HomeMy WebLinkAboutApp-Permit-ComplianceNo. kt+DC--15 1;?GZ 6UM -I�-0023q�0 FEE
&,/-C-I.COMMONWEALTH OF MASSACHUSETTS
Board of Health, yAa=k4Qvn , MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repairw Upgrade( ) Abandon( ) - eComplete System 0 Individual Components
Location
Owner's Name CAc(OS }-•
Map/Parcel# i3 itl
Address Ja 07
Lot#
Telephone# 52)a- e -q -
Installer's Name �U Ian; ��,Q��
Designer's Name z6jon e�
Address qS4� l ��S
6; Address q5, a CJY�
Telephone# 5os _ 9; / _ 23 29
Telephone#
�4 5 ��
Type of Building Lot Size i sq. ft.
Dwelling - No. of Bedrooms Garbage grinder ( )
Other - Type of Building No. of persons Showers( ) , Cafeteria ( )
Other Fixtures
Design Flow (min. required) Y YU gpd Calculated design flow Design flow provided S%U gpd
Plan: Date am 1. ibis- Number of sheets 1 Revision Date itky g l ,La1,5'
shoe
Title ) „wt? s Si p � � "That �.hQ•t e REQ �irrmov `
� 1 M 14 ash S
Description of Soils) 6,, l s!dg
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS
The undersigned agrees to ' all th ove described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to not place system in operation until a Certificate of Compliance ps been issued by the Board of Health.
Signed Date��_
No. D1iC -{ S-57ta°�.. _ _-"'/6" 11u3�(' 4�4_7
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2. Li
Board o Health, O ; MA. COMMONWEALTH OF MASSACHUSETTS
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CERTIFICATE OF COMPLIANCE
Description of Work: U Individual Component(s) d Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ),.Upgraded ( ), Abandoned ( )
by: 3014,U"("
at 3 `5 _T j\,q icri���-fSC t' C✓/ l`� L�ftY�L�l14 Sl C�1 ��
has been installe�in actor ari>re wit}i the provisions of 310 CMR 15.00 (Title 5) and,t�ue�pproved design plans/as-built plans relating to
application No. dated /c9 ` 34 -/" Approved Design Flow ,`(4 (-� (gpd)
Installer ��-c 1r ivy '� ��1 'cam Eats �O� 2Z,k�aa/ft,1"Li4.e5 /
Designer-_zu �i^i� ? n r,�gt, ,` l or- • Inspector: s1J Dater
t �
The issuance of this permit shall not be construed as a guaran that the system will function as designed.
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No. t309i'17C.""f �xFEE SS-. 0
COMMONWEALT14 Of MASSACHUSETTS ck i i o 9 q
Board of Health, VA -P -M 00114 , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair (A� Upgrade( ) Abandon( ) an individual sewage disposal system
_ .r
ID
at 42 5� 46,11 e-- - - ..1220,-` i' �`c tf4 /,°�-� ' l for as described in the application for
Disposal System Construction Permit No. dated
Provided: Construction shall be completed within t - ree Xws of the date of this permit. All local co ditions must be met.
6 ,,.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown, MA Date/0 / r>Board of Health --F- - : / ��: ��• �'�
,
No.:BOHDGIS-5162
; ' Commonwealth of Massachusetts F�
$55.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Complete System
Location: 125 THACHER SHORE RD,YARMOUTH PORT, MA 02675 Owner:
FONTS CARLOS A
� Map/Parcel#: 131.14 125 THACHER SHORE RD
� YARMOUTH PORT,MA 02675-1129
Phone:
Septic System Installer Designer
BORTOLOTTI DOWN CAPE ENGINEERING
P.O. BOX 704 MARSTONS MILLS, MA 939 ROUTE 6A
02648 YARMOUTHPORT,MA 02675
Phone: 508-362-4541
Type of Building:Dwelling Lot Size:78,408.00 Acres
Dwelling-No.of Bedrooms:4 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Ot6er Fixtures:
Plan Date:OS/Ol/2015 Number of S6eets: 1
Cafeteria:
Tit1e:TITLE 5 SITE PLAN 125 THACHER SHORE ROAD Revision Date:OS/29/2015
Design Flow(min.required):440 gpd Calculated design flow:440 gpd Design flow provided:460 gpd
Description of Soits:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:04/24/2015
- DANIEL GONSALVES,SE
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK/1000 GAL
� PUMP CHAMBER H-20 TWO COMPARTMENT TANK,DBOX,4 0-500 GAL PRECAST CHAMBERS W/STONE 3'SIDES,2.5'ENDS:
39'X10.83'X2'
The underslgned agrees to install the above described Individual Sewage Disposal System in accordance wkh 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
�
:
Commonwealth of Massachusetts
; Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00
Permission is herby granted to;
BORTOLOTTI CONSTRUCTION INC., P.O. BOX 704, MARSTONS MILLS, MA 02648
To perform:Upgrade an individual sewage disposal system.
Owner: FONTS CARI,OS A
125 THACHER SHORE RD
YARMOUTH PORT,MA 02675-1129
I
i Location: 125 THACHER SHORE RD,YARMOUTH PORT,MA 02675
Disposal System Construction Permit No.: BOHDC-15-5162,Dated:October 30,2015
Provided: Conshuction 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/1000 GAL PUMP CHAMBER H-20
TWO COMPARTMENT TANK, DBOX,4 0-500 GAL PRECAST CHAMBERS W/STONE 3'SIDES,2.5'ENDS:39'
X 10.83'X 2'
2. ELECTRICAL PERMIT REQUIRE
3. BOH TO INSPECT SOIL REMOVAL OF A&B HORIZONS ONLY
4. MFC VARIANCE APPROVAL a. SEPTIC TANK DEPTH
W
Bruce G. Murphy,MP , .S.,CHO/Amy L.von Hone, R.S.,CHO
Health rector/Assistant Health Director
The issuance of this permit shall not be construed as a guarantee th t the system will function as designed.
i
�
�
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
CERTIFICATE OF COMPLIANCE E55.00
�
Description of Work:Complete System
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:BORTOLOTTI CONSTRUCTION INC.
at: 125 THACHER SHORE RD,YARMOUTH PORT,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-15-5162,dated 11/24/2015.
�; Installer:BORTOLOTTI CONSTRUCTION INC.
� Address:P.O.BOX 704 MARSTONS MILLS,MA Inspector:AMY VON HONE,R.S.
02648
Designer:DOWN CAPE ENGINEERING
Conditions
1.SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK/1000 GAL PUMP
CHAMBER H-20 TWO COMPARTMENT TANK,DBOX,4 0-500 GAL PRECAST CHAMBERS
W/STONE 3' SIDES,2.5'ENDS:39'X 10.83'X 2'
2.ELECTRICAL PERMIT REQUIRE
3.BOH TO INSPECT SOIL REMOVAL OF A&B HORIZONS ONLY
4.MFC VARIANCE APPROVAL a.SEPTIC TANK DEPTH CJ��
Bruce G. Murphy, PH, .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.
BOH_Disposal_Construction_CofC.rpt