HomeMy WebLinkAboutApp-Permit-ComplianceNo. /�.e�/ f��/2���"' FEE
rs- 3g
COMMONWEALTH Of MASSACHUSETTS
Board of Health, O , MA.
APPLICATION FOR OISPOSASYSTEM[ CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair()Upgrade( ) Abandon( ) - ❑ Complete System D&rdfividual Components
Location S
CA -(2,0
Owner's Name 041.4
Map/Parcel#Fj
(� 'Z
Address i's G -ft�L
Lot# '
Telephone#
Installer's Name
LTj 5
Designer's Name tj Com^ q,5- ,
AddressI L-A �
�A� otft;Ad f;D -:50,
Address (1 ox --_r-
Telephone#
r 0 —
Telephone#
Type of Building f< -t--
Dwelling - No. of Bedrooms
Other - Type of Building _
Lot Size (00 -7 2Z sq. ft.
.� Garbage grinder( )
No. of persons Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow (miN7e-V
uire ) �� gpd Calculated design flow Design flow provided gpd
Plan: Date Number of sheets Revision Date
Title
Description of Soil (s)
Soil Evaluator Form No.
Name of Soil Evaluator
Date of Evaluation
DESCRIPTION OFPAIRS OR ALTERATIONS M`J 1 l.l- JAIL- L11.1eQ_ '?>fWe?aj
The undersign a to ' tall a ve described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agree not pla a th in operation until a Certificate of 9ompliant has been issued by the Board of Health.
Signed Date
Inspections
p; _�� COMMONWEALTH Of MASSACHUSETTS
Board of Health, Aryl O OT MA.
CERTIFICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) ❑ Complete System G
The u'n'dersigned hereby ce that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded ( ), Abandoned ( )
by:
at 1 S Ci.0 L.. C- -', r1�.' i i-lC-e•
has been installe�rAccord°2 e w tYi theT ovisiom of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application rNJo. dated aL �� /=�-Approved Design Flowgpd)
4
Installer 13 ti -T— 0 1-1 tP S L' '
Designer: -D6 u L) Inspector: ✓� 6 ,� �'^)� Date: --,4—
The
_...The issuance of this permit shall not be construed as a guaranee dat the system will function as designed.
.,.,').)r,JU�J�U;:�'.�Ur;+Jr.:r��,)`JJC; ".: �)::`:)G n.�<::; ;i�')� i.. .-._���.. .. _i)':.r.>i)-.')-.:i)U U�r'%J�. :J Jt/:; .-�.it".. .�. .. u.G ���'... .'.'-.. _ •r ����, ., �i.J_iI JJ J..0 .. J.. U(J I. .�U..�J.�^U, .i„..,�.�.
No. �(Ii� �'1� 1� lir-f�C_'v�
FEE
r �g
COMMONWEALTH Of MASSACHUSETTS
Board of Health, Vag -M 6 1!.) MA.
DISPOSAL SYSUM CONSTRUCTION PERMIT C� �
Permission is hereby granted to; Construct( ) RepairUpgrade( ) Abandon( ) an individual sewage disposal system
at 6A&ou (L -,P- fsV "' as described in the application for
Disposal System Construction Permit No.
� 7 - -50, dated )
Provided: Construction shall be comped wiethinsr �3f the date of this per 't. All local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown, MA Dated Board of Health '/
r
No.:BOHDC-15-1534
Commonwealth of Massachusetts F•°
so.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERNIIT
Application for a Permit to:Repair-minor-Individual Component(s)
Location: 15 CAROL RD, SOUTH YARMOUTH, MA 02664 Owner:
� FERNANDESJOHNJIRS
Map/Parcel#: 05021 FERNANDES ELAINE W TRS
15 CAROL RD
SOUTH YARMOUTH,MA 02664
Phone:
Septic System Installer Designer
ROBERT CHILDS INC. DOWN CAPE ENGINEERING,INC.
P.O. BOX 1431 SOUTH DENNIS, MA 939 ROUTE 6A
02660 YARMOUTHPORT,MA 02675
Phone: (5081362-4541
Type of Building:Dwelling Lot Size: 1.59 Acres
Dwelling-No.of Bedrooms:2 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Futuros:
Plan Date: 12/04/2014 Number of Sheeh: 1 Cakteria:
Tit1e:PLOT PLAN OF 15 CAROL ROAD Revisioo Data �
Design Flow(min.required):220 gpd Calculahd design flow:220 gpd Design 11ow provided:336J gpd
Description of Soi1s:SEE PLAN DATED O]/l4/2009
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluatioo:Ol/14/2009
DAVID FLAHERTY,R.S.
DESCRIPTION OF REPAIRS OR ALTERATIONS:MINOR REPAIR-INSTALL 40 ML POLYLINER BETWEEN EXIST[NG LEACH
FIELD AND PROPOSED BATHROOM/LAi7NDRY ADDITION(CRA WL SPACE)
The untlersigned agtees W installlhe above described Individual Sewage Disposal System in accortlanee wilh the provislons of
TITLE 5 and fuRher aarees no!to olaee in ooeratlon unBl a Certlficate of Comoliance has heen iesued bv the Boartl of Meakh.
Signed Date
Inspections
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA F88 I
DISPOSAL SYSTEM CONSTRUCTION PERMIT s0'0° (
Permission is herby granted to;
ROBERT CHILDS INC., P.O. BOX 1431, SOUTH DENNIS,MA 02660
To perform:Repair-minor an individual sewage disposal system.
Owner. FERNANDES JOHN J TRS ��
FERNANDESELAINE W TRS �.
15 CAROL RD ..
SOUTH YARMOUTH,MA 02664 � '.
Location: 15 CAROL RD, SOUTH YARMOUTH,MA 02664
Disposal System Construction Permit No.: BOHDC-15-1534,Dated:March 30,2015
Provided:Construction shall be completed within six months of the date of this permit. All local conditions must be met. ��
Conditions
1. MINOR REPAIR-INSTALL 40 ML POLYLINER BETWEEN EXISTING LEACH FIELD AND ,
PROPOSED BATHROOM/LAUNDRYADDITION(CRAWL SPACE) II
I
Bru G. urphy,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 t6at the system wiil function as designed.
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA F�
CERTIFICATE OF COMPLIANCE so.00
Description of Work: Individual Component(s)
The undersigned hereby certify that the Sewage Disposal System; Repair-minor
by:ROBERT CHILDS ING
at: 15 CAROL RD, SOUTH YARMOUTH,MA 02664
Has been installed in accordance with the provisions of 310 CMR 15.00(Title 5)and the approved
design plans or as-built plans relating to application No.: BOHDC-1S1534,dated 04/02/2015.
Installer.ROBERT CHILDS INC.
Address:P.O.BOX 1431 SOUTH DENNIS,MA 02660 Inspector:AMY VON HONE,R.S.
Designer:DOWN CAPE ENGINEERING, INC.
COOd1YlOOS
1.MINOR REPAIR-INSTALL 40 ML POLYLINER BETWEEN EXISTING LEACH FIELD AND
PROPOSED BATHROOM/LAUNDRY ADDITION(CRAWL SPA )
� Bruce G. Murphy P , R.S., CHO/Amy L.von Hone, R.S.,CHO
Health Director/Assistant Health Diredor
The issuance of t6is permit shall not be construed as a guarantee t6at the system will function as designed.
BOH_Disposal_Construction_CofC.rpt