HomeMy WebLinkAboutApp-Permit-ComplianceNo. �Q � C � 5 L -b -T _ 15 - 00 q 3 e—_ 3 FEE � Oa
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COMMONWEALTH Or" MASSACHUSETTS
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Board of Health, y&= QQ- , AM.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrad Abandon() - ❑ Complete System C111-n-dividual Components
Location
L+14 r[ aNq(�D z c9i<, PoAo
Owner's Name (214pi 51-opgc*R -L ov
Map/Parcel#
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Address 144 T7K4 u- N
Lot#
Telephone#
Installer's Name CAp42'1bjE;7 j��p
'ISE5LLC,
Designer's Name ENrwE��1XJ� S �►JC.
Address `
k(I -�CA
Address Il �
Telephone#
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Telephone# S7313
Type of Building SCS l b -1Z [ �- Lot Size L ([ 0 (D sq. ft.
Dwelling - No. of Bedrooms Garbage grinder ( )
Other -Type of Building No. of persons Showers ( ), Cafeteria ( )
Other Fixtures , r c,
Design Flow (min. required) gpd Calculated design flow 3 Design flow provided _ 4) gpd
Plan: Date ;� ` JAG - o4 (S Number of sheets Revision Date
Title L444 F [Si4t o& (3p_oo k, �a J
Description of Soil(s) /N C 4
Soil Evaluator Form No.
Name of Soil Evaluator �, � �"tEE_ Date of Evaluation 2L-R-(-,-X-DM
DESCRIPTION OF REPAIRS OR ALTERATIONS US G= QWST6 J6,- tnn-n- G X-C..L-,-_f2
ey.) ID" Pi 0 � j-20 C -a., �`c--330 C - s�r,��Fbl fhlC-rt c_'�IClLZ��� f�tT�-i � (=t.�'r'
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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 p
,jace the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date"
Inspections
A,/No. [3Qt"�QC'��"`�i EE
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COMMONWEALTH Of SSC�IUSETTS
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Board of Health, '1 Ol)TH , MA,
CERTIFICATE OF COMPLIANCE
Description of Work:.211ndividual Component(s) 0 Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded (-j-,-Abandoned( )
by: 'UPIEL-ADE e T�CSIC5 L -LC,_ _
at q4 F'"(S tf /!l- t_iD AV w E5"T VA �m U w -n-7 -
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has been installedr'�inunv acc 7 ante�--r with e provisions of 310 CMR 15.09: (Title 5) and the roved design plans/as-built plans relating to
application No. , dated l - / 5_� . Approved Design Flow�J (gpd)
Installer CA P ELU (D G 6P Q LLL
Designer:�� ercfN� i ea OUS Tl+41nspector: al Date:
The issuance of this permit shall not be construed as a guarante that.the system will function as designed.
No. 6O C.� "� ZI I P 117+c'' FEE S, 00
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COMMONWEALTH Of MASSACHUSETTS -3(I °5,
Board of Health, �72i►?0 U77 -l- , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgrade (�andon ( ) an individual sewage disposal system
at '1 L1 F15- -11 V 1 8AP4 A::-, RvX-0 65-1 yAkAeyVM as described in the application for
Disposal System Construction Permit No. / , dated -3
Provided: Construction shall be completed within Three )ears_of the date of this permit. All local conditions must be met.
�1
Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date Board of Health_./
i
No.:BOHDC-15-1211
' Commonwealth of Massachusetts Faa
E55.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Individual Component(s)
Location:44 FISHING BROOK RD, SOUTH YARMOUTH, MA 02664 Owner:
GLOVER CHRISTOPHER M
Map/ParceW: 058.234 GLOVER JENNtFER
44 FISHING BROOK RD
WEST YARMOUTH,MA 02673 �
Phone:
Septic System Installer Desiguer
CAPEWIDE ENGINEERING WORKS.INC.
153 COMMERCIAL STREET 12 WEST CROSSFIELD ROAD
MASHPEE, MA 02649 FORESTDALE,MA 02644
Phone: (5081477-5313
Type of Building:Dwelling Lot Size:0.25 Acres
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building: No.of persoos: Showers:
Other Fixtures:
Plan Dah:02/26/2015 Number of Sheets:2
Cafeteria:
Tit1e:PROPOSED SEP11C SYSTEM UPGRADE PLAN 44 FISHING BROOK Revision Datr. �
ROAD
Design Flow(min.required):330 gpd Calculahd design/1ow:330 gpd Design flow provided:348.7 gpd
Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name ot Soil Evaluator: Date of Evaluation:02/26/2015
, PETER MCENTEE,PE
DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR•EXISTING]000 GAL SEPTIC TANK,DBOX,2-500 GAL PRECAST
CIIAMBERS W/4'STOIVE:25'X 12.8'X 2'
� The undersigned agrees to InsWll the above described Indlvidual Sewage Diaposal System in accordance withlhe provisions of
TITLE 5 and further aarees not to olace in eneration until a CertHlcate of Comelianee has been issued 6v the Boartl of Heskh.
Signed Date
Inspections �
� Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT ass.00
Permission is herby granted to;
CAPEWIDE ENTERPRISES, LLC, 153 COMMERCIAL STREET, MASHPEE, MA 02649
To perform:Upgrade an individual sewage disposal system.
Owner: GLOVERCHRISTOPHERM
GLOVER JENTIIFER
44 FISHING BROOK RD
WEST YARMOUTH,MA 02673
Location:44 FISHING BROOK RD, SOUTH YARMOUTH,MA 02664
Disposal System Construction Permit No.: BOHDC-15-1211 ,Dated: March 03,2015
Provided:Construction shall be comple[ed wi[hin six months of the date of this permit. All bcal condi[ions must be met.
Condifions
1. REPAIR-EXISTING 1000 GAL SEPTIC TANK, DBOX, 2-S00 GAL PRECAST CHAMBERS W/4'
STONE:25'X 12.8'X 2'
�
Bruce G. u y,MPH, R.S., CHO/Amy L.von 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 function as designed.
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA F�
CERTIFICATE OF COMPLIANCE E55.00
Description of Work: Individual Component(s)
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:CAPEWIDE ENTERPRISES,LLC
at 44 FISHING BROOK RD, SOUTH YARMOUTH,MA 02664
Has been installed in accordance with the provisions of 310 CMR 15.00(TiUe 5)and the approved
desig�plans or as-built plans relating to application No.: BOHDC-15-1211,dated 04/30/2015.
Installer:CAPEWIDE ENTERPRISES,LLC
Address:153 COMMERCIAL STREET MASHPEE,MA Inspector:AMY VON HONE,R.S.
02649
Designer:ENGINEERING WORKS,INC.
Conditions
1.REPAIR-EXISTING 1000 GAL SEPTIC TANK,DBOX,2-500 GAL PRECAST CHAMBERS
W/4' STONE: 25' X 12.8' X 2'
Bruce G. M ph ,MPH, R.S., CHO/Amy L.von Hone, R.S., CHO
Health Diredor/Assistant Health Diredor
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
BO H_Disposa I_Construdion_CofC.rpt