HomeMy WebLinkAboutApp-Permit-ComplianceNo.
LU
70
O . (,, -' FEE17
1
Board of Health, , MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
for a Permit to Construct( ) Repair( ) Upgrade(,VAbandon() - ❑ Complete System Z4I vidual Components
Lo ation
Owner's Name
Map/Parcel# 3
Address
Lot#
Telephone# _
Installer's Name r
Designer's Name J� i
Address
Address
Telephone# e 0
Telephone# Sz=s
Type of Building, Lot Size
Dwelling - No. of Bedrooms Garbage grinder ( )
Other -Type of Building No. of persons Showers ( ) , Cafeteria ( )
Other Fixtures
Design Flow (min. required) 3 3<0 gpd Calculated design flow Design flow provided gpd
Plan: Date q Number of sheets Revision Date
Title `
Description of Soil(s) S=.< P�,,o,,, 4
Soil Evaluator Form No. Name of Soil Evaluator (�
�'��,�ll'L'�!"" Date of Evaluation �di �
OF REPAIRS OR ALTERATIONS (`�j, (`y�Y c,`7 k l - O - �—.� ,
oma,- rc,�,�L S'A.,
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 to place the tem in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date % rd
Inspections
No. D 1 -�' l�'-- FEE
COMMWEA
LTII OF MASSACHUSETTS r ► p< � 2 V25
Board of Health, Yr 2? T14 , MA.
CERTIFICATE Of COMPLIANCE
Description of Work: O I dividual Component(s) ❑ Complete System i`� YZg
The undersigned hereby certify that the Sewage Disposal System; Constricted ( ), Repaired ( ), Upgraded Abandoned(
by:
at
has been installed icorCL
n • cas ith e p ovisions of 310 CMR 15.00 (Title 5) and thea roved design plans/as-built plans relating to
application No. dated 7 L Z / Approved Design Flow (gpd)
FA-TaACA
Designer: M�� Gs'�" �Y15� � G Inspector: 17Date: 7193
The issuance of this permit shall not be construed as a guarantee that de system will function as designed.
No. t�C)k}"�� (cam-��I 6.Z- (Lt= '� �� GC3L:'R�YZ. EXc_ FEE CLQ
COMMONWEALTH LTH ®L MASSACHUSETTS CA -4- .q2-1(
Board of Health, YAeMOTP4 , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair(
Upgrade (✓j Abandon( ) an individual sewage disposal system
_ as described in the application for
Disposal System Construction Permit No. _�4 , dated 7-1 L 7.s
lbwe-1 S= C,
Provided: Construction shall be completed -within thT-ee� o t e date of this ermit. All local conditions must be met.
had
C esl
Form 1255 Rev. 5/96 A.M. Sulkin Co. own MA Date / < / hoar of Health p V '
I No.:BOHDC-15-0462
i ,
Commonwealth of Massachusetts F�
555.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Individual Compooent(s)
Location: 14 CAPT WRIGHT RD, SOUTH YARMOUTH, MA 02664 Owner:
FINN JOSEPH M �
Map/Parcel#: 067.133 14 CAPT WRTGHT RD
SOUTH YARMOUTH,MA 02664
Phone:
Septic System Installer Designer
INNOVATIVE MEYER& SONS, INC.
17 JAN SEBASTIAN WAY SANDWICH, P.O.BOX 981
MA 02644 EAST SANDWICH,MA 02637
Phone:
508-360-3311
Type of Building:Dwelling Lot Size: 11,326.00 Acres �
Dwelling-No.of Bedrooms:3 Garbage Grinder.
OMer Type of Building: No.of persons: Showers:
Other Fixtures:
Plan Date:07/09/2015 Number of Sheets:2
Cafeteria:
TiFle:SEPTTC SYSTEM REPAIR PLP.N 14 CAPTAIN WR[GHT ROAD Revision Date:
Desigu Flow(mio.required):330 gpd Calculated design flow:330 gpd Desigo tlow provided:336 gpd
DescripNon of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name otSoil Evaluator: Date of Evaluation:OS/20/2015
DARREN MEYER,R.S.
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-EXISTING lOW GAL SEPT[C TANK,DBOX,24
QUICK 4 PLUS LOW PROFILE INFILTRATORS W/STONE:24'X 1 L32'X 33"
7he underoigned agrees to install the above tlescribed Individual Sewage Disposal System in accortlanee wkh the prmisions of ��
T1TLE 5 and furfher aarees not to olace in ooeration until a CertHicate of Comoliance has heen Issued bv the Board of MeaMh. �
Signed Date
Inspeciious
i ,
' Commo�wealth of Massachusetts
� Board of Health, Yarmouth, MA Fee
, DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00
Permission is hereby granted to;
INNOVATIVE EARTHWORKS, LLC, 17 JAN SEBASTIAN WAY, SANDWICH, MA 02644
To perform: Upgade an individual sewage disposal system.
Owner: FINN JOSEPH M
14 CAPT WRIGHT RD .
SOUTH YARMOUTH,MA 02664
Location: 14 CAPT WRIGHT RD, SOUTH YARMOUTH, MA 02664
Disposal System Conshvction Permit No.: BOHDC-15-0462 , Dated:July 22,2015
Provided: Construction shall be completed within six months of the date of this permit. All local conditions must be met.
Conditions
1. SEPTIC DISPOSAL—REPAIR—EXISTING 1000 GAL SEPTIC TANK, DBOX, 24 QUICK 4 LOW PROFILE UNITS
W/OUT STONE: 24'X 11.32'X 3.3"
2. ZONE II MAXIMUM 3 BEDROOMS
Bruce G. Mu y, PH, R.S., CHO/Amy L. vo 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 F�
CERTIFICATE OF COMPLIANCE sss.ao
Description of Work:Individual Component(s)
T'he undersigned hereby certify that the Sewage Disposal System; Upgraded
by:INNOVATIVE EARTHWORKS,LLC
at: 14 CAPT WRIGHT 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.: BOHDG1SO462,dated 07/23/2015.
Installer:INNOVATIVE EARTHWORKS,LLC
Address:l7 JAN SEBASTIAN WAY SANDWICH,MA Inspector:BRUCE MURPHI',R.S.and PHILIP
02644 RENAUD
Designer:MEYER&SONS,INC.
Bruce G. Murphy,MPH, R.S.,CHO/Amy L.von Hone, R.S.,CHO
Health Director/Assistant Health Director
The issuance of t6is permit shall not be construed as a guarantee that the system will fanMion as designed.
BOH_Dispasal_Construc5on_CofC.rpt