HomeMy WebLinkAboutApp-Permit-ComplianceNo.�' � � /�/F 7 i z. t,19FEE
f� � ®MIM O LTIT OF MASSACHUSETTS
VIA �+� -IY �1�cln Y�k
�' t ' `(` Board of Health, 1�9=Ko (-%i �- 00433
W �7 C r�APPLICATI®N FOP, DISPOSAL SYSTEM[ CONSTRUCTION PERMIT
aj, Ap lication for a Permit to Construct( ) Repair( ) Upgrade(YAbandonO - ❑ Complete System ❑ Individual Components
ocation ` ' e akyOwner's
Name M 'A & w
ap/Parcel# m ; a G
Address
ot#
Telephone# j (�$ �� a
Installer's Name Cit"n
Designer's Name
Dan
c �n
Address J S \( � r i A�� t �
Address lS v D'- \N0)Ja
Telephone# _
Telephone# _
Type of Building 1L1?.1 I
Dwelling - No. of Bedrooms
Other - Type of Building _
Lot Size sq. ft.
Garbage grinder ( )
No. of persons Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow (min. required) gpd Calculated design flowOf
Design flow provided gpd
Plan: Date _�A o�u-� D o�� I� Number of sheets Revision Date Q LO
Title
Description of Soil(s)t 1 F� 0 �m o 1\) VY1 sa_vqd ,
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS Inst G,\ M W � QlC )N, h c, C � CA. G u' OX
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
furthers to not to placeXha system 'ip operation until a Certificate of Compliance has been issued by the Board of Health.
SignedA IVVII Date
Inspections r
!Otic
No. > 1 s)� Imo. ( fQ� F 'P 3 J ,
COMMONWEALTH LTH ®f M ASSACHUSETTS 6k � elk*
Board of Health, YA R_. MQ 07 , MA, l /
CERTIFICATE OF COMPLIANCE
Description of Work: /b Individual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded (/Abandoned ( )
by
at
has been installed in acco 1qance With the provisions of 310 CMR 15.00 (Title 5) and _the pproved design plans/a built�r laT_� e1, It t ;
f rlr dated �� `7 �i Approved Design Flow t ' (gpd)
application No > pp g �i d
Installer '_'..`77777, r
Designer. ,,r',i i , l( ('t.' r'1 ,c, Inspector: Li / Date: G 1
The issuance of this permit shall not be construed as a guarantee that a system will function as designed.
FEE
7 COMMONWILALT14 Of MASSAC14USETTS
Board of Health,
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgrade Abandon ( ) an individual sewage disposal system
ti y J v i - _ as described in the application for
Disposal System Construction Permit No. -/ /dated 6
Provided: Construction shall be complied within three years/of the date of this permit. ,All loll conditions .must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chades own, MA > Date > Board of Health
No.:BOHDGIS-1881
• Commonwealth of Massachusetts F�
555.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Individual Component(s)
Location: 12 SIERRA WAY,WEST YARMOUTH, MA 026�3 Owner:
MCANDREWSJOHNF
Map/Parcel#: 067.85 MCANDREWS BEVERLY A
12 SIERRA WAY
WEST YARMOUTH,MA 02673
Phone:
Septic System Installer Designer
DAN A.SPEAKMAN DAN A.SPEAKMAN CONSTRUCTION
15 SPEAK WAY HARWICH, MA 02645 15 SPEAK WAY
Phone: NORTH HARWICH,MA
(508)432-5565
Type of Building:Dwelling Lot Size: 10,454.40 Acres
Dwelling-No.ot Bedrooms:3 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Fixtures:
Plan Date:04/08/2015 Number of Sheets: 1 Cafeteria:
TitIe:SITE PLAN OF PROPOSED CONSTRUCTION 12 S[ERRA WAY Revision Date:06/11/2015
Design Flow(min.required):330 gpd Calculahd design 11ow:330 gpd Design flow provided:504 gpd
Description of SoiIs:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator. Date of Evaluatioo:03/12/2015
DAVID B.MASON,R.S.
� DESCRIPTION OF REPAIRS OR ALTERATIONS:REPATR-EXISTING 1000 GAL SEPTIC TANK,DBOX,36 QUICK 4 HIGH
CAPACITY INFILTRATORS W/OUT STONE:48'X 8.5'X 11"
The untlersigned agrees to insfall the above tlescrihed Individual Sewage Disposal System in accortlance wkh the provisions of
TITLE 5 and further aarees not to olace in ooeratien until a Cerfificate of Comeliance has heen issuad 6v the Board of Health.
Signed Date
Inspections
Commonwealth of Massachusetts
! Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT ass.00
I
i Permission is herby granted to;
, DAN A. SPEAKMAN CONSTRUCTION, 15 SPEAK WAY, HARWICH, MA 02645
To perform:Upgrade an individual sewage disposal system.
� Owner: MCANDREWSIOHNF
MCANDREWS BEVERLY A
l2 SIERRA WAY
� WEST YARMOUTH,MA 02673
I
Location: 12 SIERRA WAY, WEST Yt1RMOUTH,MA 02673
Disposal System Construction Permit No.: BOHDC-1S1881 ,Dated:June 09,2015
Provided: Constnac[ion shall be completed within six months of[he date of this permit. All local conditions must be met.
Conditions
1. REPAIR-EXISTING 1000 GAL SEPTIC TANK, DBOX, 36 QUICK 4 HIGH CAPACITY
I INFlLTRATORS W/OUT STONE: 48'X 8.5'X 11"
2. BUILDING PERMIT REQUIRED TO ELIMINATE ILLEGAL BEDROOMIN BASEMF.NT(EXlSTING
BEDROOMIN BASEMENT WITK BULKHEAD ACCESS ACCEPTABLE PER BUILDNG CODE)
3. MFC VARIANCE: 1. GROUNDWATERADJUSTMENT
�Jl�r G����(�
Bruce G. Murphy,MPH . .,CHO/Amy L.von Hone, R.S.,CHO
Health Di ctor/Assistant Health Diredor
The issuance of this permit shall not be construed as a guarantee t6at the system will funMion as desigoed.
e
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:DAN A. SPEAKMAN CONSTRUCTION
at: 12 SIERRA WAY, WEST YARMOUTH,MA 02673
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-15-1881,dated 06/24/2015.
Installer:DAN A. SPEAKMAN CONSTRUCTION
Address:l5 SPEAK WAY HARWICH,MA 02645 Inspector.AMY VON HONE,R.S.
Designer:DAN A. SPEAKMAN CONSTRUCTION
Conditions
1.REPAIR-EXISTING 1000 GAL SEPTIC TANK,DBOX,36 QUICK 4 HIGH CAPACITY
INFILTRATORS W/OUT STONE:48' X 8.5' X I1"
2.BUILDING PERMIT REQUIRED TO ELIMINATE ILLEGAL BEDROOM IN
BASEMENT(EXISTING BEDROOM IN BASEMENT WITH BULKHEAD ACCESS
ACCEPTABLE PER BUILDNG CODE)
3.MFC VARIANCE: 1.GROUNDWATER ADJUSTMENT /' /
�V(�
Bruce G. M hy, 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 funMion as designed.
i
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