HomeMy WebLinkAboutApp-Permit-ComplianceNo. Bc> c��j-b0 7-W � �� ! I Z)c � /" � FEE ��J.00
COMMONWEALTH OF MASSACHUSETTS
Board of Health, `7 -AMDOT74 , MA.
/�WICATION FOR DISPOSAL SYSTEM CONSTRUCTION ERM IT
Application for Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) - 0 Complete System Individual Components
Location
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Owner's Name
Map/Parcel#
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Address
Lot#
Telephone#
Installer's Name
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1 Designer's Name.
Addressr
��,� Address e -)�
Telephone#y3Q
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Telephone#
Type of Building Lot Size (% 9 sq. ft.
Dwelling - No. of Bedrooms Garbage grinder( }
Other - Type of Building No. of persons Showers( ), Cafeteria ( )
Other Fixtures
Design Flow (min. required) y gpd Calculated design flow Design flow provided 3 gpd
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Plait: Date S �9 Number of sheets I Revision Date
Title
Description of Soil (s) S�
Soil Evaluator Form No.
DESCRIPTION OF REPAIRS OR ALTERATIONS
Name of Soil Evaluator ✓1 Uf'al'1Pate of Evaluation
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 lace�"g�peration until a Certificate of Compliance has been issued by the Board of health.
Signed '(5 �J/ Date
No. - 6 Q 44 riG6-'(C®-3,J,}
FEE �T �Q
COMMONWEALTH OF MASSAC14USETTS
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Board of Health, MA. p" f
� / CERTIFICATE Of COMPLIANCE
Description of Work: I� Individual Component(s) 0 Complete System
The undersigned hereby certify t at t ke Sew e Disp s�l System; Constructed ( ), Repaired ( ), Upgraded �"bandoned ( }
by: , , r"
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has been installed c rcPan?e ith ei vi ions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. % dated Z / 1 Approved Design Flow a (gpd)
Installer 1z f
Designer: (9 Inspector: Date:
The issuance of this permit shall not be construed as a guarantepZat the system will function as designed.
No. i G-1 va? (iSrcCi sic -;V- tC. S,4 Z;TemS FEE � C�
COMMONWEALTH OF MASSACHUSETTS
Board of Health, �`$aM (1�, , MA.
DISPOSAL SYSTEM[ CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair(,)/ Upgrade( ) Abandon( ) an individual sewage disposal system
at ,� /Z, e r 4,1 as described in the application for
Disposal System Construction Permit Nodated .,/L- 2
Provided: (construction shall be co p �t With/1, n yy Ws�f the date of thisper l local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown, MA Date/2. J .6rd offH alalth /
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No.:BOHDGIS-6033
. Commonwealth of Massachusetts Fee
$55.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Individual Component(s) '
Location: 1 FLICKER LN,WEST YARMOUTH, MA 02673 Owner:
TATA LOUIS T
Map/Parcel#• 076.191 C/O MOULTON PATRICK&DORI
. 64 MILLER ST
FRANKLIN,MA 02038
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: 10,019.00 Sq.Ft. f
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Dwelling-No.of Bedrooms:3 Garbage Grinder: �
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Other Type of Building: No.of persons: Showers:
Other Fixtures:
Plan Date:OS/Ol/2015 Number of S6eets: 1 Cafeteria:
Tit1e:SIT'E PLAN FOR 1 FLICKER LAND Revision Date: ;
. Design Flow(min.required):330 gpd Caiculated design flow:330 gpd Design flow provided:354 gpd �
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Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:02/13/2015
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DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK,PROPOSED
DBOX,2-500 GAL PRECAST CHAMBERS W/STONE 4'ENDS,3'SIDES:29'X 11'X 2'
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance wkh the provisions of !
TITLE 5 and further aorees not to olace in ooeration until a Certificate of Comoliance has been issued bv the Board of Heakh.
Signed Date
Inspections �
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Commonwealth of Massachusetts .
Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00
Permission is herby granted to;
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BOSETTI SEPTIC SYSTEMS, 199 CHURCH STREET, EAST HARWICH, MA 02645
To perform:Upgrade an individual sewage disposal system. '
Owner: TATA LOUIS T
C/O MOULTON PATRICK&DORI ;
64 MILLER ST �
FRANKLIN,MA 02038 �
Location: 1 FLICKER LN,WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.: BOHDC-15-6033,Dated:December 02,2015 '
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-EXISTING 1000 GAL SEPTIC TANK, PROPOSED DBOX,2-500 GAL ,
PRECAST CHAMBERS W/STONE 4'ENDS,3'SIDES:29'X 11'X 2' '
2. MFC VARIANCE APPROVAL: a. SETBACKS
3.ZONE II MAXIMUM 3 BEDROOMS ;
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Bruce G. Murp ,M H, R.S.,CHO/Amy L.von Hone, R.S.,CHO
alth 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�Iealth, Yarmouth, MA Fee
CERTIFICATE OF COMPLIANCE $55.00
Description of Work:Individual Component(s)
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:BOSETTI SEPTIC SYSTEMS
at: 1 FLICKER LN,WEST YARMOUTH,MA 02673
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-15-6033,dated Ol/14/2016.
Installer:BOSETTI SEPTIC SYSTEMS '
Address:l99 CHURCH STREET EAST HARWICH,MA Inspector:AMY VON HONE,R.S.
02645
Designer:RONALD J.CADILLAC,PLS,RS,PC
Conditions
1.SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK,PROPOSED DBOX,2-
500 GAL PRECAST CHAMBERS W/STONE 4'ENDS,3'SIDES:29'X 11'X 2'
2.MFC VARIANCE APPROVAL:a.SETBACKS
3.ZONE II MAXIMUM 3 BEDROOMS }p� �A
< <.X�-
Bruce G. hy, MPH, R.S., CHO/Amy L.von Hone, R.S.,CHO
Health Director/Assistant Health Director j
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
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BOH_Disposal_Construction_CofC.rpt ;
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