HomeMy WebLinkAboutApp-Permit-ComplianceNo. gpµ OC -I S"21Jfo 471.-D 77z -/S OOS-bZSZ(4/�s�JF E '�LZ40
COMMONWErlL11I OF MAS�U��11'13�
Board of Health,yp
4AAOMA , M.
APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgradev�-AbandonO - Complete System ❑Individual Components
Location °
Owner's Name
Map/Parcel#
Address
Lot#Telephone#
5Q& ,? O
Installer's Name
Designer's Name Gclo
Address 1106 CA i - L
Address C�
Telephone#Q —
Telephone#
Type of Building CA CI C. CO rt PTL - - Lot Size ib 9 �j 6 sq. ft.
Dwelling - No. of Bedrooms Garbage grinder( )
Other - Type of Building No. of persons Showers ( ) , Cafeteria ( )
Other Fixtures
Design Flow (min. required) 3 3 C) gpd Calculated design flow ?1? v Design flow provided 9� gpd
Plan: Date 1 f I rL0 t Number of sheets Z Revision Date
Title —L(yn, 0\0 6,
Description of Soil(s)
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS I uD c WH 1 1 O CA -1 qPAI—tf, (lVISl Y U5 \>
The'undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agreetto not to the tem in operation until a Certificate of Compliance has been issued by the Board of Health.
d-- -,t QL
SigneA. Q,o Date
z
Inspections
�,C0MM WEALTH Of MASSACHUSETTS
FEE 153100
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Board of Health; AR -M , MA.
X. CERTWICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) "Complete System
The undersigned hereby certify that the Sewage�isposal System; Constructed ( ), Repaired (Upgraded ( ), Abandoned ( )
by: XA-0 C,$�3n �) 1�e�/ Cr,.t" 3P
at i..`lam o-tke� w� &.r.,'N wi 4aR NG.Y,1,.1'A^ i1 � itnd).�
liasbeenr installed i'ci�&drer dwith th,e�pfb� sid�rS of 310 ,CMR 15.00., (Title 5)',and
application No. dafed %L�Approved Design Flow
design plans/as-built plans relating to
Designer: eU', - c-\,-% Inspector: P C,1j(-W aC'Z .J" Date: "T ✓ 7►
The issuance of this permit shall not be construed as a guar ee that the system will function as designed.
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No. G—I S - `� �P S FEE. S
COMMONWEALT14®E MASS HUSETTS z
Board of Health,MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( v<Upgrade ( ) Abandon ( ) an individual sewage disposal system
at lc `� ! ;. Y'.lv ic, a ,t zt'W vin , : �7,i (kz� 1 as described in the application for
TT —
Disposal System Construction Permit No. /, dated `2 1 i�
Provided: Construction shall be completed within t ee ears 4the date of this per l local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown, MA Date / -i Board oiW th
' No.: BOHDGIS-2156
Commonwealth of Massachusetts Fee
ass.00
Board of Healtt►, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Complete System
Location: 65 FREEMAN RD,YARMOUTH, MA 02675 Owner:
FEDERAL NAT'L MORTGAGE ASSOC
Map/Parcel#: 106.44 P O BOX 650043
DALLAS,TX 75265-0043
Phone:
Septic System Installer Designer
COMPASS REALTY ECO-TECH RAPID RESPONSE
P.O. BOX 2384 MASHPEE, MA 02649 155 GEORGE RYDER ROAD
Phone: SOUTH CHATHAM,MA 02633
(508)364-0894
Type otBuilding:Dwelling Lot Size: IQ890.00 Acres
Dwelling-Na.of Bedrooms:3 Garbage Grinder.
Other Type of Building: No.of persons: Showers:
Other Fixtures:
Plan Date:04/09@015 Number of Sheets:2 Cafeteria: � -
Tit1e:SEWAGE DISPOSAL SYSTEM 65 FREEMAN ROAD Revision Date:OS/1 V2015
Design Flow(min.required):330 gpd Calculated design flow: 330 gpd Design flow provided:3603 gpd
Description of SoiIs:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:04/O8/2015
DAVID COUGHANOWR,R.S.
DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-PROPOSED 1500 GAL POLY SEPTIC TANK,DBOX, 10 HIGH
CAPACITY INFILTRATORS W/OUT STONE:3125'X 2.83'X 11"PER TRENCH(2)
• The untlersigned agrees to install the above described Intlivitlual Sewage Disposal System in accortlance with the provisions of
TITLE 5 antl further aorees not to nlace in ooere[ion untll a Certificate of Comoliance has heen issuetl bv the 8oard of Health.
Signed Date
Inspectious
' Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT ass.00
Permission is herby granted to;
COMPASS REALTY DEVELOPMENT, P.O. BOX 2384, MASHPEE, MA 02649
To perform:Upgrade an individual sewage disposal system.
Owner: FEDERAL NA7"L MORTGAGE ASSOC
P O BOX 650043
DALLAS,TX 75265-0043
Location: 65 FREEMAN RD, YARMOUTH,MA 02675
Disposal System Construction Permit No.: BOHDC-15-2156, Dated: May 22,2015
Provided: Construction shall be completed within six months of the date of this permit. All local conditions must be met.
Conditions
1. REPAlR-PROPOSED 1500 GAL POLY SEPTIC TANK, DBOX, 10 HIGH CAPACITY INFILTRATORS
W/OUT STONE: 31.25'X 2.83'X Il"PER TRENCH(2)
2. ZONE II MAXIMUM 3 BEDROOMS
��
Bruce G. M hy, MPH, R.S., 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 that the system will function as designed.
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
CERTIFICATE OF COMPLIANCE ass.00
Description of Work: Complete System
The undersigned hereby cer[ify that the Sewage Disposal System; Upgraded
by: COMPASS REALTY DEVELOPMENT
at:65 FREEMAN RD, YARMOUTH,MA 02675
Has been installed i�accordance with the provisions of 310 CMR 15.00(Title 5)and the approved
design plans or as-built plans relating to application No.: BOADC-15-2156, dated 06/04/2015.
Installer.COMPASS REALTY DEVELOPMENT
Address:P.O.BOX 2384 MASHPEE,MA 02649 Inspector:AMY VON HONE,R.S.
Designer: ECO-TECH RAPID RESPONSE
Conditions
1.REPAIR-PROPOSED 1500 GAL POLY SEPT[C TANK,DBOX, 10 HIGH CAPACITY
INFILTRATORS W/OUT STONE:31.25' X 2.83'X 11" PER TRENCH(2)
2.ZONE II MAXIMUM 3 BEDROOMS
� ,
Bruce G.,N! phy, PH, R.S., CHO/Amy L.von Hone, R.S., CHO
c Health Director/Assistant Health Diredor
The issaance of this permit shall not be construed as a gaarantee that the syatem will function as designed.
BOH_Disposal_Construction_CofC.rpt