HomeMy WebLinkAboutApp-Permit-Compliance/ z , -a ,�/ �( J (� W / 0,.>UJ -P, vee
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BBIDo(ojt�cJ19 LJ FEE
COMMONWEALTH Of MASSACHUSETTS b e xl -4,4w4
Board of Health, Vy1. VT* , MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade�andonO ❑ Complete System 101ndividual Components
Location 46 Ceig A (n (6 5 C m
Owner's Name T -e[4 M q, --r
Map/Parcel# `7�
Address jqqr,Gj K ..l Ph a Yen Qa/
Lot#
Telephone# 61-7 333
Installer's Name t� b� G� �h
Designer's Name /j/9.j UA UL° y+ C
Address `d r n 4c . ri �c`d
Address /0 0 opt
Telephone# �j'
Telephone# 1�0 ir
Type of Building
Dwelling - No. of Bedrooms
Other - Type of Building _
No. of persons
Lot Size .l 0 sq. ft.
Garbage grinder ( )
Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow (min. reuired) gpd Calculated design flow _� Design flow provided gpd
Plan: Date E1,3 1 ?,0 Is Number of sheets .?- Revision Date
Title
Description of Soil(s) -e,P Sol-/ t—�
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation
The undersigned agreesp6 insoll the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to no place a tem ' o r n until a Certificate o Compliance has been issued by the Board of Health.
Signed Date^
Inspections
M
No.jii�+��«•t'S" 2.r1� FEE
COMMONWEALTH Of MASSACHUSETTS o
Board of Health, MA.
CERTIFICATE Of COMPLIANCE
Description of Work: Vndividual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded (, Abandoned( )
by: GWS i 1S 6lrar4rj Co-wf
at L4 0 Cc, 05 i ?Ca c . vl Zl
has been installed 1f? ccor arice ith t?e�r 'sions of 310 CkIR 15.00 (Title 5) and�th, ap ro've'd design plans/as-built plans relating to
application No. �/ dated fro ' / Approved Design Flow 3 (gpd)Installer t. 1 / t� 13 ro r -f Cc h Sd' A � _ e- -7
Designer: -1 SS f4 �/ �, C Inspector: // i� L✓�. / Date:
The issuance of this permit shall not be construed as a guaranCee that the system will function as designed.
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No.^FEEi
C® ON L114 Of MASSACHUSETTS -tea
Board of Health, Yagj4 0 u7TI- , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct`(, ) Repair( ) Upgrade (r} ---Abandon( ) an individual sewage disposal system
at l� r�(s n.�-c i'n fbl.(Cn nVffq d&4 rh U,-- / � %��,✓ as described in the application for
Disposal System Construction Permit No. / 7,/-->-/
..-%, dated
Provided: Construction shall be com/ e ed wK n t ee S e date of this permit. All local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date -'y Board o
No.: BOHDGIS-2519
Commonwealth of Massachusetts Fee
555.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Individual Component(s)
Location:40 CAPT BACON RD, SOUTH YARMOUTH, MA 02664 Owner:
� MARR JEFFREY T
Map/Parcel#: 078.112 MARR DEBORAH M
11 MARK LN
MILTON,MA 02186
Phone:
Septic System Installer Designer
ELLIS BROTHERS EAS SURVEY,INC.
PO BOX 59 YARMOUTHPORT, MA P.O.BOX 1729
02675 SANDWICH,MA 02563
Phone: 508-888-3619
Type of Building:Dwelling Lot Size: I4,810.00 Acres
Dwelling-No.of Bedrooms:3 Garbage Grinder: .
Other Type of Buildiog: No.of persons: Showers:
Other Fixtures:
Plan Date:OS/31/2015 Number of S6eets:2 Cafeteria: �
TiFle:SITE&SEWAGE REPAIR PLAN 40 CAPTAIN BACON RD Revision Date:
Design Flow(min.required):330 gpd Calculahd design flow:330 gpd Design ilow provided:336 gpd
Descriptlon of SoiIs:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:04/302015
EDWARD STONE,PLS
� DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-EXISTING ]000 GAL SEPT[C TANK,DBOX,24 QUICK 4 STANDARD
INFILTRATORS W/OUT STONE: 1133'X 24'X 8"
The undersigned agrees W install the above described Individua13ewage Disposal System In accordance with the provisions of
T TITLE 5 and further aarees not W olace In oceration until a Cerfifitate of Comoliance has 6een issued bv the Board ef Haakh.
Signed Date
Inspections
� Commonwealth of Massachusetts
Board of Health, Yarmouth, MA FBB
DISPOSAL SYSTEM CONSTRUCTION PERMIT 555.00
Permission is herby granted to;
ELLIS BROTHERS CONSTRUCTION, PO BOX 59,YARMOUTHPORT, MA 02675
To perform:Upgrade an individual sewage disposal system.
Owner. MARRJEFFREY T
MARR DEBORAH M
11 MARK LN
MILTON,MA 02186
Location:40 CAPT BACON RD, SOUTH YARMOUTH,MA 02664
Disposal System Conshuction Permit No.: BOHDC-15-2519,Dated:June 3Q 2015
Provided: Construction shall be completed within six months of the date of this permit. All local wnditions must be met.
Conditions
1.REPAIR-EXISTING 1000 GAL SEPTIC TANK, DBOX, 24 QUICK 4 STANDARD INFILTRATORS
W/OUT STONE: 11.33'X 24'X 8"
2. ZONE II MAXIMUM 3 BEDROOMS
Bruce G. rphy, MPH, R.S., CHO/Amy L. von Hone, R.S., CHO
Health Diredor/Assistant Health Director
T6e 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 $55.00
Description of Work:Individual Component(s)
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by: ELLIS BROTHERS CONSTRUCTION
at:40 CAPT BACON RD,SOUTH YARMOUTH,MA 02664
, 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-15-2519,dated 07/07/2015.
Instalier:ELLIS BROTHERS CONSTRUCTION
Address:PO BOX 59 YARMOUTHPORT,MA 02675 Inspector:AMY VON HONE,R.S.
Designer:EAS SURVEY,INC.
Conditions
1.REPAIR-EXISTING 1000 GAL SEPTIC TANK,DBOX,24 QUICK 4 STANDARD
INFILTRATORS W/OUT STONE: 11.33'X 24'X 8"
2.ZONE II MAXIMUM 3 BEDROOMS
��
Bruce G. Murphy, H, 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.
BO H_Disposal_Construction_CofC.rpt