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HomeMy WebLinkAboutApp-Permit-ComplianceIf No. 00C A 5-2117 FEE * 5(3,00 COMMONWEALTH OF MASSACHUSETTS C"��GO Board ofHealth, Q011� , MA.13 LOTO —K— APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT 0051!t Application for a Permit to Construct( ) Repair( ) Upgrade�_KAbandon( ) - .2_6111�mplete System 0 Individual Components JaA f'Location ( j Map/Parcel# ` 12-3/aacLe. 11-2 Address'44-7 R+t O q - Lot# Telephone# J g _ q Installer's Name �� Designer's Name Da Address QberAddress 939 Q Sf Telephone# 6 aL-Ltm Telephone# Type of Building— Dwelling - No. of Bedrooms Other - Type of Building _ Other Fixtures No. of persons Lot Size sq. ft. _ Garbage grinder ( ) Showers ( ), Cafeteria ( ) Design Flow (min� req � 'red) D gpd Calculated design flow Design flow provided _pd Plan: Date �I I�- Number of sheets Revision Date Title Description of Soil (s) Soil Evaluator Form No. Name of Soil Evaluator tPC, Date of Evaluation __,06 DESCRIPTION OF REPAIRS OR ALTERATIONS The undersi in ees to stall the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees ton to place th m in er tion until a Certificate LLof Compliance has been issued by the Board of Health. Signed Date J� f (I I h Inspections No. I5' COMMONWEALTH OF MASSACHUSETTS FEE � Board of Health, MA. CERTIFICATE OF COMPLIANCE Description of Work: 0 Individual Component(s) _,Q -Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded ( ), Abandoned ( ) by: (_ 1. at has been in, l�ro,�nse �ljr,�ktiq p— visions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. dated Approved Design Flow(gPd) l Installer .tet Designer: _ tInspector: (!� i_�.�i .�1 Date: The issuance of this permit ishall not be bonstruedas a guarantee that the system will function as designed. t r No. ���—I�",G-� i 11� + ISX C V Pt O J FEE (--_ COMMONWEALTH OF MASSACHUSETTS Board of Health, \ /q � , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( ) Upgrade ( ),,_Abandon( ) an individual sewage disposal system at J_ \ L--. , ► ! as described in the application for i 1; I iU v s Disposal System Construction Permit � . /`.7 9 ;, dated - i Provided: Construction shall be complieel ttl�mthreeye`a�s/of the date of this permit. All local conditions must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown, MA Date - /6 - sC Board 7 eat .r No.:BOHDGIS-2117 Commonwealth of Massachusetts Fee • 555.00 Board of Health, Yarmouth, MA ' APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT , Application for a Permit to:Upgrade-Complete System Location: 447 ROUTE 6A,YARMOUTH PORT, MA 02675 Owner: �� BIERIG BRIAN W Map/Parcel#: 123.122 BIERTG GAIL E 447 ROUTE 6A YARMOUTH PORT,MA 02675-1824 Phone: Designer Septic System Installer B&B EXCAVATION DOWN CAPE ENGINEERING.INC. 14 TEABERRY LANE FORESTDALE, 939 RTE 6A MA 02644 YARMOUTHPORT,MA 02675 Phone: (5081362-4541 Type of Building:Dwelling Lot Size:24,393.60 Acres Dwelling-No.of Bedrooms:4 Garbage Grinder: Other Type of Buildiog: No.of persons: Showers: Other Fixtures: Plan Date:OS/08/2015 Number of Sheets: 1 Cafeteria: Title:TITLE 5 SITE PLAN 447 ROUTE 6A Revision Date: Design Flow(min.required):440 gpd Caiculated design flow:440 gpd Desigo How provided:458 gpd � Description of SoiIs:SEE PLAN Soil Evaluator Form No.: Name of Soil Evaluator: Dah of Evaluation:OS/06/2015 DtWIEL GONSALVES,SE - DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-PROPOSED I500 GAL SEPTIC TANK,DBOX,21 HIGH CAPACITY INFILTRATORS W/OUT STONE:37.5'X 11.3'X 11" The undersigned agrees to install the above descrlbed Indivitlual Sewage Disposal System In aecordance wkh the provisions of • 71TLE 5 and further aarees not to olace fn ooeration untll a Certiflcate of Comollance has heen issued hv the Board of NeaRh. Signed Date Inspections Commonwealth of Massachusetts ' Board of Health, Yarmouth, MA Fee DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00 Permission is herby granted to; B&B EXCAVATION, 14 TEABERRY LANE, FORESTDALE, MA 02644 To perform: Upgrade an individual sewage disposal system. Owner. BIER[G BRIAN W BIERIG GAIL E 447 ROUTE 6A YARMOUTH PORT,MA 02675-1824 Location:447 ROUTE 6A,YARMOUTH PORT,MA 02675 Disposal System Construction Pernut No.: BOHDC-1�2117,Dated: May 19,2015 Provided: Construction shall be completed within six months of the date of this permit. All bcal conditions must be met. Conditions I. REPAIR-PROPOSED I500 GAL SEPTIC TANK, DBOX, 21 HIGH CAPACITY INFILTR4TORS W/OUT STONE.• 3 Z S'X]1.3'X Il" � �JfI Bruce G. urphy, 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.