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Home My WebLink AboutApp-Permit-ComplianceN No. �l i� "U ,'� FEE V COMMO LTI4 OF MASSACHUSETTS c ° � �O� C—� ^�A � B and o Health, A , MA. % 1 � d Y l y 2 r10 trr�a Q 1 J5 -0°575�Amm- CATI®N FOR DISPOSAL SYSTEM CONSTRUCTI®N PERMIT *"' 3Lc R•li Application for a Permit to Construct( ) Repair04 Upgrade( ) Abandon() - ❑ Complete System Plfi;�vidual Components Location Owner's NameL G Map/Parcel# (10 f Address 10 :T4Ji,-Ak64-4 A- 7 C Lot# x 77 Telephone# Installer's Name CQ�- s "�, L01 Designer's Name N Address ' (o , Address �� , Telephone# "� —8 _2 ��(p Telephone# Type of Building ( �l 1) l® Ab"4i5 Lot Size 2 2— sq. ft. Dwelling - No. of Bedrooms —1 Garbage grinder ( ) Other - Type of Building No. of persons Showers( ), Cafeteria ( ) Other Fixtures Design Flow (min. requiredgpd Calculated design flow 44(3Plan: Date lc Number of sheets Title Design flow provided Ag= gpd Revision Date Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS wD g -&a t -A J A- /`D 15 42 5 C-7 of 1EFM per�'� The undersigned agrees to ' e bove described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agree of t plac th em in operation until a Certificate of Compli ce been issued by the Board of Health. Signed Date 167 Inspections /I No. 600DC-1 tz; k Z-�•7 FEE ' COMMONWEALTH Of MASSACHUSETTS Board of Health, %P --1M 0 UT 7+ , MA. 6 >r� j �CJ/ CERTIFICATE Of COMPLIANCE CA� Description of Work: SIndiLl Component(s) Complete System F&, S x� The undAersigned hereby certifyjh-'t the Sewage Disposal by: at DS em; Constructed ( ), Repaired (; ), Upgraded ( ), Abandoned ( ) O N ---> EX r- A-il 61 has been installed in ccordance with he 7ovisions of 310 CMR 15.00 (Title 5) and thea proved design plans/as-built plans relating to application No. 1 S 7/% date '1 -- is /�. Approved Design Flow (gpd) Installer r�i'� c f �: � :�a -P r1 N e�' 1. C �1 ILA 1. — Designer:Duwr,j CA -0-G J�NL�r�1 �=e �.,NG Inspector: � Date: The issuance of this permit shall not be construed as a guarante4 that t4e system will function as designed. No. 1301 D C ` -2U2 q kQi ei( 1UP5 1 tic FEE S ?-t COMMONWFALT14 Of MASSACHUSETTS ck fl e d � Board of Health, yi4 RM 0 U 1-14 , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair(y-) Upgrade( ) Abandon( ) an individual sewage disposal system at 10 Sr T>> e on aL. On . +-- as described in the application for Disposal System Construction Permit No. , dated �) . Provided: Construction shall be completed within three yeas of the date of this permit. All local conditions must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown, MA Date Board of Health No.:BOHDC-15-2046 Commonwealth of Massachusetts Fee so.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to:Upgrade-Individual Component(s) Location: 10 INDIAN MEMORIAL DR, SOUTH YARMOUTH, MA Owner: 02664 CHAPASKO CARLA A Map/Parcel#: 060.61 101NDIAN MEMORIAL DR SOUTH YARMOUTH,MA 02664 Phone: Septic System Installer Desiguer RON'S EXCAVATING DOWN CAPE ENGINEERING,INC. 81 ECHO ROAD-UNIT 1 MASHPEE, 939 ROUTE 6A MA 02649 YARMOUTHPORT,MA 02675 Phone: (508)362-4541 Type of Building:Dwelling Lot Size:9,58320 Acres Dwelling-No.of Bedrooms:4 Garbage Grioder: Other Type of Building: No.of persons: Showers: Other Fixtures: Plan Date:OS/04/2015 Number of Sheets: 1 Cafeteria: Tit1e:TI7T,E 5 SITE PLAN 101NDIAN MEMORIAL DRIVE Revision Date: Design Flow(min.required):440 gpd Calculated design ilow:440 gpd Design ilow provided:453 gpd Description of Soi1s:SEE PLAN Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:04/30/2015 DANIEL GONSALVES,SE DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-EXISTING 1000 GAL SEPTIC TANK,H-20 DBOX,4-500 GAL PRECAST H-20 CHAMBERS W/STONE 4'ENDS,3'S1DES:42'X 10.83'X 2' The undersigned agrees to install the above descrlbed Individual Sewage Disposal System in accortlance with the provisions of TITLE 5 and furfher aorees not io olaee in ooeration until a