HomeMy WebLinkAboutApp-Permit-ComplianceNo. FEE 5 65� 0
COMMONWEAI.TH Of MASSACHUSETTS
Board of Health, Y89MOU1 NM.
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APPLICATION FOR DISPOSAL SYSTEM CO TRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) - Complete System U Individual Components
Location
Owner's Name
Map/Parcel#
xlwd 4
Address
Lot#
Telephone#
Installer's Name
Aj
Desizner's Name
AddressC
-
Address
Telephone#
oel -I-
Telephone#
Type of Building Lot Size sq. ft.
Dwelling - No. of Bedrooms Garbage grinder(
Other - Type of Building No. of persons Showers ( ), Cafeteria
Other Fixtures
Design Flow (min. required) 3Yo — gpd Calculated design flow
Plan: Date IT 17- IT Number of sheets
Title
Description of Soil(s)
Soil Evaluator Form No.
DESCRIPTION OF REPAIRS OR ALTERATIONS
Name of Soil Evaluator
OAR i e
V
Design flow provided -0 1>gpd
Revision Date
Date of Evaluation / -2---?— 15
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to n=oplac the sysjtEMj&operation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date 12,
Inspections
No. 4(o - FEE
COMMON WEALT140UMA-SSAC14USETTS)6 f-0 A 1.1
Board of Health,6 tM MA. CWAI
CERTIFICATE OF COMPLIANCE
Description of Work: LJ Individual Component(s) 8 Complete System
The undersigned hereby
by: of
at
has been insta le in
application No.
Installer
certify hat the Sewag�e Disposal Systega; Constructed Repaired Upgraded -Abandoned
4-iae-,P��!,o-,isions of 310 CMR 15.00 (Tide 5) and thne,4pproved design plans/as-built plans relating to
ce
dated 2 Approved Design Flow (gpd)
P CO- 7t.
Designer: Z--,a,*V1a,1 Inspector: L61 rC-IW�CM-t"' Date: ljj�= --A-7 -/S-
The issuance of this permit shall not be construed as a guar teeat the system will function as designed.
No. FEE 100
74 COMMONWEALTH Of MASSAC14USETTS CAI* (0 35?1
Board of Health, AM.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct Repair( ) Upgrade( Abandon( ) an individual sewage disposal system
at <;,e i, as described in the application for
Disposal System Construction Permit No. dated
Provided: Construction shall be completed within three years of the date of this permit. 26dl 1pcal conditions mWst be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date Board of Health
No.:BOHDC-15-6385
` Commonwealth of Massachusetts Fee
$55.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Complete System
Location: 1 SPRUCE ST, SOUTH YARMOUTH, MA 02664 Owner:
OLIVER SALLY L TR '
Map/Parcel#:041.35 OLIVER 1 SPRUCE RLTY TRUST
50 PRINDMLLE AVE
FRAMINGHAM,MA 01702
Phone:
Septic System Installer Designer
BOSETTI SEPTIC RONALD J.CADILLAC.PLS,RS.PC '
199 CHURCH STREET EAST P.O.BOX 258 '.
HARWICH, MA 02645 WEST YARMOUTH,MA 02673
Phone: 508-775-9700
5084300812
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Type of Building:Dwelling Lot Size: 10,890.00 Sq.Ft.
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Fixtures: '
Plan Date: 12/17/2015 Number of Sheets: 1 '
Cafeteria:
Tit1e:SITE PLAN 1 SPRUCE STREET Revision Date: '
Design Flow(min.required):330 gpd Calculated design flow:330 gpd Design flow provided:345 gpd
� Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation: 12/03/2015
RONALD J.CADILLAC,RS
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,12
ARC 36HC CHAMBERS W/OUT STONE IN TRENCH FORMATION:2 TRENCHES 30'X 2.89'X 0.89'
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of
TITLE 5 and further aarees not to olace in ooeration until a Certificate of Comoliance has been issued 6v the Board of Heakh.
Signed Date
Inspections ,
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Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT $55.00
Permission is herby granted to;
BOSETTI SEPTIC SYSTEMS, 199 CHURCH STREET, EAST HARWICH, MA 02645 '
To perform:Upgrade an individual sewage disposal system.
Owner: OLIVER SALLY L TR
OLIVER 1 SPRUCE RLTY TRUST
50 PRINDIVILLE AVE
FRAMINGHAM,MA 01702
Location: 1 SPRUCE ST, SOUTH YARMOUTH,MA 02664
Disposal System Construction Permit No.: BOHDC-15-6385,Dated:December 22,2015
Provided:Construction 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, 12 ARC 36HC CHAMBERS i
W/OUT STONE IN TRENCH FORMATION:2 TRENCHES 30'X 2.89'X 0.89' '
(
Bruce G. Murph , P , R.S., CHO/Amy L.von Hone, R.S.,CHO ',
Ith Director/Assistant Health Director
The issuance of this permit shall not be construed as a guarantee that the system will function as designed. '
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Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
CERTIFICATE OF COMPLIANCE $55.00
Description of Work:Complete System
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:BOSETTI SEPTIC SYSTEMS
at: 1 SPRUCE ST,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-15-6385,dated 12/29/2015.
Installer:BOSETTI SEPTIC SYSTEMS
Address:199 CHURCH STREET EAST HARWICH,MA Inspector:AMY VON HONE,R.S.
02645
Designer:RONALD J.CADILLAC,PLS,RS,PC
Conditions
1.SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,12 ARC 36HC
CHAMBERS W/OUT STONE IN TRENCH FORMATION:2 TR NCHES 3 ' .89'X 0.89' '
Bruce G. rph ,MPH, R.S., CHO/Amy L.von Hone, R.S., CHO
Heaith Director/Assistant Health Director
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
BOH_Disposal_Construction_CofC.rpt
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