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—�� 7 COMMONWEALTH OF MASSACHUSETTS
Board of Health, 1 Ag,\K O UT�A , MA.
FEE
job
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTI®N PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade Abandon( ) - Complete System ❑ Individual Components
Location IDN \/ l i:�r_WS-TP,1'
Owner's Name tA ko AAg,(, ,.( TcL_
Map/Parcel# r7
Address ,10 �� . o -fl
Lot#
Telephone#
Installer's Name C A?G0(D� ( L(�
Designer's Name �� � �,,�' WOp.LS �.1r,1C;
Address i 1S 3 Co ( ST MASq&g
Address t/ C,06SP15 Tz
Telephone#
Telephone# -5U it - 0.1 - 5 3 i 3
Type of Building V ARs to bioTt, A-(, Lot Size (4 , DL40 sq. ft.
Dwelling - No. of Bedrooms Garbage grinder ( )
Other - Type of Building No. of persons Showers ( ) , Cafeteria ( )
Other Fixtures
Design Flow (min. required) 33.0 gpd Calculated design flow
Plan: Date '7 - a -;to( 5 Number of sheets _ _ 1__>1
Title 1 1 Q l &J V l L- W?0 Ut2
Description of Soil(s) M Dl V►N��'d C
Soil Evaluator Form No.
Design flow provided 355,.;k gpd
Revision Date
Jt
Name of Soil Evaluator Date of Evaluation '7-2-2015
DESCRIPTION OF REPAIRS ORALTERATIONS = W:5TkC, ME(A-) (5®O GAA— (:5CPTt ' -c*0 V_ -to
ysCw D -Dov Zip GLb ADS Am! 3G !c ac .S t) -4 p"16Lb Cp&)FjfzvpAttbN
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to not t ace the system in operation until a Certificate of Compliance has been issued by the Board of health.
Signed Date
Inspections
No. 60 1A DC (5-
1
re'"
P;_- /4 J
COMMONWEALTH ®F M ASSACHUSETTSDC
7 -
Board
-Board of Health, 17t"[ , MA.
CERTIFICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) 6LieComplete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded+ , Abandoned ( )
by: d A?G(01br_- M PA 1,5 &-!Z 4-Le—
at
-LGat Ho o 9A`/1// s r / S -r QjFg: "' W{ -y qkP_ ,, IlTIA
has been installed ir1 cc or C-Ce"tda tfie pevilons of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. P %J -7, dated 7-/ �i % Approved Design Flow=:_,gpd)
f
Installer (JAPEIA-Abrz 64fWAUSEf L= 4,
Designer: "1060— I f. & i6&Q_VCS ZWC. Inspector: �%� Date:
The issuance of this permit shall not be construed as a guar e�tht hesystem will function as designed.
No. m-5 "'C�� CAf CA I -PIG FEE 4 5
7 COMMONWEALTH OF MASSACRUSETTS
Board of Health, I /'Cw4o Cm MA.
DISPOSAL SYSTEM[ CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgrade (,-��Abandon ( ) an individual sewage disposal system
atl0y� �� Vii"' WE3s7i" YAWkOortl as described in the application for
r
Disposal System Construction
�Permit No..L�-7 7, dated 7" / '- /
Provided: Construction shall become to with' years of the date of this perma. l local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown, MA Date i�% �� .>Board of Health
O
No.:BOHDC-15-0203
� Commonwealth of Massachusetts Fee
$55.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL 5YSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Complete System
Location: 110 BAWIEW ST,WEST YARMOUTH, MA 02673 Owner:
UTLEY MICHAEL P
Map/Parcel#: 02879 llo BAYVIEW ST
WEST YARMOUTH,MA 02673
Phone:
Septic System Installer Designer
CAPEWIDE ENGINEERING WORKS.INC.
153 COMMERCIAL STREET 12 WEST CROSSFIELD ROAD
MASHPEE, MA 02649 FORESTDALE,MA 02644
Phone: 508-477-5313
Type of Building:Dwelling Lot Siu:4,356.00 Acres
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building: No.ot persons: Showers:
Other Fixtures:
Plan Date:07/02/2015 Number of Sheets:2 Cafeteria:
Tit1e:PROPOSED SEPTIC SYSTEM UPGRADE PLAN 110 BAYVIEW STREET Revision Date:
Design Flow(min.required):330 gpd Calculated design flow:330 gpd Design flow provided:3552 gpd
Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator. Date of Evaluation:07/02/2015
PETER MCENTEE,PE
DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,20 ADS ARC 36HD UNITS
W/OUT STONE IN FtELD CONFIGURATION:20'X 14.2'X 7"
7he untleroignetl agrees to inatall the above tlescribetl Indlvidual Sewage Disposal System in aceorda�ee with the provisions of
� TITLE 5 and fuRher aarees not to olace in ooeration until a CeRificate of Comeliance has 6een issued bv the Board of Heakh.
Signed Date
Inspections
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA FeB
DISPOSAL SYSTEM CONSTRUCTION PERMIT 555.00
Permission is herby granted to;
CAPEWIDE ENTERPRISES, LLC, 153 COMMERCIAL STREET, MASHPEE, MA 02649
To perform: Upgrade an individual sewage disposal system.
Owner: UTLEY MICHAEL P
I10 BAYVIEW ST
WEST YARMOUTH,MA 02673
Location: 110 BAYVIEW ST,WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.: BOHDG1S0203 ,Dated:July 13,2015
Provided:Construction shall be completed within six months of the date of this permi[. All local conditions must be met.
Conditions
1. REPAIR-PROPOSED 1500 GAL SEPTIC TANK, DBOX, 20 ADS ARC 36HD UNITS W/OUT STONE
IN FIELD CONFIGURATION:20'X 14.2'X 7"
2. MFC VARlANCE APPROVAL:a. FOUNDATION SETBACK
.
.
Bruce G. M h ,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 FBe
CERTIFICATE OF COMPLIANCE sss.00
Description of Work:Complete System
The undersigned hereby cedify that the Sewage Disposal System; Upgraded
by:CAPEWIDE ENTERPRISES,LLC
at: 110 BAYVIEW ST, 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-IS0203,dated 07/17/2015.
Installe�: CAPEWIDE ENTERPRISES,LLC
Address:153 COMMERCIAL STREET MASHPEE,MA Inspector:AMY VON HONE,R.S.
02649
Designer:ENGINEERING WORKS,INC.
CondiHons
1.REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,20 ADS ARC 36HD UNITS W/OUT
STONE IN FIELD CONFIGURATION:20' X 14.2'X 7"
2.MFC VARIANCE APPROVAL: a.FOUNDATION SET ` �n'
l�
Bruce . M hy,MPH, R.S., CHO/ my L.von Hone, R.S.,CHO
Health Director/Assistant Health Diredor
The issuance of this permit s6a11 not be construed as a guarantee that the system will funMion as designed.
BOH_Disposal_Construdion_CofC.rpt