Certificate of Comoliance has heen issued 6v the Board of Meakh. Signed Date ]nspections Commonwealth of Massachusetts Board of Health, Yarmouth, MA F� DISPOSAL SYSTEM CONSTRUCTION PERMIT 555.00 Permission is herby granted to; RON'S EXCAVATING INC.,81 ECHO ROAD-UNIT 1, MASHPEE, MA 02649 To perform:Upgrade an individual sewage disposal system. Owner. CHAPASKO CARLA A lOINDIAN MEMORIAL DR SOUTH YARMOUTH,MA 02664 Location: 10 INDIAN MEMORIAL DR, SOUTH YARMOUTH,MA 02664 Disposal System Construction Permit No.: BOHDC-152046,Dated: May 12,2015 Provided:Consvuction shall be completed within six months of the date of this permit. All bcal conditions must be met. Conditions 1. REPAIR-EXISTING 1000 GAL SEPTIC TANK, H-20 DBOX, 4-500 GAL PRECAST H-20 CHAMBERS W/STONE 4'ENDS, 3'SIDES:42'X 10.83'X 2' �V(x( Bruce G urphy, 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 iunction as designed. Commonwealth of Massachusetts Board of Health, Yarmouth, MA F� CERTIFICATE OF COMPLIANCE E55.00 Descriprion of Work: Individual Componeut(s) The undersigned hereby certify that the Sewage Disposal System; Upgraded by:RON'S EXCAVATING INC. at 10 INDIAN MEMORIAL DR,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-1S2046,dated OS/12/2015. Installec RON'S EXCAVATING INC. Address:81 ECHO ROAD-LJNIT 1 MASHPEE,MA Inspector:AMY VON HONE,R.S. 02649 Designer:DOWN CAPE ENGINEEffiNG,INC. Conditious 1.REPAIR-EXISTING 1000 GAL SEPTIC TANK,H-20 DBOX,4-500 GAL PRECAST H-20 CHAMBERS W/STONE 4' ENDS,3' SIDES: 42' X 10.83' X 2' Bruce G. Murphy,MPH, R.S., CHO/Amy L. von Hone, R.S.,CHO Health Director/Assistant Health Direc[or The issuance of t6is permit shall not be construed as a guarantee that the system will function as designed. BOH_Disposal_Construction_CofC.rpt No.: BOHDC-15-2024 � Commonwealth of Massachusetts F� 555.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to:Upgrade-Individual Component(s) Location: 101NDIAN MEMORIAL DR, SOUTH YARMOUTH, MA Owner: 02664 CHAPASKO CARLA A Map/Parcel#: 060.61 10 INDIAN MEMORIAL DR SOUTH YARMOUTH,MA 02664 Phone: SepNc System Installer Designer ROBERT CHILDS INC. DOWN CAPE ENGINEERING.INC. P.O. BOX 1431 SOUTH DENNIS, MA 939 ROUTE 6A 02660 YARMOUTHPORT,MA 02675 Phone: (5081362-4541 Type of Building:Dwelling Lot Size:9,583.20 Acres Dwelling-No.of Bedrooms:4 Garbage Grinder. Other Type of Building: No.of persons: Showers: Other Fixtures: Plan Date:OS/04/2015 Number of Sheets: 1 Cafeteria: Title:TITLE 5 SITE PLAN lOINDIAN MEMORIAL DRIVE Revision Date: Design Flow(min.required):440 gpd Calculated design flow:440 gpd Design ilow provided:453 gpd Description of Soi1s:SEE PLAN Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:04/30/2015 DANIEL GONSALVES,SE • DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-EXISTING 1000 GAL SEPTIC TANK,DBOX,4-500 GAL PRECAST CHAMBERS W/STONE 4'ENDS,3'SIDES:42'X 10.83'X 2' 7he undersignetl agrees to insfall the above described Indivitlual Sewage Disposal System In accortlance with the provisions of ' 71TLE 5 and further aarees not to olace in ooeration until a Certiflcate of Comoliance has heen issued 6v the Board of Mealth. Signed Date Inspectious ' Commonwealth of Massachusetts Board of Health, Yarmouth, MA Fee DISPOSAL SYSTEM CONSTRUCTION PERMIT 555.00 Permission is herby granted to; ROBERT CHILDS INC., P.O. BOX 1431, SOUTH DENNIS, MA 02660 To perform: Upgrade an individual sewage disposal system. Owner: CHAPASKO CARLA A ]OINDIAN MEMORIAL DR SOUTH YARMOUTH,MA 02664 Location: 10 INDIAN MEMORIAL DR, SOUTH YARMOUTH,MA 02664 Disposal System Construction Permit No.: BOHDGIS-2024,Dated: May 06,2015 Provided:Construction shall be completed within six months of the date of this permit. All local conditions must be met. Conditions 1. REPAIR-EXISTING]000 GAL SEPTIC TANK, DBOX, 4-500 GAL PRECAST CHAMBERS W/ STONE 4'ENDS, 3'SIDES: 42'X 10.83'X 2' � � Bruce G hy, MPH, R.S., CHO/Amy .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.