HomeMy WebLinkAboutApp-Permit-ComplianceNo. y� - �cJ"�UQ�u� 84 T." / J `' 00- 3 9 `v-� FEE I I� . 00
/-6 COMMONWEALM OF M ASS C14USETTS
e // / Board of Health, )Lk -mo 0-tk MA. L
APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTI®N PERMIT
Application for a Permit to Construct,(,)�Repair( ) Upgrade( ) Abandon( rCIMpleteSystem ❑ Individual Components
Location AtAe. _
I Owner's Name
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Map/Parcel# -9
Address ('/`Q�� .�`j Z-56„j7Jj?iv�/
Lot# Z--4-
Telephone#
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7;7V<-nstaller's
ns er sName(,
Designer's Name
Address s
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Address
Telephone# :5"/-> 9 -2- . — 1--:7-7
Telephone#
Type of Building ;P1- Lot Size �70 ,?d? sq. ft.
Dwelling - No. of Bedrooms Garbage grinder
Other - Type of Building No. of persons Showers ( ) , Cafeteria ( )
Other Fixtures
Design Flow (min. required) --:7e-1X6-gpd Calculated design flow 14'4� Design flow provided �, gpd
Plan: Date `s ' 1 _ �� N, b' ' of sheets Revision Date
Title ��� � 9 : 'a; -gs
Description of Soil(s) _
Soil Evaluator Form No.
Name of Soil
DESCRIPTION OF REPAIRS OR ALTERATIONS
AIL -
Date ` of Evaluation :7-71/1
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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 Oladethe sysr in o Certificate of Compliance has been issued by the Board of Health.
Signed Date
Inspections il-k=
r
No. V)Q N )C. -6'" 08(.!,0FEE f110.00
r
/ - L COMMON LTII OF M ASSACIIUSETTS
Board of Health, \/A P-N&O ani , MA.
CERTIFICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) 0 Complete System
The undersigned her certify that the Sewage Disposal S stem; Constructed ( ), Repaired ( ), Upgraded ( ), Abandoned ( )
,
at
has been instalfkfn a ordant'e wi05tfk provisions of 310 CMR 15.00 (Title 5) and a proved design plans/as-built plans relating to
application No. dated Approved Design Flow (gpd)
Installer
Designer: S C-_. Inspector:`= ✓{i1f Date:
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
No. - - FEE / / . 00
COMMONWILAIT14 Of MASSACHUSETTS _ C4--* 2A tI Z
Board of Health, Agmo lT-" , MA.
11)� DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair(/) Upgrade( ) Abandon( ) an individual sewage disposal system
at Z� Cit/�,1
� �- ! �.-� �-'" - --0, C, as described in the application for
Disposal System Construction Permit No.
Provided: Construction shall be completed within dw&.4=s of the date of this permit,/ All local conditions must be met.
_
Form 1255
Rev. 5196 A.M. Sulkin Co. Charlestown. MA fj Date I 73 Board of Health
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No.:BOHDGIS-0860
Commonwealth of Massachusetts FeB .
s++o.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:New Construction-Complete System
Location: 5 EMERALD AVE,WEST YARMOUTH, MA 02673 Owner:
FOREMAN MICFIAEL A
Map/Parcel#: 022278 FOREMAN CINDY LEE �
8 VALETERRACE
SOUTHBOROUGH,MA 01772
Phone:
SepHc System Installer Designer
ELLIS BROTHERS BSC GROUP INC.
23 ENTERPRISE ROAD 349 ROUTE 28 UNIT D
YARMOUTHPORT, MA 02675 WEST YARMOUTH,MA 02673
Phone:
(5081778-8919
Type of Buddiog:Dwelling � Lot Siu:0.16 Acres
Dwelliog-No.of Bedrooms:4 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Fiztures:
Plan Date: ]0/10/2014 Number of Sheets: I Cakteria:
Title:SEPTIC SYSTEM UPGRADE 5 EMERAI.D AVENUE Revision Date:
Design Flow(min.rcquired):440 gpd Calwlahd design Oow:440 gpd Desigo flow provided:450 gpd
Description otSoOs:SEE PLAN �
Soil Evaluator Form No.: Name otSoil Evaluator: Date of Evaluation:08/07/2014
KIERAN E�ALY,P.L.S.
DESCRIPTION OF REPAIRS OR ALTERATTONS:NE W-DEMO&REBUILD, 1500 GAL SEPTIC TANK,DBOX,3-500 GAL •
PRECAST CIIAMBERS W/STONE 4'ENDS,2/5'SIDES,-3.25'BETWEEN CHAMBERS:40'X 10'X 2'
The undersigned agreea to imfall the above tleseribed IndNitlual Sewage Diaposal System in accordanee wifh the provisions of •
71TLE 5 antl further aarees not to olace In ooaration untll a CerliFlcate of Comollance has heen Issuetl 6v the 8oartl of Heakh.
Signed Date
Inspections
1
�
Commonwealth of Massachusetts
' Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT $70•�
I
�
Permission is herby granted to;
ELLIS BROTHERS CONSTRUCTION, 23 ENTERPRISE ROAD,YARMOUTHPORT, MA 02675
To perForm:New Construction an individual sewage disposal system.
Owner. FOREMAN MICHAEL A
FOREMAN CINDY LEE
�� 8 VALE TERRACE
' SOUTHBOROUGH,MA 01772
Location: 5 EMERALD AVE,WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.: BOHDG1S0860,Dated:January 22,2015
Provided:Construction shall be wmpleted within six months of the date of this permit. All local conditions must be me[.
Conditions
1. NEW-DEMO&REBUILD, 1 S00 GAL SEPTIC TANK, DBOX, 3-S00 GAL PRECAST CHAMBERS
W/STONE 4'ENDS, 2/5'SIDES, 3.25'BETWEEN CFIAMBERS: 40'X IO'X 2'
2. BOH TO INSPECT SOIL REMOVAL PRIOR TO INSTALLATION
�v
Bruce G. rphy,MPH, R.S., CHO/Amy L.von Hone, R.S.,CHO
HeaRh Director/Assistant Health Director
The issuance of this permit shall not be construed as a guarantee that the system will functiou as designed.
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA F�
CERTIFICATE OF COMPLIANCE s++o.00
, Description of Work:Complete System
The undersigned hereby certify that the Sewage Disposal System; New Construction
by:ELLIS BROTHERS CONSTRUCTION
Iat:5 EMERALD AVE,WEST YARMOUTH,MA 02673
i 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.: BOHDGIS-0860,dated 04/23/2015.
Installer: ELLIS BROTHERS CONSTRUCTION
Address:23 ENTERPRISE ROAD YARMOUTHPORT, Inspector:AMY VON HONE,R.S.
MA 02675
Designer:BSC GROUP INC.
Conditions
1.NEW-DEMO&REBUILD,1500 GAL SEPTIC TANK,DBOX,3-500 GAL PRECAST
CHAMBERS W/STONE 4' ENDS,2/5' SIDES,3.25' BETWEEN CHAMBERS: 40'X 10'X 2'
2.BOH TO INSPECT SOIL REMOVAL PRIOR TO INSTALLAT �
V
Bruce G. Murp y, H, R.S., CHO/Amy L. on 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 funMion as designed.
BO H_Disposal_Construdion_CofC.rpt