HomeMy WebLinkAboutApp-Permit-ComplianceNo. O SDC—,5'' 0 � � � � � ''O`����fy FEE
COMMONWEALTH OF MASSAC14USETTS
Board of Health, YA&tA0 0--14 , MA.
APPLICATION F®P, DISPOSAL SYSTLM[ CONSTRUCTION PERMIT
t Application for a Permit to Construct( ) Repair(4/Upgrade( ) Abandon( ) - ❑ Complete System individual Components
Location t- O% �-
Owner's Name 1
Map/Parcel# i0b
Address
Lot#
Telephone#
Installer's Name �Ja
Designer's Name J-rG
Address l "" 91 r
Address ,3? )%1 1,7
Telephone# 6b% -,),)/"3r 0Z44V9
Telephone# � �� 'S!/
Type of Building
Dwelling - No. of Bedrooms
Other - Type of Building _
Lot Size �6 �%� sq. ft.
Garbage grinder ( )
No. of persons Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow (min. required) 33 gpd Calculated design flow Design flow provided gpd
Plan: Date gilt., i Y. oho 15 Number of sheets � Revision Date
Title
Description of Soil(s) 5" S ll
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation
The undersigned agrees to install ve described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to not topl e spKm in operation until a Certificate of Com fiance has been issued by the Board of Health.
Signed Date C 4
Inspection
No. L+ EE
COMMONWEALT14 Of MASSACHUSET�S -2
Board of Health,
CERTIFICATE Of COMPLIANCE NCE /err -Fe
Description of Work: t"dividual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired (Upgraded ( ), Abandoned ( )
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at ' i' ��G1 t'��,r:, t�'�ra er'.�>. 7`l� i r'� T- '`-i �t i` coir �e_-1a��� �
has been installed in accor`lc ante ith the" ro ,isions of 3.10 CMR 15.00 (Title 5) and thea proved design plans/as-built plans relating to
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application No. ./ ^'i`y `, dated % ` / "" � . Approved Design Flow /y (gpd) : +
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Installer �Z:r 44, / 3: _% 'gr ��, rt. � i i; Ro ett L.® /a/u) w,� / �i� .
Designer: �!/ rr ia�r if�� �" Inspector: Date:
The issuance of this permit shall not be construed as a pwautee that the system will function as •designed. M
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No. 5 011 j%'L.. J S q �2� ls�}---r D L_o ' FEE 00
0 COMMONWEALTH OF MASSACHUSETTS
Board of Health, MA.
DISPOSAL SYSTLM[ CONSTRUCTION PERMIT
Perlm�-Dission is herebygranted to; Construct(
at ! t 0-1t b dr r,r , ., m � ; r,
) Repaire Upgrade( ) Abandon( ) an individual sewage disposal system
as described in the application for
Disposal System Construction Permit No. % 1 dated
Provided: Construction shall be comp eted within tl4�ee-ymstf the date of this permiit. All local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown, MA Date r� / Board of Health
1
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i - No.:BOHDC-15-4023
� Commonwealth of Massachusetts Fee
$55.00
; . Board of Health, Yarmouth, MA
� APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Individual Component(s)
� Location: 7 PARSONAGE POINT,YARMOUTH,MA 02675 Owner:
WALSH TTMOTHY J
Map/Parcel#: 106.34 25 GLENDALE AVE
SOMERVILLE,MA 02144
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Phone:
Septic System Installer Designer
BORTOLOTTI DOWN CAPE ENGINEERING.INC.
P.O. BOX 704 MARSTONS MILLS, MA 939 ROUTE 6A
� 02�$ YARMOUTHPORT,MA 02675
Phone: 508-362-4541
I Type of Building:Dwelling Lot Size: 18,731.00 Acres
,i
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Ot6er Figtures:
Plan Date:07/14/2015 Number of Sheets: 1 Cafeteria:
Title:TITLE 5 SITE PLAN 7 PARSONAGE POINT Revision Date:
Design Flow(min.required):330 gpd Calculated design flow:330 gpd Design flow provided:349 gpd
Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:06/18/2015
DANIEL GONSALVES,SE
' � DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-EXISTING 1000 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
Inspections
,
t
� .
a Commonwealth of Massachusetts
i -
I " Board of�Iealth, Yarmouth, MA Fee
� ` DISPOSAL SYSTEM CONSTRUCTION PERMIT 555.00
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� Permission is herby granted to;
BORTOLOTTI CONSTRUCTION INC., P.O. BOX 704, MARSTONS MILLS, MA 02648
To perform:Upgrade an individual sewage disposal system.
I'I Owner: WALSH TTMOTHY J
� 25 GLENDALE AVE
SOMERVILLE,MA 02144
Location:7 PARSONAGE POINT,YARMOUTH,MA 02675
Disposal System Construction Permit No.: BOHDGIS-4023,Dated: September 18,2015
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, DBOX,2-500 GAL PRECAST
CHAMBERS W/4'STONE:25'X 12.83'X 2'
2.ZONE 11 MAXIMUM 3 BEDROOMS
3. MFC VARIANCE APPROVAL:a. FOUNDATION SETBACK
V �
Bruce G. urphy,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.
�
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� � Commonwealth of Massachusetts
� Board of Health, Yarmouth, MA Fee
' � CERTIFICATE OF COMPLIANCE $55.00
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Description of Work:Individual Component(s)
The undersigned hereby certify that the Sewage Disposal System; Upgraded
i
by:BORTOLOTTI CONSTRUCTION INC.
at: 7 PARSONAGE POINT,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-15-4023,dated 11/13/2015.
Installer:BORTOLOTTI CONSTRUCTION INC.
Address:P.O.BOX 704 MARSTONS MILLS,MA Inspector:AMY VON HONE,R.S.
02648
Designer:DOWN CAPE ENGINEERING,INC.
� �
Bruce G. Murphy,,� P , R.S.,CHO/Amy L.von Hone, R.S.,CHO
� Health Director/Assistant Health Director
The issuance of t6is permit shall not be construed as a guarantee that the system will function as designed.
BO H_Disposal_Construction_CofC.rpt