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HomeMy WebLinkAboutApp-Permit-Compliancejr I �7 No.i� 47 C -I S�C�t J y f 3 ✓ FEE53� 00 I-®NINI®N LTLI ®kSS�IIUS�TTS� I Board of Health,:ar(L, MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTI®N PERMIT Application for a Permit to ConstructVRepair( ) Upgrade( ) Abandon( ) - 2 omplete System ❑ Individual Components Location j' 8 ,htu 6 k ft Owner's Name !i f Ge ar y Map/Parcel# �� Address oAlN Lot# 5, Telephone# Installer's Name 1 e 13 © � -/% Designer's Name Address S — a ` lle A Address Telephone# a & w. VI t, Telephone# Type of Building Dwelling - No. of Bedrooms Other - Type of Building _ Lot Size � � sq. ft. Garbage grinder ( ) No. of persons Showers ( ), Cafeteria ( ) Other Fixtures Design Flow (min. required) gpd Calculated design flow Design flow provided' gpd Plan: Date .o w s, Number of sheets "Z' Revision Date Title Description of Soil(s) _ Soil Evaluator Form No 3". DESCRIPTION OF REPAIRS Name of Soil Evaluator Date of Evaluation _/" / �— Pel Z1�s���/.f x,14 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 cyst in operation until a Certificate of Compliance has been issued `'byytthe Board of Health. tr Signed ,: Dater a(s� �� 1 oN L/ I y OKI rut) Inspections u e 5r�nIle- Y jNfe. tL14 q_et;oPL.. 0 No. FEE:.7-� /�- COMMONWEALTH OF MASSACHUSETTS � . _C� �/a 1 Board of Health, YAP -Mo u- f•�r , MA. l S a Q _ >' � CERTIFI ATE OF COMPLIANCE Description of Work: Ll Individual Component(s) ® Complete System The undersigned hereby fe)tify th(�t the Syage Disposal Sy tem; Constructed ( ), Repaired ( ), Upgraded-( by: vi t� is ✓ G -'1 has been installed in a o dance wit the ovisi�us_of 0 CMR 15.00 (Title 5) and e approved design plans/as-built plans relating to application No. %� /dated � � Approved Design Flow "_(gpd) Installer✓l7I d Designer- j i' c Inspector: �``� Dater ° f The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. V� t,.' # �..�i Q FEE COMMONWEALTH OF MASS, CHUSTTS' Board of Health, Yom, OTM DISPOSAL° SYSTEM C®NSTRUCTIQN, PERMIT Permission is hereby granted to;LCons uct ) Repair( ) Upgrade(.Abandon( ) an individual sewage disposal system at��'t/ .� L� dfl—I Jif Disposal System Construction Permit No. 6 ,dated Sf /� `4 >. as described in the application for Provided: Construction shall be completed within three years of the date of this peTit! All local conditions must be met. Form 1255 Rev. 5196 A.M. Sulkin Co. Chadestown, MA Date<—f - f Board of He th C --�- /,,A f `l.,�rt j p) ,y f ,�r1 r t Gy_I -A �.-; No.:BOHDC-75-2157 " 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: 58 NANTUCKET AVE, SOUTH YARMOUTH, MA 02664 Owner: . GEARY PATRICIA R Map/Parcel#: 033.149 605 M[DDLE ST UNIT 5 BRAINTREE,MA 02184 Phone: Septic System Installer Designer BOSETTI SEPTTC MORAN ENGINEERING ASSOC.,LLC 199 CHURCH STREET EAST 941 ROUTE 28 HARWICH, MA 02645 HARWICH,MA 02645 Phone: (508k432-2878 Type of Building:Dwelling Lot Size:9,583.20 Acres Dwelling-No.of Bedrooros:3 Garbage Grinder: Other Type of Building: No.of persons: Showers: Other Fiatures: Plan Date:03/10/2015 Number of S6eets:2 Cafeteria: Tit1e:SEPTIC SYSTEM DESIGN PLAN 58 NANTOCKET AVEN[JE Revision Date:04@3/2015 Design Flow(min.required):330 gpd Calculated design tlow:330 gpd Design flow provided:335 gpd Description oF SoiIs:SEE PLAN Soil Evaluator Form No.: Naroe of Soil Evaluator: Date of Evaluation:Ol/15/2015 DAN CROTEAU,P.E. DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR- I500 GAL WATERPROOFED SEPTIC TANK, 1000 GAL WATERPROOFED PUMP CHAMBER,DBOX,24 QUICK 4 PLUS STANDARD LOW PROFILE INFILTRATORS W/OUT STONE: 17'X , 16'X3" The undersigned agrees to install the above tlescribed Indivldual Sewage Dispoaal System in accordance wifh the provisions of TITLE 5 and further aarees not to olace in ooeration until a CertHicate of Comoliance has heen issued 6v the Baard of Heatth. Signed Date Inspections Commonwealth of Massachusetts Board of Health, Yarmouth, l�ili Fee DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00 Permission is herby granted to; BOSETTI SEPTIC SYSTEMS, 199 CHURCH STREET, EAST HARWICH, MA 02645 To perform:Upgrade an individual sewage disposal system. Owner. GEARY PATRICIA R 605 MIDDLE ST UNIT 5 BRAINTREE,MA 02184 Location:58 NANTUCKET AVE,SOUTH YARMOUTH,MA 02664 Disposal System Construction Permit No.: BOHDGIS-2157,Dated: May I5,2015 Provided:Construction shall be completed within six months of the date of this permit. All local conditions must be met. CondiHons 1. REPAIR-1500 GAL WATERPROOFED SEPTIC TANK, 1000 GAL WATERPROOFED PUMP CHAMBER, DBOX, 24 QUICK 4 PL US ST,9IVDARD LOW PROFILE INFILTRATORS W/OUT STONE: 17'X16'X3" 2. BOH TO INSPECT SOIL REMOVAL (A LAYER ONLY) 3. ELECTRICAL PERMIT REQUIRED Bruce G. rph , 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 funMion as designed. Commonwealth of Massachusetts Board of Health, Yarmouth, MA F� CERTIFICATE OF COMPLIANCE ass.00 Description of Work:Complete System The undersigned hereby certify that the Sewage Disposal System; Upgraded by: BOSETTI SEPTIC SYSTEMS at:58 NANTUCKET AVE,SOUTH YARMOUTH,MA 02664 Has been insta7led 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-IS2157,dated OS/28/2015. Installer: BOSETTI SEPTIC SYSTEMS Address:199 CHURCH STREET EAST HARWICH,MA Inspector:BRUCE MURPHY,R.S. 02645 Designer:MORAN ENGINEERING ASSOC.,LLC Conditions 1.REPAIR- 1500 GAL WATERPROOFED SEPTIC TANK, 1000 GAL WATERPROOFED PUMP CHAMBER,DBOX,24 QUICK 4 PLUS STANDARD LOW PROFILE INFILTRATORS W/OUT STONE: 17'X 16'X 3" 2.BOH TO INSPECT SOIL REMOVAL(A LAYER ONL1� 3.ELECTRICAL PERMIT REQUIRED �j C Bruce G. M hy, MPH, R.S., CHO/Amy L. von Hone, R.S.,CHO Health Direc[or/Assistant Health Diredor The issuance of this permit shall not be construed as a guarantee that the system will funMion as designed. BOH_Disposal_Construction_CofC.rpt