HomeMy WebLinkAboutApp-Permit-ComplianceNo. Bo yyDc -15 V LD t ICS -16-00-34 2,L( FEE
COMMONWEALTH Of MASSACHUSETTS
Board of Health, Y/41eM07-4, MA.
l l I APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade(, Abandon( ) - adoomplete System D Individual Components
Location /
r f- Owner's Name
Map/Parcel# 2—
Address pue—&LA Vo it f n-0 f
Lot#
Telephone# 26 1� 9
Installer's iucNado
Designer's Name
U 21
Address ! fw-be"Address
9 3q --,L4Q l R -5f
Telephone# �- 7'� — 6Telephone#
5Q9-,3&2 �-' 6
Type of Building RS Lot.Size �i 0 sq. ft.
Dwelling - No. of Bedrooms Garbage grinder( )
Other - Type of Building No. of persons Showers ( ) , Cafeteria ( )
Other Fixtures
Design Flow (min. required) �� gpd Calculated design flow Design flow provided gpd
Plan: Date Number of sheets Revision Date
Title
Description of Soil(s) tt
Soil Evaluator Form No. Name of Soil Evaluator EW 06Li [Vee Date of Evaluation 11 5
DESCRIPTION OF REPAIRS OR ALTERATIONS ft1 D 1571 f+l b 6-bQ X (11,) ii . I (1 �1 I f c fig `5
r-e,Cf )`/:P 1105, i11ab ( D I L J) EAU -3 7-Z
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agre t n t to place tem ' eration until a Certificate of om liance has been issued by the Board of Health.
Signed)L,4 Date _
Inspections
No. �V�'A _ FEE 0�
COMMONWEALTH Of MASSACHUSETTS �3219
Board of Health, yy4EM 0 0774 , MA. ;
CERTIFICATE Of COMPLIANCE
Description of Work:
The ur rs W het
at O 1
has been installe in
applicatiox)-No.
❑ Individual Component(s) UMomplete System
�y certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded (-)-,-Abandoned ( )
-j� rn,/n-A(t-)r i
r n e 'th e pro��sions of 310 CMR 15.00 (Title 5) and the proved design plans/as-built plans relating to
f', dated ��. '� 7 Approved Design Flow and
Installer t U 4-39
Designer:)4tit tri�a�f
Inspector: :.s G Date:
/ I
The issuance of this permit shall not be construed as a guaiee that the system will function as designed.
No. I t. -- E-� j / FEE 55• `"0
-� 9y /
COMMONWEALTH OF MASSACHUSETTS
Board of Health, YAIZM Q % , MA.
DISPOSAL SYSTEM[ CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgrade(/r Abandon( ) an individual sewage disposal system
at f ! s 1 l ( - as described in the application for
i
Disposal System Construction Permit No./; :: �1, dated
-7
Provided: Construction shall be completed within tkia: x -q f the date of this permit. Adl,115cal conditions m st be met.
Form 1255 Rev.. 5/96 A.M. Sulkin Co. Chadestown, MA Date ^�7 "� /Board of Health
vt/ '-7. l.��fn' '.'/ ;;•' �i,n/A / 11i/A,4,4✓A® 11,111114,1
No.:BOHDC-15-6287
' Commonwealth of Massachusetts Fee
$55.00
Board of�Iealth, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Complete System
Location: 17 ROUTE 6A,YARMOUTH PORT, MA 02675 Owner:
ANGELLIS PHILIP M
Map/Parcel#: 112.24 ANGELLIS CATHY Z
109 SIMONDS RD
LEXINGTON,MA 02173-1620
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:6,970.00 Sq.Ft.
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Fixtures:
Plan Date: 10/29/2015 Number of Sheets: 1 Cafeteria•
Title:TITLE 5 SITE PLAN 17 ROUTE 6A Revision Date: 12/16/2015 •
� 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: 10/14/2015
DANIEL GONSALVES,SE
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SETPIC TANK,DBOX,16
HIGH CAPACITY H-20 UNITS W/OUT STONE:25'X 11.3'X 11°
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 Com�liance has been issued bv the Board of Heakh.
Signed Date
Inspections
.
� � Commonwealth of Massachusetts
� Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT 555.00
I
I
Permission is herby granted to;
B&B EXCAVATION, 14 TEABERRY LANE, FORESTDALE, MA 02644
To perform:Upgrade an individual sewage disposal system.
Owner: ANGELLIS PHILIP M
ANGELLIS CATHY Z
109 SIMONDS RD
LEXINGTON,MA 02173-1620
Location: 17 ROUTE 6A,YARMOUTH PORT,MA 02675
Disposal System Construction Permit No.: BOHDGIS-6287,Dated:December 17,2015
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 SETPIC TANK, DBOX, 16 HIGH CAPACITY H-20
UNITS W/OUT STONE:25'X 11.3'X 11"
2. BOH TO INSPECT SOIL REMOVAL
3. PLUMBING PERMIT REQUIRED
4. MFC VARIANCE APPROVALS:a.WETLAND/DRAINAGE b. FOUNDATION SETBACK PER BOH
APPROVAL 11/16/2015
Bruce G. M phy PH, 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.