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HomeMy WebLinkAboutApp-Permit-ComplianceNo.✓ FEE �®NN® ITHOf MASSACHUSETTS %�� nn Board of Health, Okamo UTM , MA. -TK / (P — DD P 2,7 APPLICATION FORDISPOSAL SYSTEM CONSTRUCTI®N PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade Abandon( ) -� Complete System ❑ Individual Components Location 29 nfQ t,Owner's Name 1 Map/Parcel# p p Q%�(e 2 Address Z C n �-. 01DIC, C3 Lot# Telephone# c,2D .— 2-71) — z b Installer's Name X Designer's Name00 Wn (a" 3��InMOpvinl Address Address q39 Telephone#�� Telephone# -3 J% Type of Building Dwelling - No. of Bedrooms Other - Type of Building _ No. of persons Lot Size Z sq. ft. Garbage grinder ( ) Showers( ), Cafeteria ( ) Other Fixtures Design Flow (min. required) gpd Calculated design flow Design flow provided gpd Plan: Date ,a, I �_� Number of sheets ' Revision Date Title Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONSJS W QQ i /f /0 JT 14 l U D F-0 X 00 5® D �a1 The undersigpjcd agrees to install the above described Individual Sewage Disposal Systems�}} in accordance with the provisions of TITLE 5 and further afire s to of to place the tem in eration until a Certificate of Compliancerhas been issued by the Board of Health. Signed Date _2Z�, Inspections rM No. &IJ+Yc . S-- 4O� FEE _J; Q 0 C7 COMMONWEALTH OF MASSAC14USETTS a Board of Health, YA-IZIW101>n CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) _a Complete System The undersig d hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( )> Upgraded,„(..- Abandoned ( ) by: � A ( at 2.9 1 n to 0 has been instalte`din a�cord�nceViOtht?ro��si-Qns of `310 CMR 15.00 (Title 5) and the a proved design plans/as-built plans relating to application -No. �� dated '-�� .� Approved Design now gpd) Installer , o i_:r.�f Lr --UL% Designer: %LQ k 2X,r� C� Inspector:1t�r..,P�l.' _ Date: i©.f%vl 6— The issuance of this permit shall not be construed as a guarantee that C, system will function as designed.— 0 Ct00000.iJy�U_q il.L7.s2.a C, U G O 000 U 0 0 V U O OC OOOiJO00G 00000(]OU000OO GODUOUO� ]"uil C'OOCO• _ :JGO GOO'OJGGOCt0000ODUUi v"' 70�`GUG 00000000 GGC)0000000v000p 0000001 No. botTpc".��J"ti ... L> at..�P"7 Y An 6 1 til FEE COMMO,,NWEAL114 Of MASSACHUSETTS 'S Board of Health, YAP4tOO + , MA. i-_ DISPOSAL SYSTEM C®NSTR TION PERMIT Permission is hereby granted t�Construct( ) Repair( ) Upgrade Abandon( ) an individual sewage disposal system at z,?S /�� ( ! '"i ((C as described in the application for Disposal System Construction Permit No. /�� ��� dated ..� Provided: Construction shall be completed within thre�r�S of the date �of this per �.All' local conditions ust be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown, tin Date --� 17 Board of � / ' No.: BOHDC-15-4483 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: 28 CAPT BACON RD, SOUTH YARMOUTH, MA 02664 Owner: DIMAIO MARY 1 Map/Parcel#: 088248 C/O WILLIAM DIMAIO 12 ORCIfARD ST BYFIELD,MA 01922 Phone: Septic System Installer Designer B&B EXCAVATION DOWN CAPE ENGINEERING.INC. 14 TEABERRY LANE FORESTDALE, � 939 ROUTE 6A MA 02644 YARMOUTHPORT,MA 02675 Phone: 508-362-4541 Type of Building:Dwelling Lot Siu:24,394.00 Acres DwelGng-No.o[Bedrooms:5 Garbage Grinder: Other Type of Building: No.of persons: Showers: Other Fatures: Plan Date:08/21/2015 Number of Shcets: 1 Cafehria: TitIe:77TT.E 5 SITE PLAN 28 CAPTAIN BACON ROAD Revision Date:08/28/2015 Design Flow(min.required):550 gpd Calwlahd design Oow:550 gpd Design tlow provided:561 gpd DescripNon of Soi1s:SEE PLAN Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:08/19/2015 DANIEL GONSALVES,SE DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,4- 500 GAL PRECAST CHAMBERS W/4'STONE:42'X 12.83'X 2' • The untleraigrretl agrees to install the above deseribeA Intlivitlual3ewage Disposal System In accordance wifh the provisions of TITLE 6 and furfher aarees not to olace in ooerotion until a CaRifieafe ef Comoliance has heen Issued bv the Board of Heakh. Signed Date Inspec6ons . � Commonwealth of Massachusetts • Board of Health, Yarmouth, MA FeB DISPOSAL SYSTEM CONSTRUCTION PERMIT sss•oo Permission is herby granted to; B&B EXCAVATION, 14 TEABERRY LANE, FORESTDALE, MA 02644 To perform:Upgrade an individual sewage disposal system. Owner: DIMAIO MARY J C/O WILLIAM DIMAIO 12 ORCHARD ST BYFIELD,MA 01922 Location:28 CAPT BACON RD,SOUTH YARMOUTH,MA 02664 Disposal System Construction Permit No.: BOHDG1S4483,Dated: September 29,2015 Provided:ConsUvction shall be completed within six months of the date of this permit. All local conditions must be met. CONDITIONS: 1.SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK, DBOX,4-500 GAL PRECAST CHAMBERS W/4'STONE:42'X 12.83'X 2' 2. PORTION OF LOT IN ZONE II INCLUDING LOCATION OF LEACH FACILITY-M IMUM 5 BEDROOMS ���� Bruce G. h , MPH, R.S., CHO/Amy L.von Hone, R.S., CHO Health Director/Assistant Health Director The issuance of this permit s6a11 not be construed as a gu rantee that the system will funMion as designed. Commonwealth of Massachusetts Board of Health, Yarmouth, MA F� CERTIFICATE OF COMPLIANCE E55.00 Description of Work:Complete System The undersigned hereby ceRify that the Sewage Disposal System; Upgraded by:B&B EXCAVATION at:28 CAPT BACON 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-IS4483,dated 10/14/2015. Installer:B&B EXCAVATION Address:l4 TEABERRY LANE FORESTDALE,MA Inspector:PHILIP RENAUD 02644 Designer:DOWN CAPE ENGINEERING,INC. Bruce G. Murph ,M , 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 guarant that the system will fuoction as designed. BOH_Disposal_Construdion_CoTC.rpt