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HomeMy WebLinkAboutApp-Permit-Compliance1-110 No. ,��i�/r���I ✓ � F E . �,/COMMONWEALM Of MASSACHUSETTS Board of Health, IC ION FOR DISPOSAL SYSTEM CONSTRUCTIO IT '/X. 'A 1'c� for a Permit t onstruct() Repair(�Upgrade() Abandon() - ❑Complete SystemYdMidal Components �P Location 4 Owner's Name /),(,o L J Map/Parcel# Z Address 'r4 FYI Ute. Lot# Telephone# nstaller's Name /V! t 1 � V s � / Designer's Name 90.4 .0 6/14 ddress �1 V Vr L ji3 Address 66AV 7 SY YA m^ Telephone# 4j. V - C> Telephone# '7 '7,'5'- 9 7 06 Type of Building Dwelling - No. of Bedrooms Other - Type of Building _ 3 Other Fixtures Design Flow (min. required) gpd Calculated design flow Plan: Date - 7-9 --/ 5 Number of sheets Title 'S Description of Soil(s) _ 2 Soil Evaluator Form No. Name of Soil Evaluator DESCRIPTION OF REPAIRS OR ALTERATIONS �� r / No. of persons Lot Size // Z)� sq. ft. Garbage grinder( ) Showers ( ), Cafeteria ( ) Design flow provided 311ric gpd Revision Date of Evaluation 7- ZZ !Zf- The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to of top ce syste operation until a Certificate of Compliance has been issued by the Board of Health. Signed / qtr i��' Date Inspections No. _N*bC -4'S`Z700 COMMONWEALTH Of MASSACHT� _or Board of Health �AtzM MA.� ®�1'�-1- , JAIL ®k CUPYRIL HM—h Description of Work: ® Individual omponent(s) ❑ Complete System The undersigned hereby cer'' h t the Sewage D's osal System; Constructed ( ), Repaired ( ), Upgraded. ,0/ bandoned ( ) by: at , has been installed ifi'a ora ato sirs of 310 CMR 15.00 (Title 5) and the proved design plans/as-built plans relating to application No. ` /� dated -6 " f d Approved Design Flow and Installer 13 ©/f - e k .. Designer: P-00iA n,14- �� 1. Inspector: /.f Date: The issuance of this permit shall not be construed as a guar ttealt the system will function as designed. No. FEE � 00 C®MMONW a LT14®F MASSACHUSETTS lei Board of Health, Y4 -2- 1M d U-04 , MA. DISPOSAL SYSTEM[ ®NSTRUCTI®N PERMIT Permission is hereby granted p; Construct( ) Repair( Upgrade( ) Abandon( ) an individual sewage disposal system at as described in the application for Disposal System Construction Permit No. �� . , dated" -rS- 27J6 Provided: Construction shall be completed within tk arsof/thed}ate of this permit. All local conditions must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown. MA Date 7!✓ oard of Health r /Q �,/ / %/�'//''�� r'li9'v'/�Ge,Li .0 flc:6.•'/ /��� .3�4if1 i %�Gi /J� 4-r , No.:BOHDC-15-2700 � Commonwealth of Massachusetts Fee E55.00 Board of Health, Yarmouth, MA ` APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT I IApplication for a Permit to:Upgrade-Individual Component(s) , Location: 19 CAPT BESSE RD, SOUTH YARMOUTH, MA 02664 Owner: ' LOVELY DOROTHY A TR Map/Parcel#: 078.12 LOVELY REAL1'Y TRUST 19 CAPT BESSE RD SOUTH YARMOUTH,MA 02664 Phone: Septic System Installer Designer BOSETTI SEPTIC RONALD J.CADILLAC.PLS,RS.PC 199 CHURCH STREET EAST P.O.BOX 258 � HARWICH, MA 02645 WEST YARMOUTH,MA 02673 Phone: 508-775-9700 Type of Building:Dwelling Lot Siu: 11,326.00 Acres Dwelling-No.of Bedrooms:3 Garbage Grinder. Other Type of Building: No.of persons: Showers: � iOther Fixtures: � Plan Date:07/24/2015 Number of Sheets: 1 Gteteria: TiHe:SI1'E PLAN FOR 19 CAPTAIN BESSE ROAD Revision Date: Design Flow(mio.required):330 gpd Calculated design Flow:330 gpd Design ilow provided:368 gpd Descriptioo of Soi1s:SEE PLAN Soil Evaluator Form No.: Name otSoil Evaluator: Date of Evaluation:07/16/2015 RONALD J.CADILLAC,RS . ' DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-EXISTING ]000 GAL SEPTIC TANK,DBOX,21 ARC 36HC UNITS W/OUT STONE:35'X 8.67'X 0.89' The untleraigned agrees W insfalllhe above described Indlvldual5ewage Disposal System in accordance wkh the provlsions of ' TITLE 5 antl further aarees not W olace in oeention until a Certificate of Comoliance has heen issued bv the Board of Fleakh. Signed Date Inspections Commonwealth of Massachusetts : Board of Health, Yarmouth, MA Fee DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00 Permission is hereby granted to; BOSETTI SEPTIC SYSTEMS, 199 CHURCH STREET, EAST HARWICH, MA 02645 To perform: Upgrade an individual sewage disposal system. Owner: LOVELY DOROTHY A TR LOVELY REALTY TRUST 19 CAPT BESSE RD SOUTH YARMOUTH,MA 02664 Location: 19 CAPT BESSE RD, SOUTH YARMOUTH,MA 02664 Disposal System Construction Permit No.: BOHDGIS-2700 , Dated: August 10,2015 Provided: Consffuction shall be completed within six months of the date of this permit. Ali local conditions must be met. CONDITIONS: 1. SEPTIC DISPOSAL- REPAIR- EXISTING 1000 GAL SEPTIC TANK, DBOX, 21 ARC 36HC UNITS W/OUT STONE:35'X 8.67'X 0.89' 2. MFC VARIANCE APPROVAL: a. SETBACK 3. ZONE II MAXIMUM 3 BEDROOMS 4. CONTRACTOR MUST CONFIRM LEGAL SONOTUBES SUPPORTING DECK ARE NOT ON TOP OF EXISTING SETPIC TANK � � _ Bruce G. Murphy, H, .S., CHO/Amy L. von Hone, R.S., CHO He Director/AssistantHealthDirector , The issuance of this permit shall not be construed as a guarantee t6at the system will function as designed Commonwealth of Massachusetts Board of Health, Yarmouth, MA Fee CERTIFICATE OF COMPLIANCE ass.00 Description of Work: Individual Component(s) The undersigoed hereby certify that the Sewage Disposal System; Upgraded by: BOSETTI SEPTIC SYSTEMS at: 19 CAPT BESSE 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-15-2700, dated 09/15/2015. Installer:BOSETTI SEPTIC SYSTEMS Address:199 CHURCH STREET EAST HARWICH,MA Inspector:AMY VON HONE,R.S. 02645 Designer:RONALD J.CADILLAC,PLS,RS,PC U�c�� Bruce G. Murp y, PH, R.S., CHO/Amy L.von Hone, R.S., CHO � Health Diredor/Assistant Health Diredor The issuance of this permit shall not be construed as a guarantee that the system will function as designed. BOH_Disposal_Construdion_CofC.rpt