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HomeMy WebLinkAboutApp-Permit-Compliance7W,� L0�7- i 7 COMMONWEALTH OF MASSACHU T -S Board of Health, LfO} MQ , MA. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade( AbandonO - ID Complete System ❑ Individual Components Location Owner's Name 0 f' Map/Parcel# 79 &yz-ell 7 Address Lot# - Telephone# Installer's Name p Designer's Name Address 9 L!� rN f�46, �,+� �� Address Telephone# y b 9 Telephone# Type of Building s/ Lot Size 3Y sq. ft. Dwelling - No. of Bedrooms !r Garbage grinder ( ) Other - Type of Building No. of persons Showers( ), Cafeteria ( ) Other Fixtures Design Flow (mina required) 7, 7— p gpd Calculated design flow Design flow provided 7.70 gpd Plan: Date `' �` 13 r Number of sheets Revision Date Title Description of Soils) _ Soil Evaluator Form No. DESCRIPTION OF REPAIRS OR ALTERATIONS OF Name of Soil Evaluator go i't d, CZ Date of Evaluation / % IS 0a/s 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 p ce the s torn operation until Certificate of C7", ce has been issued by the Board of Health. z Signed 1��' + Date /-`` Jf ,�f `1Z , � at No. 15nm)C-IS-�Di'-HCl 6%� d po r 'j�, COMMONWEALTH OF MASSACH SETTS Board of Health, VAM ni ffl� , MA, CERTIFI TSE Of COMPLIANCE ©� Description of Work; El Individual Component(s) Complete System The undersigned. reby. certifyihat the Sewag Disposal S stem; (Constructed ( ), Repaired (`), Upgraded 4 ,1�6andoned ( ) at r, has been insta e rVccZa�c*e provisions of 310 CMR 15.00 (Title 5) and the a proved design plans/as-built plans relating to application No. .d ,dated - Approved Design Flow 2 r (Vd) Installer t / /l + Designer:y�� �.� ('�9 //Gr Inspector: Date`:` The issuance of this permit shall not be construed as a guaran a at ge system will function as designed. No. .. Oosi�m Sem- 5jsTF S --- FEE I SJ. 00 -7 COMMONWEALTH OF MASSACHUSETTS / 1 Board of Health, ( rw f 72M OLZDi- MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is h' erebygra%nted to Construct((4 Repair( ) Upgrade( .''Abandon( ) an individual sewage disposal system ,at T 9-ef f� G�'�, as described in the application for Cori' i ��` ` �'P��� Disposal System Costruction Permit No.�d_ -- ated Provided: Cor�trtic�in shall be compl�tediwt"tliin i� e date of this permit. All local conditions must be met. Form 1255:,Rev, 5196 A. uikin Co. ChadestoWn, MA Dat��" % BoarOfG Health . � No.:BOHDC-15-6140 . Commonwealth of Massachusetts Fee g55.00 Board of Health, Yarmouth, MA ' APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to:Upgrade-Complete System Location: 8 CAPT BESSE RD, SOUTH YARMOUTH, MA 02664 Owner: MORRIS RAYMOND V(LIFE EST) Map/Parcel#: 078.17 8 CAPT BESSE RD SOUTH YARMOUTH,MA 02664 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 ; Type of Building:Dwelling Lot Size: 11,326.00 Sq.Ft. Dwelling-No.of Bedrooms:2 Garbage Grinder: ` i Other Type of Building: No.of persons: Showers: Other Fiactures: Plan Date: 12/07/2015 Number of Sheets: 1 � Cafeteria: I Tit1e:SITE PLAN 8 CAPT.BESSE ROAD Revision Date: f , Design Flow(min.required):220 gpd Calculated design flow:220 gpd Design flow provided:230 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,8 ADS ARC 36HC iINITS W/OUT STONE:46.33'X 2.83'X 0.89' The undersigned agrees to install the above described Indfvidual 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 6een issued bv the Board of Heakh. Signed Date � � Inspecrions r I . � . Commonwealth of Massachusetts ' ` Board of Health, Yarmouth, MA Fee DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.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: MORRIS RAYMOND V(LIFE ES'1� ; 8 CAPT BESSE RD ' SOUTH YARMOUTH,MA 02664 Location: 8 CAPT BESSE RD,SOUTH YARMOUTH,MA 02664 � Disposal System Construction Permit No.: BOHDC-15-6140,Dated:December 09,2015 � 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,8 ADS ARC 36HC UNITS ': W/OUT STONE:46.33'X 2.83'X 0.89' ; I 2.ZONE II MAXIMUM 2 BEDROOMS �` ! Bruce . Mu hy, MPH, R.S., CHO/Amy L.von Hone, R.S.,CHO i Health Director/Assistant Health Director ' � The issuance of this permit shall not be construed as a guarantee that the system will function as designed. � I � � , � I h � ; i i 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: 8 CAPT BESSE 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-15-6140,dated 12/22/2015. 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-REPAIIt-PROPOSED 1500 GAL SEPTIC TANK,DBOX,8 ADS ARC 36HC UNITS W/OUT STONE:46.33'X 2.83'X 0.89' 2.ZONE II MAXIMUM 2 BEDROOMS C�/�� Bruce G. ur y,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. i { i BOH_Disposal_Construction_CofC.rpt ; i i