HomeMy WebLinkAboutApp-Permit-Compliancer5 1,trT�(
No. L'bT2 1(0 V o( 1 1 FEE
COMMONWALM OF MASSACHUSETTS
Board of Health,MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade andon( ) - ClmpleteSystem ❑ Individual Components
Location 26P 676,- 6,e (L
L
Owner's Name 1 S t
Map/Parcel#
3-413,20
Address
Lot# 4
Telephone# .I
7
.- ?j 3 Z 2-
Installer's Name ` A V f
G-IOOAI
Designer's Name
�—
AddressoGut 21
, Moak
Address
-'v d 4/, C h
Telephone# - 2 7!L-
q -7 5-3
Telephone# - 2a
o- 33
Type of Building � � 17� N(i Lot Size� Q,_ U sq. ft.
Dwelling - No. of Bedrooms Garbage grinder ( )
Other - Type of Building No. of persons Showers ( ) , Cafeteria ( )
Other Fixtures
Design Flow (min. re uir d) 330 gpd Calculated flow �3 o Design flow provided 333 gpd
Plan: Date % �5- Number of sheets Revision Date
Title
Description of Soil(s)
Soil Evaluator Form No. Name of Soil Evaluator •C rti Date of Evaluation Z
DESCRIPTION OF REPAIRS OR ALTERATIONS ;PP V 1v (- X S f n 4 r e S5f o o i S Cr A /v/&t/
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The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to o plac system in operation until a Certificate of gompliance has been issued by the Board of Health.
`Z7 lS
Signed Date
l G. a/cc
Inspections / J �^ / /fit
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No. 014 bC-- } 5 FEE 60
COMMONWEALT14 OF MASSACHUSETTS -6'�//� c 3,5. q
Board of Health, ,1 Algm o uN , MA.
CERTIFICATE OF COMPLIANCE
Description of Work: 'Ll Individual Component(s) ❑ Complete System 13LkF7-�/4
The undersigned hereb certify that the Sewage�isposal System; Constructe O, Repaired (14Upgraded ( )(�fKa`n ke
by: Z V7t �CTj0
at
`�c'� /S - u o-6sions of 310 CMR 15.00 ) p g p p g
has been installed in ac ordance with h p (Title 5 and the roved design Tans/as-built plans relating to
application No. �1; dated 0 Approved Design Flow (gpd)
Installers
Designer: Inspector: l t✓' Date:
The issuance of this permit shall not be construed as a guar tee at the system will function as designed.
c •: <•;:T �:, :: :'-t-,^,-`.r`-:O �-!-�t?'C�q �.; j•'". c.t -�?5r.. ., .'t'"C.._C,�...J(_L"J�%j�•L�`��%lLY''i.��:i�.l�. c., o��°s ,c�, rw1cC<„-�.�.,t... _. e.,+, ,.. le u..'3c�JV:3q0'ota. i)or�,:�s�O C'6 .OqG
`1' 01" u 2- - FEE x. 00
COMMONWEALTH Of MASSACHUSETTS 4k# 3 3q.3
Board of Health, YA MOV714 , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; �Co`n�struct( ) Repair( ) Upgrade�q Abandon( ) an individual sewage disposal system
at � 1D (`N Ems-- t�-4�.3 • as described in the application for
Disposal System Construction Permit No.
^�' '� , dated
comp '� p
Provided: Construction shall be com ete within t of the date of this ermi . �11 local conditions must be met.
-�i d $
Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date SRP- Board of -,Health �
hA/l 'fig A, -.It,)-. -A \ori e !!i,A.s/.f//e / ---)) _/___X1, &_",J / A,
. No.:BOHDC-15-4419
Commonwealth of Massachusetts F�
555.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Complete System
Location: 26 GARDINER lN, SOUTH YARMOUTH, MA 02664 Owner:
PISELLI LAWRENCE A TRS
Map/Parcel#: 034.38 PISELLI ENIS C
17 WISWALL ST
WESTNEWTON,MA 02165-2105
Phone:
SepHc System Installer Designer
RANGER MEYER&SONS.INC.
46 CROWELL ROAD EAST P.O.BOX 981
FALMOUTH, MA 02536 EAST SANDWICH,MA 02537
Phone: 508-362-2922
Type of Buildiog:Dwelling Lot Siu:6,534.00 Acres
DwelGng-No.ot Bedrooms:3 Garbage Grinder:
Other Type oFBuilding: No.of persons: Showers:
Other Fiatures:
Plan Date:07/16@015 Number of Sheets:2 Cafeteria:
Tit1e:PROPOSED SEPTTC SYS1'EM UPGRADE PLAN 26 GARDINER LANE Revision Date:
Desigo Flow(min.requircd):330 gpd Calculated design 11ow:330 gpd Design flow provided:336 gpd
Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluaror. Date of Evaluation:06/24/2015 �
DARREN MEYER,R.S.
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPT[C DISPOSAL-REPAIR-PROPOSED 1500/500 GAL SEPTIC TANK/PUMP
CHAMBER COMBINATION WATERPROOFED TANK,DBOX,24 QUICK 4 STANDARD LOW PROFILE INFILTRATORS W/OUT
' STONE:24'X 1132'X 3"
The undersignetl agrees to install the above described Individual Sewage Disposal System in aeeortlanee with the provisions of
TITLE 5 and further aarees not to olace in ooeration until a Cerlifieate of Comoliance has 6een iasued bv the Board of Heakh.
Signed Date
Inspections
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA F�
DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00
Permission is hereby granted to;
RANGER CONSTRUCTION, 46 CROWELL ROAD, EAST FALMOUTH, MA 02536
To perform: Upgrade an individual sewage disposal system.
Owner. PISELLI LAWRENCE A TRS
PISELLI ENIS C
17 WISWALL ST
WESTNEWTON,MA 02165-2105
Location: 26 GARDINER LN, SOUTH YARMOUTH, MA 02664
Disposal System Construction Permit No.: BOHDC-15-4419 , Dated: August 28,2015
Provided: Construction shall be completed within six months of ffie date of this permit. All local eonditions must be met.
CONDITIONS:
1.SEPTIC DISPOSAL-REPAIR-PROPOSED 1500/500 GAL SEPTIC TANK/PUMP CHAMBER
COMBINATION WATERPROOFED TANK, DBOX, 24 QUICK 4 STANDARD LOW PROFILE
INFILTRATORS W/OUT STONE: 24'X 11.32'X 3"
2. BOH TO INSPECT SOIL REMOVAL
3. ELECTRICTAL PERMIT REQUIRED
4. MFC VARIANCE APPROVAL a. FOUNDATION SETBACK
Bruce G. Murph ,�s�/�von Hone, R.S., CHO
� Health Director/Assistant Health Director
- The issuance of this permit s6a11 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 E55.00
Description of Work:Complete System
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:RANGER CONSTRUCTION
at:26 GARDINER LN,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-15-4419,dated 09/21/2015.
Installer:RANGER CONSTRUCTION
Address:46 CROWELL ROAD EAST FALMOUTH, Inspector:AMY VON HONE,R.S.
MA 02536
Designer.MEYER&SONS,INC.
C V������
Bruce G.� y,MPH, 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.
BOH_Disposal_Construdion_CofC.rpt