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HomeMy WebLinkAboutApp-Permit-Compliancer Pnk.� No. COMMONWEALTH Of M ASSAC14USETTS 3ssz Board of Health. "'f4 �'y` o b -n ► , MA. p fi�� APPLICATION FOP DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade( -Abandon( ) - ❑ Complete System ` X[ndividual Components Location v -e, Owner's Name kt�v-­o'L }fie+krrsa--. Map/Parcel# S 1 - $ Address 't oj, Lot# Telephone# Installer's Name �p„ �� Designer's Name Address , �� X �y_T��b-krJ,'� MIN (g26 Address \2%41(_Ce ss Telephone# SO Tg - 400 --11 Sq Telephone# c57o_ S?— O Z6 Type of Building IZe S I cckkK4--re S ' �''� t Lot Size Zai 7 91 +7—sq. ft. Dwelling - No. of Bedrooms 3 Garbage grinder ( ) Other - Type of Building N No. of persons Showers ( ) , Cafeteria ( ) N JA Other Fixtures Design Flow (min. required) 13 gpd Calculated design flow S-546 Design flow provided S q gpd Plan: Date Number of sheets Z-- Revision Date Title Pih,o d s -&-d &eev dt{LSv t 4tm UoocL r&0(( to" q � ay CCAO k 'Dr-, V 6L4,yk O" -W M4 Description of Soil(,) d' l0 A 16s Ly j Q —�-12u S Ln of Z --A 32 e- � Soil Evaluator Form No. Name of Soil Evaluator 4"'e4C�(_ 7�hi-Z-e Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS F'-'t� t I �� W� © LQ( Lf -C -K\- The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and furtherAZLges to not to place the system in operation until a Certificate of Compliance has been issued by the Board of health. Sign Date 6 -10 -15 - Inspections No.`11`` `j i r�� FEE COMMONWEALTH Of MASSACHUSETTS C" 3,58 2-, Board of Health, lir �°i'"� , MA. CERTIFICATE Of COMPLIANCE Description of Work: dividual Component(s) 0 Complete System 9 The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded Abandoned ( ) hv� 4 'i,-,.•wr���. .'fit l�,c,f•�r.��n\ ...a.-. n�P" at 4 has been instal e to ac or(fanc with the pr- 'sions of 310 CMR 15.00 (Title 5) and the ap oved design plans/as-built plans relating to application No. /C--' /,-7' , dated 6 '"t 2_ \ . Approved Design Flow sF�-) • (gpd) Installer Designer: y'o' icyti UN v Ne !�) Inspector: ' - Date: The issuance of this permit shall not be construed as a guar tee at the system will function as designed. z). 5--v L a.J '�;:.._rY�r n -c< '-.! s���� -�.� -rJ No.h l`C`2 - `% 'jay _ �: FEE 00 Board of Health, Ykrru -J A , MA. �,. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( ) U.pgradet`j Abandon( ) an individual sewage disposal system at Vi as described in the application for Disposal System Construction Permit No., dated Provided: Construction shall be com lete within thrPP the date of this permit. ;All local conditions must be met. r' 6 &tom . ' i, 1 Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown, MA Date `� ��� l Board of Health t. --E - % No.: BOHDC-15-2389 � Commonwealth of Massachusetts Fee $55.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to: Upgrade-Individual Component(s) Location: 4 BAYRIDGE DR, YARMOUTH, MA 02675 Owner: PETERSON SHAWN L MeP/Parcel#: 151.89 PETERSON SETH TROY&CRAIG 4 BAYRIDGE DR YARMOUTH PORT,MA 02675 Phone: Septic System Installer Designer DOUGLAS A.BROWN ENGINEERING WORKS.INC. P.O. BOX 145 CENTERVILLE, MA 12 WEST CROSSFIELD ROAD 02632 FORESTDALE,MA 02644 Phone: (5081477-5313 Type of Building:Dwelling Lot Size:2Q909.00 Acres Dwelling-No.ot Bedrooms:3 Garbage Grinder: Other Type of Building: No.of persons: Showers: Other Fixtures: PlanDate:06/Ol/2015 NumberofSheets:2 Cafeteria: TitIe:PROPOSED SEPTIC SYSTEM UPGRADE PLAN 4 BAYWDGE DRIVE Revision Date: Design Flow(roin.required):330 gpd Calculated design flow:330 gpd Desigu}low provided:372.9 gpd Description of Soi1s:SEE PLAN Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:OS/14/2015 PETER MCENTEE,PE DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-EXISTING 1000 GAL SEPTIC TANK,DBOX,21 ARC 36HD STANDARD UNITS W/OUT STONE:35'X 8.5'X 7.13" . The undersignetl agrees to insfall the above tleseribed Individual Sewage Disposal System in accortlance with the provisions of 717LE 5 antl further aarees not to olate in ooeration until a Certificafe of Comolianee has heen issued bv the Board of Fleakh. Signed Date Inspections , Commonwealth of Massachusetts Board of Health, Yarmouth, MA Fee DISPOSAL SYSTEM CONSTRUCTION PERMIT $55.00 Permission is herby granted to; DOUGLAS A. BROWN INC., P.O. BOX 145, CENTERVILLE, MA 02632 To perform: Upgrade an individual sewage disposal system. Owner. PET'ERSON SHAWN L PETERSON SETH TROY&CRAIG 4 BAYRIDGE DR YARMOUTH PORT,MA 02675 Location:4 BAYffiDGE DR,YARMOUTH,MA 02675 Disposal System Construction Permit No.: BOHDC-15-2389,Dated:June 12,2015 Provided: Construction shall be completed within six months of the date of this permit. All local conditions must be met. Conditions 1. REPAIR-EXISTING 1000 GAL SEPTIC TANK, DBOX, 21 ARC 36HD STANDARD UNITS W/OUT STONE: 35'X 8.5'X 7.13" 2. MFC VARIANCE: 1. LEACH FACILITY DEPTH V Bruce G. Murp ,MP , R.S., CHO/Amy L.von Hone, R.S., CHO alth Director/Assistant Health Director 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 Fee CERTIFICATE OF COMPLIANCE sss.00 Description of Work: Individual Component(s) The undersigned hereby certify that the Sewage Disposal System; Upgraded by:DOUGLAS A. BROWN INC. at:4 BAYRIDGE DR,YARMOUTH,MA 02675 Has been installed in accordance with the provisions of 310 CMR 15.00(TiUe 5)and the approved design plans or as-built plans relating to application No.: BOHDC-152389,dated 06/19/2015. Installer: DOl7GLAS A. BROWN INC. Address:P.O. BOX 145 CENTERVILLE,MA 02632 Inspector.AMY VON HONE,R.S. Designer:ENGINEERING WORKS,INC. Conditions 1.REPAIR-EXISTING 1000 GAL SEPTIG TANK,DBOX,21 ARC 36HD STANDARD UNITS W/OUT STONE: 35' X 8.5'X 7.13" 2.MFC VARIANCE: 1.LEACH FACILITY DEPTH Bruce G. Murphy, MPH, R.S., CHO/Amy L.von Hone, R.S., CHO Health Diredor/Assistant Health Director The issuance of this permit shall not be construed as a guarantee that the system will function as designed. BO H_Disposa I_Construction_CofC.rpt