HomeMy WebLinkAboutApp-Permit-ComplianceOr
No. I -e
t yl vim. Wwc
14
CO®� �[ SS �fISETTS -,r
C1�� Board of Health,
APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTI®N P
Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( - ❑ Complete System Indi 'd
FEE5S`
(it -(n 7315-
S OWO,a 1
Dizo,,:
Location
Owner's Name
Map/Parcel# , 1
Address � n
t)�N
Lot#
Telephone#
Installer's Namt� , r .
Address1 S V
Designer's Name
Address
Y
Telephone# 1-'1 '
Telephone# r ti
S' '> qqv
Type of Building V -4C '3
Dwelling - No. of Bedrooms
Other - Type of Building _
Other Fixtures
Design Flow (min. required)
Plan: Date L
Title Pr -MA1313RA T ---r
Description of Soil(s) _
Soil Evaluator Form No.
901
No. of persons
Ad gpd Calculated design flow 1 6A V
Number of sheets 11
Name of Soil Evaluator
DESCRIPTION OF REPAIRS OR ALTERATIONS J'C O I C
Lot Size
sq. ft.
_ Garbage grinder ( )
Showers ( ), Cafeteria ( )
Design flow provided
Revision Date
W< -,3A "4ary %nj
Date of Evaluation
gpd
The un agrees to install the cribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further es to n t to place tem in o ration until a Certificate of Compliance has been issued by the Board of Health.
Signed maid" Date
Inspectionsf— --4 —LiS- kkeJ b Cr0 d 'l k4o,
FEE �� J.00
COMMONWEALTH OF MASSAC14USETTS
(Board of Health, yAr,-MQ LD -14 Rr / T��
Description of Work: ,Individual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal,System;y Consu:ucted -( `), Repaired { ), Uprade O, Ab
by: C-6 N 5-SIZ U S t 6 rJ
at �-7 I+A2.Y;O(L V-OAi)
has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No&W M f) /Fdated/Q' 16 -14 Approved Design Flow��(gpd)
Installer(� �.N S P EA kM
Designer:
Inspection
Date:
r
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
FEE 5s- OO
Board of Health, YA9, ? O YTV , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted, to Construct( ) Repair( ) Upgrade Abandon( ) an individual sewage disposal system
at—q-7 467243 0 2 1ZD W SJ as described in the application for
Disposal System Construction Permit Nc�0* L4 ,dated /h
1sf —,�-'� ;jjd,�j�
Provided: Construction shall be completed within tears of tjhe date of this permit. All local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date 10'10 �-14 Board of Health
/
j — l , / n -, ,I 1A / I wn1U/ 1 , I.
� No.:BOHDGI4-0445 '�,
Commonwealth of Massachusetts F�
• sss.00
Board of Health, Yarmouth, MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT I
Application for a Permit to:Upgrade-
Locatiou: 47 HARBOR RD,WEST YARMOUTH, MA 02673 Owner
Map/Parcel#: 029.1 Name:
DOYLE MICHAEL J
Address:
DOYLE J M&DOYLE B M&J C 11 HADLEY
COURT
Phone:
Sepdc System Installer
Name:
DAN A. SPEAKMAN
CONSTRUCTION ���
A�9Qf2fidK WAY HARWICH, MA '
02645
Phone:
Type of Building:Dwelling Lot Size:0.21 sq.ft.
Dwelling-No.of Bedrooms:4 Garbage Grinder.
Other Type of Building: No.of persoos: Showers: Cafeteria:
Ot6er Fictures: I
I
Plan Date:04/24/2014 Number of Sheets: I �
Title:PROPOSED IMPROVEMENTS PLAN 47 HARBOR ROAD Revision Date:07/14/2014 I
Design Flow(miu.required):440 gpd Caleulated design flow:440 Desigo ilow provided:457.1 gpo li
gpd
Descripfioo of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation: I
. I
, DESCR[PTION OF REPAIRS OR ALTERATIONS:EXISTING 1500 GAL SEPTIC TANK �
DBOX
2-500 GAL PRECAST CHAMBERS W/STONE TO EXISTING 2-500 GAL PRECAST CHAMBERS W/STONE FOR
� PROPOSED ADDITION(MAXIMUM 4 BEDROOIv�
The unde�signed agrees to install the above tleseribetl Intlivitlual Sewage Disposal Sysfem In accordance wkh the provisions
of TITLE 5 and fuRher apress not to plaee in operalion uMil a CeRifieate of Compliance has been Issued by the Board oT Health.
Signed Date '
Inspections . ���'.
Commonwealth of Massachusetts
` Board of Health, Yarmouth, MA. Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00
Permission is herby granted to;DAN A. SPEAKMAN Address: 15 SPEAK WAY
HARWICH,MA 02645
To perform:Upgrade an individual sewage disposal system.
Owner: DOYLE MICHAEL J
DOYLEJM&DOYLEBM&JC
11 HADLEY COURT
ARLINGTON,NY 02474
Location:47 HARBOR RD, WEST YARMOUTH,MA 02673
Disposa7 System Construcrion Permit No.: BOHDC-140445,Dated:October 10,2014
�� Provided:Construction shall be completed within six mon[hs of[he date of this permit. All local conditions must be met.
Conditions
1. Esisting I500 ga1 Septic Tank, DBox, 2-500 ga[Precast Chambers w/Stone to Existing 2-500 gal
Precast Chambers w/Stone for Proposed Addition(Mazimum 4 Bedroom)
�����/��.�c� I
Bruce G. fy} rpl y,MPH, R.S.,CHO— /�L.von Hone, R.S.,CHO
Health Director/AssistaM Health Diredor
The issaance of this permit shall not be construed as a guarantee that the system will function as designed. ',
I
,�
I
I
�
I
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA F�
CERTIFICATE OF COMPLIANCE sss.00
Description of Work:
The undersigned hereby ceRify that the Sewage Disposal System; Upgraded
by:DAN A. SPEAKMAN CONSTRUCTION
at:47 HARBOR RD,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-140445,dated Ol/21/2015.
Installer:DAN A.SPEAKMAN CONSTRUCTION
Address:l5 SPEAK WAY HARWICH,MA 02645 Inspector:AMY VON HONE,R.S.
Designer: SULLNAN ENGINEERING
CondiHons
1.EaisNng 1500 gal Septic Tank,DBoa,2-500 gal Precast Chambers w/Stone to Existing 2-500 gal
Precast Chambers w/Stone for Proposed AddiHon(Maximum 4 Bedr
�
Bruce G. Murph P , R.S., CHO/Amy L.von Hor�, R.S.,CHO
Health Diredor/Assistant Health Diredor
The issuance of this permk shall not be construed ss a guarantee that t6e system will function as designed.
i
�
BOH Disposal_Construc6on_CoiC.rpt !