HomeMy WebLinkAboutApp-Permit-ComplianceNo. Ppoovc si5-152J � � FEE
4 CDC.,7 C)
4�7 COMMONWEALT14 Of NIASSACITiJSETTS
Board of Health, Y��1'�to ( , MA. -r �t
APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) UpgradeA) Abandon( ) - ❑ Complete System �vidual Components
Location
Owner's Name
Map/Parcel#
Address UO
PZLS-) , C' AA:4.Q
Lot# ,_5-
Telephone#,-�8' -- 9k'e„
9 -7
Installer's Name �L)Z�
Designer's Name
Address )OV, &V t, *1je
Address_ j
6 �'
Telephone#lf R)8- 13110.-d Y`7
Telephone#
MM
Type of Building �� eke '� '(� - lam"'/ W --fRf 644 Size iJ „ I '?�el 2 sq. ft.
Dwelling - No. of Bedrooms Garbage grinder F -}-
Other - Type of Building No. of persons Showers&, Cafeteria ( )
Other Fixtures ' -3 Y/
Design Flow (min. required) //0 gpd Calculated design flow >1 3_ Design flow provided _ Q gpd
Plan: Date,) - %J Number of sheets
Title
Description of Soil(s)
Soil Evaluator Form No.
Name of Soil Evaluator
DESCRIPTION OF REPAIRS ORALTERATIONS DyeA-3 &3C b /1
4.
The undersigned agrees to install the above described Individual Sewage Disposal Syste
further agrees not to pl ce the system in operation until a Certificate of Compliance
Signed P�-6�--�� Date
Inspections
No. -45-152-1 �$.00
C®MIMI®NWILAI.TII ®E M ASSACIIUSETTI j k o -.f / 5--'
Board of Health, _�} tL�1+1011771 , MA.�
� v
CERTIFICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) ❑ Complete System,
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded Abandoned ( )
by:
at 62- "s-pbaes
has been installe in c ojV*d'ance5withpo/Vzsions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. dated =t. Approved Design Flow ;FS-
Installer 9A4 4AIWQW0 - - 1 1 -2� - I -� 4,
.Designer: >f`�J�LP f/ ���/,li'%� '' Inspector: - i �� Date: �
r The issuance of this permit shall not be construed as a guar a th t the system will function as designed.
No. liC �. Ic"� - (�.�- Z.. z i� J�`LCfljl i�l�� �A (�I N'FEE (�®
� - -7 7 COMIM ONWEALT14 Of M ASSACIIUSETTS
Board of Health, MA. -
DISP®SAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgrade (`) Abandon ( ) an individual sewage disposal system
at 62- rjtsj -S %tJr' ___ _ as described in the application for
Disposal System Construction Permit No. I<:7 77.3? , dated ��..
jir; .
Provided: Construction shall be compl�ed dKid' s -?the date of this permit. All local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin�o Charlestown, MA Date 7 —/ Soard of Health
% / . , i s c 44
No.:BOHDC-15-1521
Commonwealth of Massachusetts FBe
• sss.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Individual Component(s)
Location: 62 HASTING AVE,WEST YARMOUTH, MA 02673 Owner:
CRUPI 1RICIA
Mep/PerC¢I#: W6238 S l36 NW PON'ERS FERRY RD
ATLANTA,GA 30327-4634
Phone:
Septic System Installer Designer
NORTHERN SWEETSER ENGINEERING
P.O. BOX 995 DENNISPORT, MA 02639 P.O.BOX 713
Phone: SOUTH DENNIS,MA 02660
(508)385-6900
Type of Building:Dwelling Lot Siu:026 Acres
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building: No.of persoos: Showers:
Other Fixtures:
Plan Date:02/t 1/2015 Number of S6eets: 1 Cafeteria:
TiNe:PROPOSED SEPTIC DESIGN FOR 62 HASIINGS AVEN[JE Revision Date:02/19/2015
Design Flow(mio.required):330 gpd Calculated design flow:330 gpd Design flow provided:351 gpd
DescripHoo of SoiIs:SEE PLAN
Soil Evaluaror Form No.: Name of Soil Evaluator. Dah of Evaluatioo:02/11/2015
, ROBIN WILCOX,PLS
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-EXISTING]000 GAL SEPTIC TANK,DBOX,4
HIGH CAPACITY INFILTRATORS W/STONE:36'X 11'X l0"
. The unde�signed agrees to insfall fhe above described Individual Sewage Disposal System in accordance wkh the provisbns of
TITLE 5 and fur[her aarees not to olace in ooeration untll a CertlFlcafe of Comoliance has 6een lasued hv[he 8oartl o(Maal[h.
Signed Date
Inspections
� Commonwealth of Massachusetts
• Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00
Permission is herby granted to;
NORTHERN SEALCOATING&PAVING, P.O. BOX 995, DENNISPORT, MA 02639
To perform:Upgrade an individual sewage disposal system.
Owner: CRUPI TRICIA
5136 NW POWERS FERRY RD
ATLANTA,GA 30327-4634
Location:62 HASTING AVE, WEST YARMOUTH,MA 02673
Disposal System Coastruction Permit No.: BOHDC-15-1521 ,Dated:March 25,2015
Provided:ConsWction shall be completed within six months of[he date of this permi[. All local conditions must be met.
Conditions
1. SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK, DBOX, 4 HIGH CAPACITI'
INFILTRATORS W/STONE. 36'X 11'X IO"
2. PORTION OF DECK OYER SEPTIC TANK TO BE REMOVED
3. ZONE II MAXIMUM 3 BEDROOM
�V C�f
Bruce G. Murp , H, R.S., CHO/Amy L.von Hone, R.S., CHO
H alth 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 Fee
CERTIFICATE OF COMPLIANCE sss.00
Description of Work: Individual Component(s)
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:NORTHERN SEALCOATING 8c PAVING
at:62 HASTING AVE,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-15-1521,dated OS/14/2015.
Installer:NORTHERN SEALCOATING&PAVING
Address:P.O.BOX 995 DENNISPORT,MA 02639 Inspector:AMY VON HONE,R.S.
Designer: SWEETSER ENGINEERING
Conditions
1.SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK,DBOX,4 HIGH
CAPACITY INFILTRATORS W/STONE: 36' X 11' X 10"
2.PORTION OF DECK OVER SEPTIC TANK TO BE REMOVED
3.ZONE II MAXIMUM 3 BEDROOM /,
V
Bruce G., rp , 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.
BOH_Disposal_Construdion_CofC.rpt