HomeMy WebLinkAboutApp-Permit-ComplianceNo. 80W C -1 S-i-1 q I V
/�- -,7-Z7 COMMONWEALTH OF MASSACHUSETTS
Board of Health, YA-/L.MO , MA.
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p ication for a Permit to Construct( ) Repair(d Upgrade( Abandon( - ElComplete System Vindividual Components
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Owner's Name
ap/Parcel# /3 .—Zv>/
Address G
Lot#
Telephone# $e p -3
Installer's Name
Designer's Name S
Address y�Address
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Telephone# t -® O
�Telephone# So p 3#; —
Type of Building
Dwelling - No. of Bedrooms
Other - Type of Building _
Other Fixtures
No. of persons
LotSize �? 2, 2 / O sq. ft.
Garbage grinder (KID
Showers( ), Cafeteria ( )
Design Flow (min. required) . gpd Calculated design flow 33 6 Design flow provided
Plan: Date za — Number of sheets Revision Date
Title
Description of Soil(s) O
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SA
-T2S" gpd
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Soil Evaluator Form No. Name of Soil Evaluator -STojn_ % Date of Evaluation Z— 41%
DESCRIPTION OF REPAIRS OR ALTERATIONS i„,� s.7 / u )fir J .5" 00,.,)5t o/= 1� ,� `c..g,E✓ S-9 (f✓
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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 Vot to place the sys m in operation until a Certificate of Compliapce has been issued by the Board of Health.
Signed Date /0--,57 ^ /S
Inspections YA
No. 4�."' t 6vr N . t9 t' )" FEE
COMMONWEAI.T14 OF MASSAC14USETTS � S Nf�LA
Board of Health, �A[Zmoynl , , MA. oV�-'�ZQ���
CERTIFICATE Of COMPLIANCE
Description of Work: 12 dividual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded bandoned ( )
at
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. r '�� r7, dated A Approved Design Flow -Sd 5` (gpd)
Installer r __
Designer: f Tc,i-i <r3 .4 d Inspector: f-.s Date:
The issuance of this permit shall not be construed as a guarantee th the system will function as designed.
No. 1� " l . -{ , � Llq q FEE S�3
--� COMMONWEALT14 Of MASSAC14USETTS
Board of Health, V"IyMOO71 , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair kX Upgrade(/ " Abandon( ) an indh idual sewage disposal system
at C as described in the application for
Disposal System Construction Permit No. �� =� dated
Provided: Construction shall be completed within Qi� f the�dof this permit. All/ ll local conditions must be met.
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Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date A r - / � Board of Health
No.:BOHDGIS-4490
Commonwealth of Massachusetts Fee
� 555.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Individual Component(s)
Location: 62 HOMESTEAD LN,YARMOUTH PORT, MA 02675 Owner:
SAWYER BRADLEY C
Map/Parcel#: 132.18 SAWYER DIANA A
62 HOMESTEAD LN
�� YARMOUTHPORT,MA 02675-122t
Phone:
Septic System Installer Designer
B.C.K.GENERAI. STEPHEN HAAS,PE
� 97 TOWN BROOK ROAD WEST P.O. BOX 16
; YARMOUTH, MA 02673 SOUTH DENNIS,MA 02660
Phone:
508362-8132
Type otBuilding:Dwelling Lot Size:4Q075.00 Acres
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
� Other Fixtures:
Plao Date:09/14/2015 Number of Sheets: 1 Cafeteria:
� Tit1e:SEPTIC SYSTEM DESIGN 62 HOMESTEAD LANE Revision Dah:
Design Flow(min.required):330 gpd Calculated design Oow:330 gpd Desigu ilow provided:525 gpd
Descripfion of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluatioo:07/22/2015
� STEPHEN HAAS,PE
- DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-EXISTING]000 GAL SEPT[C TANK,H-20 DBOX,
24 HIGH CAPACITY H-20INFILTRATORS W/OUT STONE:37.5'X 12.8'X 11"
The undersigned agrees to insfall the above tleseribed Indlvldual Sewage Disposal System In accortlante wifh the provisions of
• TITLE 5 and furfher aarees not to olate in ooeration untll a Cartifitate of Comoliance has heen issuetl bv the Board of Fleakh.
Signed Date
Inspections
Commonwealth of Massachusetts
' Board of Health, Yarmouth, MA F�
DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00
Permission is herby granted to;
B.C.K. GENERAL CONTRACTOR,97 TONM BROOK ROAD,WEST YARMOUTH, MA 02673
To perform:Upgrade an individual sewage disposal system.
Owner. SAWYERBRADLEYC
SAWYER DIANA A
62 HOMESTEAD LN
YARMOUTH PORT,MA 02675-1221
Location:62 HOMESTEAD LN,YARMOUTH PORT,MA 02675
Disposal System Construction Permit No.: BOHDC-15-4490,Dated:October O5,2015
. Provided:Construction shall be completed within six months of the date of[his permi[. All bcal conditions must be met.
CONDITIONS:
� 1. SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK, H-20 DBOX,24 HIGH CAPACITY H-20
INFILTRATORS W/OUT STONE: 37.5'X 12.8'X 11"
2. MFC VARIANCE APPROVALS: a.WETLANDS SETBACK b. DEPTH
�157(i
Bruce G. u hy, 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 function as designed.
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
CERTIFICATE OF COMPLIANCE 555.00
Description of Work:Individual Component(s)
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:B.C.K. GENERAL CONTRACTOR
at:62 HOMESTEAD LN,YARMOUTH PORT,MA 02675
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-1S4490,dated 10/16/2015.
Installer:B.C.K.GENERAL CONTRACTOR
Address:97 TOWN BROOK ROAD WEST Inspector:PHILIP RENAUD
YARMOUTH MA 02673
Designer. ST�PHEN HAAS,PE
Conditions
SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK,H-20 DBOX,24 HIGH
CAPACITY H-20 INFILTRATORS W/OUT STONE:37.5'X 12.8' "
Bruce G. Mu y, PH, 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 funMion as designed.
BOH_Disposal_Construction_CofC.rpt