The URL can be used to link to this page

Home My WebLink AboutApp-Permit-ComplianceNo. 0VDC-[4-05(7 � FEE 55.0a It Ir4 (WWAT ITII ®r MASSA1-ITIJSFTTS 3z1 18 Board o Health, numo MA, /J/�✓ / C f , -Z•P`e4PPI.ICTI N F®I� I�IS�®SSI. SYSTEM CONSTRUCTI®N PERMIT Application for a Permit to Construct( ) Repair(. Upgrade- -/ Abandon( ) - aco-�mplete System El Individual Components Location Lo+ W 1-f 6 11 'FL( I i V -0 (--e— 'R(-, A-z� Type Owner's Name -e-aaim Map/Parcel# l(P 6 Address I k -F�w -ov`e� `-LQ PL'l Vt�0/U Lot# H b Telephone# Installer's Name (m flA-2AR`PCGU TA Designer's Name ` (2-K _ D 6(-u L �D U AddressLo C -V U ct LG(,vu_ D -e -n N ess P p TO 0 �- 12 b S W . Telephone# 5n - 139 S -- ct q 5- LF Telephone# - c) 6 4 - ©S.9- ± 9 - Type of Building Lot Size 15, 0 0 0 sq. ft. Dwelling - No. of Bedrooms Garbage grinder ( ) Other - Type of Building No. of persons Showers ( ) , Cafeteria ( ) Other Fixtures Design Flow (min. required) 3 Q gpd Calculated design flow Design flow provided 3 3 gpd Plan: Date 9 /1 '�/ 9- 0 (q Number of sheets Revision Date Title E Description of Soils) i Soil Evaluator Form No. AA 4 sA-N D , Ccy-2s rr s lavgD I-tth% Name of Soil Evaluator C6 V R KaAV W r Date of Evaluation 0-4-0-3/9-014 DESCRIPTION OF REPAIRS OR ALTERATIONS '' `'1�1 C -t)C U hj2tA s ew ccDI P- ck ( S (J 0 S The undersigned agre to ' tove described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to no p e in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date _ _�� lg o / a o is • r Inspections 1,641a,4 MW /� w�- No. l30IA DC —1 q —051 '] � zvl'� �� 7E � is ®MMON�I.TII Of M SS CHUSETE- cL-i+ 32-119 Board of Health,VQ 2 a CERTIFICATE Of COMPLIANCE Description of Work: 0 Individual Component(s) .;�omplete System The undersigned hereby certify that the Sewage Disposal System; Constructed( ), Repaired ( ),Upgraded Abandoned( ) by: S Eia. LC OAT1 ter-- 4 PAV 1 fJC-' i Iti1 C at IM FILLMn2.F kV). has been installediif WCopadcFw- ithcfhe`l rodisions of 310 CMR 15.00 (Title 5) and the ap oved design plans/as-built plans relating to application No. / �7 `/ , dated '7 -/13 -/<-Approved Design Flow _ gpd) of Installer M i\,1 CPII�J 1..10 -moi' Designer: t c O - "I tFi, - Inspector: Date: -51' Z The issuance of this permit shall not be construed as a guarana that the system will function as designed. NUkI*ikH 5(E�ALcoA-)NG '} AvIt1G- FEE S5.00 COMMONWEALTH Of MASSACHUSETTS dt 32118 Board of Health,� IZ , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( ) Upgrade(eXAbandon ( ) an individual sewage disposal system at I 1 F-1 L -L. M 0 i2C �'- © , as described in the application for Disposal System Construction Permit No. �, dated Provided: Construction shall be cmplet`ewithn is of the date of this permit. All local conditions must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown, MA Date /C -Board of Health L� �' No.:BOHDC-14-0517 ' Commonwealth of Massachusetts su o0 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERNIIT Application for a Permit to:Upgrade-Complete System Location: 11 FILLMORE RD,WEST YARMOUTH, MA 02673 Owner: ARMESON JOAN F Map/Parcel#: 063.66 C/O MEGA GROUP RL1'Y TRUST � P O BOX 2388 HYANTIIS,MA 02601 Phone: Septic System Installer Designer NORTHERN ECO-TECH RAPID RESPONSE P.O. BOX 995 DENNISPORT, MA 02639 P,O.BOX 1265 Phone: WEST CHATHAM,MA 02669 (5081364-0894 Type of Building:Dwelling Lot Siu:0.33 Acres Dwelling-No.of Bedrooms:3 Garbage Grinder: Other Type otBuilding: No.of persons: Showers: Other Fiztures: Plan Date:09/18/2014 Number of Sheets:2 Cafeteria: TitIe:SEWAE DISPOSAL SYSTEM PLAN 11 FILLMORE ROAD Revision Date: 12/16/2014 Desigo Flow(min.rcquircd):330 gpd Calculahd design Oow:330 gpd Desigo flow provided:333 gpd DescripNon of Soi1s:SEE PLAN � Soil Evaluator Form No.: Name of Soil Evaluator: Date o(Evalaation: � . • DAVID COUGHANOWR,R.S. DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR- I500 GAL SEPTIC TANK,1000 GAL PUMP CHAMBER,DBOX,25'X 18' . X 6"LEACH FIELD The undersigned agrees to Install the above desetibeC Intlividual Sewage Disposal Syatem In accordanee with Me provislons of TITLE 5 and fuRher aarees not tn olace in ooeratien un[il a Cerflficate of Comolianee has heen Issued 6v[he 8oard of Fleakh. Signed Date Inspections Commonwealth of Massachusetts Board of Health, Yarmouth, MA F88 DISPOSAL SYSTEM CONSTRUCTION PERMIT ass.00 Pernussion is herby granted to; NORTHERN SEALCOATING&PAVING, P.O. BOX 995, DENNISPORT, MA 02639 To perform:Upgrade an individual sewage disposal system. Owner: ARMESONJOANF GO MEGA GROUP RLTY 1RUST P O BOX 2388 HYANMS,MA 02601 Location: 11 FILLMORE RD,WEST YARMOUTH,MA 02673 Disposal System ConsWction Permit No.:BOHDC-140517,Dated: February 13,2015 Provided:Construction shall be comple[ed within six months of[he da[e of[his pertnit. All tocal condi[ions must be met. Conditions 1. BOH TO INSPECT SOIL REMOVAL 2. ELECTRICAL PERMIT REQUIRED 3. MFC VARIANCES GRANTED PER BOH ON 02/09/201 S(EXPIRATION OS/09/2015): 1. GROUNDWATER SEPARATION 2. DRAINAGE WETL�IND SEPARATION / Bruce G. urp ,MPH,�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 will fuoMion as designed.