HomeMy WebLinkAboutApp-Permit-ComplianceNo. OT1IDC-`I —19177
16 — e/
T16 FEE t �,00
COMMONWEALTH Of MASSACHUSETTS � � �D 3 q q3 c�"�
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Board of Health, 11Ti , km -
APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTI®N PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrad�Abandon( ) -'0 Complete System O Individual Components
Location �� ('
Owner's Name CA
Map/Parcel# 6 P� Z
Address EGiI� �(
Lot#
Telephone# 50p - -79 -- i' 9
Installer's Name -A
Designer's Name DO w (�
Address i 'T�a b( -,((- 1-n
Address 93 LMCI - ctl- mo-tqbR2
Telephone# �� _ <�
Telephone#
Type of Building L66 L.ot Size 0Z— sq. ft.
Dwelling - No. of Bedrooms Garbage grinder ( )
Other - Type of Building No. of persons Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow ( in. required) �� gpd Calculated design flow Design flow provided gpd
Plan: Date �z8 1 Number of sheets Revision Date
Title
Description of Soil(s)
Soil Evaluator Form No. Name of Soil Evaluator 1 Date of Evaluation T7
DESCRIPTION OF REPAIRS OR ALTERATIONS i 6 DO �cd H t0 C;Ppf t<- +O is tf VJ U(:jJX
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agree not to place syste operation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date x 115
. Inspections
mid. FEE .00
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COMMONWEALTH Of MAS$ CHUSETT���-
�` law
Board of Health, ,'.6UT7I- , MA.
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CERTIFICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) a<70-mplete System
The undersigned hereby certify that the Sewage Disposal Sstem; Constructed,,( ), Repaired ( ), Upgraded.j�-�Abandoned ( )
by: .r 13 Ek( -ova -hon N;.
at S r-hrikl ReuD
has been installeetn accordance ith the provisions of 310 CMR 15.00 (Title 5) and t e approyed-degignplans/as-built plans relating to
J.�
application -No. —6, dated Approved Design Flow (gpd)
I
Installer (] V
s /
Designer: �(� 11� ! ;1 �( i��;_Q 7 ! lGi Inspector:' Ut -Date: f —/5 -/Ay
The issuance of this permit shall not be construed as a guarantee at the 4em will function as designed
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No. 6 6 i-1 C. -J5- 16 a 17 FEE
�— COMMONWEALTH Of MASSACHUSETTS 3 S�
Board of Health, jVI 6 l��T i , MA.
➢DISPOSALSTST CONSTRUCTION PERMIT
Permission is herebygranted to; Construct( ) Repair( ) Upgrade( Abandon( ),an individual sewage disposal system
at 14q c.1 C K 1f-"nI 1 as described in the application for
Disposal System Construction Permit No. 16 'd/ , dated / ` 4 �6 .
Provided: Construction shall be completed withi>e-�ea��srof the date of this permit.; All local conditions must be met.
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4
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown, MA Date Board of Health
� No.:BOHDGIS-6177
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: 48 EAR�Y RED BERRY LN,YARMOUTH, MA 02675 Owner:
MANN FRANCES L
Map/Parcel#: 115.192 GO KAREN MACTAVISH
PO BOX 112
DOVER,MA 02030-0112
Phone:
Septic System Installer Designer
B&B EXCAVATION DOWN CAPE ENGINEERING
14 TEABERRY LANE FORESTDALE, 939 ROUTE 6A
MA 02644 YARMOUTHPORT,MA 02675
Phone: 508-362-4541
5084770653
Type of Building:Dwelling Lot Size: 10,019.00 Sq.Ft.
Dwelling-No.of Bedrooms:2 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Fixtures:
Plan Date:09/28/2015 Number of Sheets: 1
Cafeteria:
Tit1e:TITLE 5 SITE PLAN 48 EARLY RED BERRY LANE Revision Date: 12/28/2015
' Design Flow(min.required):220 gpd Calculated design flow:220 gpd Design flow provided:349 gpd
Description of Soi1s:SEE PLAN
` Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:09/17/2015
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:2S 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 Heakh.
Signed Date
Inspections
i
I
Commonwealth of Massachusetts
, ° Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT ass.00
Permission is herby granted to;
B&B EXCAVATION, 14 TEABERRY LANE, FORESTDALE,MA 02644
To perform:Upgrade an individual sewage disposal system.
Owner: MANN FRANCES L
C/O KAREN MACTAVISH
PO BOX 112
DOVER,MA 02030-0112
Location:48 EARLY RED BERRY LN,YARMOUTH,MA 02675
Disposal System Construction Permit No.: BOHDC-15-617'7,Dated:January 04,2016
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,2-500 GAL PRECAST
CHAMBERS W/4'STONE:25'X 12.83'X 2'
2.ZONE II MAXIMUM 2 BEDROOMS
3. MFC VARIANCE APPROVALS: a. SETBACKS
4.SLEEVE SEWER LINE OVER WATER LINE CROSSINGS
�
Bruce G. Mu y, MPH, R.S., CHO/Amy L.von Hone, R.S., CHO
�' ealth Director/Assistant Health Director
The issuance of this permit shall not be construed as a guarantee that the system wili function as designed.
1
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
CERTIFICATE OF COMPLIANCE ass.00
Description of Wark:Complete System
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:B&B EXCAVATION
at:48 EARLY RED BERRY LN,YARMOUTH,MA 02675
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-15-6177,dated Ol/15/2016.
Installer:B&B EXCAVATION
Address:l4 TEABERRY LANE FORESTDALE,MA Inspector:AMY VON HONE,R.S.
02644
Designer:DOWN CAPE ENGINEERING
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.ZONE II MAXIMUM 2 BEDROOMS
3.MFC VARIANCE APPROVALS:a.SETBACKS
4.SLEEVE SEWER LINE OVER WATER LINE CROSSINGS
` (��(
Bruce G. Murp , 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.
BO H_Disposal_Construction_CofC.rpt