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HomeMy WebLinkAboutApp-Permit-ComplianceNo. �JQ FL I 1 —(JPO J J L,W 7 9 JS FEE Xo/ ff/'P�rk� COMMONWEALTH Of MASS C14USETTS & Board of Health, yA�lVlOt , MA. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTI®N PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade Abandon() - ZYC:omplete System ❑ Individual Components Location 1W Ohivii s —e 1 etl`n ewJ 1 1 Owner's Name 4er Map/Parcel# f l s ;73 Address Lot# Telephone#60-.5,)-9- Orr)) Obf Installer's Name (3 i&7 ol Ccr1SV, Designer's Name Address e)- 3 �� �,� n 2�IW Address S'oleter-s- a1 13 cv' 7/3 S• 0, Telephone# s c . c,- CO3- 3, Telephone# S G,(�• 3 -is- 4©G Type of Building Lot Size / sq. ft. Dwelling - No. of Bedrooms P -7— Garbage grinder ( ) Other - Type of Building No. of persons Showers ( ) , Cafeteria ( ) Other Fixtures Design Flow (min. required) 2- by gpd Calculated design flow _�0 Design flow provided 3 / gPd Plan: Date AICIV 107 , 644y Number of sheets Revision Date .01 Title Description of Soils) S' --e S-../ 1-!2j Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS SP S P n h C 0f S X4�1, The undersigned afire tall the ove escribed In ' 'dual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to n 1 e ntil a Certificate of Cianpliance has been issue by the Board of Health. Signed Tncni-rtinnc 7J ( � 014-- lei /Li —T /.. I' 6wCmr 7y1- A�,h-e , 1-? 4 No.(J1�t ��CI�i _ .0 l COMMONWEALT14 Of MASSACHFEE USETTS 2 ' Board of Health, -� ''�`' 0 (MI MA. CERTIFICATE Of COMPLIANCE Description of Work: ❑ Individual Component(s) 1.21"Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded-(—-Xbandoned ( ) by: S: il)5 Ce,,,�,z_ at 1("A fi i G:1 5� 4"4-r f jr ^"Vn Cw) 1 /1f) has been installed i>ti a?cordJ11nce`,6ith`f1Ye poo application No./� �it'Yi, dated _ Installer 4 I `t f �3 EC , 1.y rS of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to Approved Design Flow � % (gpd) , f W 4 c rL, t/.f / r _../.� Designer: �-L --. e / k7t; / rte" Inspector: , f- °'i' t U✓ _ Date: fi The issuance of this permit shall not'be construed as a guarante that the system will function as designed. '_-, �, )^, .>n.�C :ic:� _ �(5;.=. C)O CL,>000.OQ 00001I000OOOOO JOO CO OO OO�OO.U�OO GO.00G OOGOCO.^,000OCOOO OO OOO Q00000)Oi100_?.00O OO GOO GOOOOUO(�= No. r ,� i}T , L'�:� l ICi..Fi.��� 9� ���� FEE` .106 COMMON ALTH Of MASSACHUSETTS c�.� Board of Health, yAfc'J MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) ,._ Repair( ) UpgradeL-4—Abandon( .) an individual sewage disposal system at ? tri P�/ f ��s� �. i n �" �G °' ` %y7 '� as described in the application for 0 i✓ Disposal System Construction Permit No. /li "ll J, dated 1� Provided: Construction shall be completed within t# ee e�the date of this permit. All local cbndPons must be met. I �. Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown, MA Dade if - Board of Health i ��! / �� No.:BOHDGI4-0631 ' 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: 160 UNION ST,YARMOUTH, MA 02675 Owner: MIRABELLI,JANET Map/Parcel#: 115.73 MIRABELLI,PETER J 195 GOFF RD WETHERSFIELD,CT 06109-2404 Phone: Septic System Installer � Designer ELLIS BROTHERS SWEETSER ENGINEERING 23 ENTERPRISE ROAD P.O.BOX 713 YARMOUTHPORT, MA 02675 SOUTH DENNIS,MA 02660 Phone: (5081385-6900 Type of Buiiding:Dwelling Lot Size:0.30 Acres Dwetling-No.of Bedrooms:2 Garbage Grinder• Other Type of Building: No.of persons: Showers: Ot6er Fixtures: Plan Date: 11/12/2014 Number of Sheets• 1 � Cafeteria: Tit1e:PROPOSED SEPTIC DESIGN 160 iJTTION STREET Revision Date: 12/08/2014 Design Flow(min.required):220 gpd Calculated design flow:220 gpd Design flow provided:351 gpd Description of Soi1s:SEE PLAN Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation: 11/12/2014 ' ROBIN WILCOX,PLS I DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-1500 GAL SEPTIC TANK,DBOX,4 HIGH CAPACITY INFILTRATORS W/STONE:36'X 11'X 10" 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 oneration until a Certificate of Comnliance has been issued bv the Board of Health. Signed Date Inspections i E t I � 1 � j � : Commonwealth of Massachusetts Board of Health, Yarmouth, MA Fee DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00 Permission is herby granted to; ELLIS BROTHERS CONSTRUCTION,23 ENTERPRISE ROAD,YARMOUTHPORT, MA 02675 To perform:Upgrade an individual sewage disposal system. Owner: MIRABELLI,JANET MIRABELLI,PETER J 195 GOFF RD WETHERSFIELD,CT 06109-2404 Location: 160 IJNION ST,YARMOUTH,MA 02675 Disposal System Construction Permit No.: BOHDC-14-0631 ,Dated:December 23,2014 Provided: Construction shall be completed within six months of the date of this permit. All local conditions must be met. Conditions 1. REPAIR-1 S00 GAL SEPTIC TANK, DBOX, 4 HIGH CAPACTlY INFILTRATORS W/STONE: 36'X 11'X 10" 2. ZONE II MAXIMLIM 2 BEDROOMS �V � 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. • f ! � ; i Commonwealth of Massachusetts Board of Health, Yarmouth, MA Fee CERTIFICATE OF COMPLIANCE $55.00 Description of Work:Complete System The undersigned hereby certify that the Sewage Disposal System; Upgraded by:ELLIS BROTHERS CONSTRUCTION at: 160 UNION ST,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-140631,dated 04/06/2015. Installer:ELLIS BROTHERS CONSTRUCTION Address:23 ENTERPRISE ROAD YARMOUTHPORT, Inspector:AMY VON HONE,R.S. MA 02675 Designer: SWEETSER ENGINEERING Conditions 1.REPAIR- 1500 GAL SEPTIC TANK,DBOX,4 HIGH CAPACITY INFILTRATORS W/STONE: 36'X11'X10" 2.ZONE II MAXIMUM 2 BEDROOMS l Bruce G. ur y,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. i ( BOH_Disposal_Construction_CofC.rpt � �