Lot Siu:031 Acres Dwelling-No.of Bedrooms:3 Garbage Griuder. Other Type of Building: No.of persons: S6owers: Other Fiatures: Plan Date:03/18/2015 Number of Sheets: 1 Cateteria: Title.SI7E PLAN 8 CAPTAIN CROCKER ROAD Revision Date: Design Flow(mio.required):330 gpd Calculated design ilow:330 gpd Design ilow provided:342 gpd DescripNoo of Soi1s:SEE PLAN Soil Evaluator Form No.: Name of Soil Evaluator: Date ot EvaluaHon:03/12/2015 � DAVID B.MASON,R.S. �. DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-1500 GAL SEPTIC TANK,DBOX,4 INFII,TRATOR 3050'S W/STONE 3' SIDES,1'ENDS:30.44'X]0.25'X 1.85' _ The undersig�d agrees to install the above tleseribetl Individual Sewage Dkposal System in aeeordance wkh the provisions of TITLE S and further aarees not W olace in ooention untll a CertlFlcafe of Comolianee has been b:ued hv the Board of Health. Signed Date Inspec[ions Commonwealth of Massachusetts Board of Health, Yarmouth, MA Fee DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00 Permission is herby granted to; DAN A. SPEAKMAN CONSTRUCTION, 15 SPEAK WAY, HARWICH, MA 02645 To perform:Upgrade an individual sewage disposal system. Owner. FIJSSELL,CHRISSY . FUSSELL,CHRISSY � 15 GALLAGHER LN ' MARSTONS MILLS,MA 02648 ��.. Location: 8 CAPT CROCKER RD,SOUTH YARMOUTH,MA 02664 ! Disposal System Conslruction Permit No.: BOHDG1S1462 ,Dated:March 30,2015 ' Provided: Construc[ion shall be completed within six months of the date of this permit. All local conditions mus[be met. Conditions 1 REPAIR-I500 GAL SEPTIC TANK, DBOX, 4 INFILTRATOR 3050'S W/STONE 3'SIDES, 1'ENDS: 30.94'X I0.25'X 1.85' 2. ZONE II MAXIMUM 3 BEDROOM � � Bruce G. rp , 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 � I Commonwealth of Massachusetts Board of Health, Yarmouth, MA F88 CERTIFICATE OF COMPLIANCE sss.00 ' Description of Work:Complete System The undersigned hereby certify that the Sewage Disposal System; Upgraded ' by:DAN A. SPEAKMAN CONSTRUCTION at:8 CAPT CROCKER RD,SOUTH YARMOUTH,MA 02664 Has been installed in accordance with the provisions of 310 CMR I5.00(TiUe 5)and the appmved design plans or as-built plans relating to application No.: BOHDC-15-1462,dated 04/Ol/2015. Installer:DAN A. SPEAKMAN CONSTRUCTION ' Address:l5 SPEAK WAY HARWICH,MA 02645 Inspector.AMI'VON HONE,R.S. Designer:DAN A. SPEAKMAN CONSTRUCTION ', Conditions ' 1REPAIIt- 1500 GAL SEPTIC TANK,DBOX,4 INFILTRATOR 3050'S W/STONE 3' SIDES,I' ENDS:30.44'X 10.25'X 1.85' 2.ZONE II MAXIMUM 3 BEDROOM � Bruce G. rp , MPH, R.S., CHO/Amy L.von Hone, R.S.,CHO Health Diredor/AssistaM Health Director � The issuance of this permit shall not be construed as a guarantee that the system will function as designed. BOH_Disposal_Construction_CofC.rpt