HomeMy WebLinkAboutApp-Permit-ComplianceCOMMONWEALTH Of MASSACHUSETTS
Board of Health, )kemo , MA.
FEE ' 55- Co
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APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade.(�AbandonO - Complete System ❑ Individual Components
Location o in amnOwner's
Name
Map/Parcel# sog
Address l
Lot#
Telephone#
Installer's Name
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Designer's Name DLI-)
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Address I
Address q 9, G)IA Q (n G,t
Telephone# `7
Telephone# 50 r " (p z- 4 y
Type of Building
Dwelling - No. of Bedroo
Other - Type of Building
No. of persons
Lot Size /A w-;) sq. ft.
Garbage grinder( )
Showers ( ), Cafeteria ( )
Other Fixtures PC
Design Flow (min.required) gpd Calculated design flow Design flow provided gpd
Plan: Date cl 115Number of sheets Revision Date
Title
Description of Soil(s)
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation d
:RIPTION OF REPAIRS OR ALTERATIONS Is
2,) 1416 500ra- 1 I and-,lnc-' d
The undersi a agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further a es o t to place tem ' peration until a Certificate of ompl' ce Pals been issued by the Board of Health.
Signed Date 1
ki " o p
Inspections
No. %0!- DC (S -(o03 S FEE $ Oil
Z COMMONWEALTH Of MASSACHUSETTS (,tom 31 WO
Board of Health, Y0t9.-k1QJT14- , MA.
CERTIFICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) 2d Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded (r.4 -,Abandoned ( )
at G(7ilaI !-Sri("ot) US7. /- t -, L
has been installed in ac`c`$uilauiet wit`ll theprovisions 'of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
applicatioi�NQ. �i 2 9 Z dated ✓ L - 1 Approved Design Flow �(gpd)
Installer i l = l ) t
Designer. D (� �n Inspector: b Date: Z
The issuance of this permit shall not be construed as a guarante that the system will function as designed.
No. 150kAD('I-\cj�i-�('13 1� �ACJAVA-DON — - FEE `J a0
COMMONWEALTH Of MASSACHUSETTS (16 (,p
Board of Health, p� PYA 2M O uOr1 , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgrade („YAbandon ( ) an individual sewage disposal system
ati i i _ f) (_t� ( ” (! r) adsscribed in the application for
_ t �, J Z ,-
Disposal System Construction Permit No. >--.dated
Provided: Construction shall be completed within 6 of the dilate of this perr 't. All local conditionns/. must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA
Date/ -2 ��� Board ofHealth �� =
. No.:BOHDC-15-6035
Commonwealth of Massachusetts Fee
' ass.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Complete System
Location: 18 CAPT BACON RD, SOUTH YARMOUTH, MA 02664 Owner:
HiJDAK RONALD A
Map/Parcel#: 088.250 HiJDAK PEGGY ANN
18 CAPT BACON RD
SOUTH YARMOUTH,MA 02664
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
5084770653
Type of Building:Dwelling Lot Size: 12,197.00 Sq.Ft.
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building: No.of persons: Showers: ,
Other Fia�tures: '
Plan Date: 11/19/2015 Number of Sheets: 1 Cafeteria• I
Tit1e:TITEL 5 SITE PLAN18 CAPTAIN BACON ROAD Revision Date: • �'
, Design Flow(min.required):330 gpd Calcutated design flow:330 gpd Design flow provided:349 gpd
Description of Soiis:SEE PLAN
; Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation: 11/19/2015
CRAIG J.FERRARI,S.E.
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,2-
500 GAL PRECAST CHAMBERS W/4'STONE:25'X 12.83'X 2'
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 bv the Board of Health.
Signed Date
i
Inspections �
I
i
Commonwealth of Massachusetts
` Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT 555.00
Permission is herby granted to;
B&B EXCAVATION, 14 TEABERRY LANE, FORESTDALE, MA 02644
To perform:Upgrade an individual sewage disposal system.
Owner: HUDAK RONALD A
HUDAK PEGGY ANN
18 CAPT BACON RD
SOUTH YARMOUTH,MA 02664
Location: 18 CAPT BACON RD,SOUTH YARMOUTH,MA 02664
Disposal System Construction Permit No.: BOHDC-15-6035,Dated:December 15,2015
Provided: Construction shall be completed within six months of the date of this permit. All locai conditions must be met.
CONDITIONS:
1. SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK, DBOX,2-500 GAL PRECAST
CHAMBERS W/4'STONE:25'X 12.83'X 2'
2. MFC VARIANCE APPROVAL: a. SETBACK
�
Bruce G. Murphy, PH, R.S., CHO/Amy L.von Hone, R.S.,CHO
He Director/Assistant Health Director
The issuance of this permit shall not be coostrued 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 S55.00
Description of Work:Complete System
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:B&B EXCAVATION
at: 18 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-15-6035,dated 12/23/2015.
Installer:B&B EXCAVATION
Address:l4 TEABERRY LANE FORESTDALE,MA Inspector:AMY VON HONE,R.S.
02644
Designer:DOWN CAPE ENGINEERING,INC. ;
Conditions
1.SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,2-500 GAL '
PRECAST CHAMBERS W/4'STONE:25'X 12.83'X 2'
2.MFC VARIANCE APPROVAL: a.SETBACK
V C�l
Bruce G. rphy, 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.
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BO H_Disposal_Construction_CofC.rpt
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