HomeMy WebLinkAboutApp-Permit-ComplianceNo. 60 FEE
(��' FEE
D C®NIM[®N LTH Of MASSACHUSETTS
Board of Health,MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repairpj _Upgrade( ) Abandon() - Complete System ❑ Individual Components
Location
Owner's Name
Map/Parcel#f'54
Address , iJ ler vim, C% -
Lot# S
Telephone# .O _ (Q /&
Installer's Name13. ta 4iwr''M
I Designer's Name I J .
Addressy c�SrYc 5 '�
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Address /17 /%�
Telephone#Telephone#
Type of Building
Dwelling - No. of Bedrooms
Other -Type of Building
Other Fixtures
Design Flow (min. required) .�� gpd Calculated design flow
Plan: Date4bLk ;LOlq Number of sheets
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Title
Description of Soil(s)
Soil Evaluator Form No.
Name of Soil Evaluator
No. of persons
DESCRIPTION OF REPAIRS OR ALTERATIONS -06W 1-0049 14 to S 2P1�
a 010— sq. ft.
Garbage grinder ( )
Showers ( ), Cafeteria ( )
Design flow provided -3S(2 gpd
ision Date
Date of Evaluation
The undersigned agrees to ins a abo described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further"agrees to not to the in in operation until a Certificate of CompYanance as been issued by the Board of Health.
Signed Date
Inspe5tions� /�' /�� 5�-2L' c2lLL�, / T4/7 / 4 -f 1 &14�r/
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No. V�OI.4FEE
0,5 COMMONWEALTH OF MASSACHUSETTS
Board of Health, 0 UVII , MA.
CERTIFICATE OF COMPLIANCE
Description of Work: ❑ Individual Component(s) CComplete System
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The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired (r.� Upgraded ( ), Abandoned
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has been insttaTI&In accordance w th the provilsions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. i' ".. ,� dated i` 14'f - l ; . Approved Design Flow ?l ` (gpd)
Installer [_&114,4141, '/) ��� �� C:L' % , 1 r G O _
Designer:At t rui-)(-,( t r r) c) =; , L1YInspector: t '. Date:
The issuance of this permit shall not be construed as a guarantee that the system will. function as designed.
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No. P20 A(� �TQ��Z�L-C� FEE �� ,1.
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A6r--- rJ ; COMMONWEALTR Of MASSACHUSETTS W
Board of Health, �V?O tT , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair(+-� Upgrade( ) Abandon( ) an individual sewage disposal system
at � �� /-t as described in the application for
Disposal System Construction Permit No. /5 ,u, ; dated
Provided: Construction shall be c6mple' ed within t�� of the date of this pefmit. All local conditions must be met.
6 k;ov 5 ;
Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date /"/�'� Board of Health
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No.:BOHDGI4-0666
Commonwealth of Massachusetts Fee i
' $55.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
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Application for a Permit to:Upgrade-Complete System f
Location: 279 WOOD RD, SOUTH YARMOUTH, MA 02664 Owner:
POLIQUIN KENNETH R
Map/Parcel#: 069.156 POLIQUIN R&BOYLE L S
65 VERNON CENTER I�IGHTS
VERNON,CT 06066
Phone:
Septic System Installer Designer
BORTOLOTTI DOWN CAPE ENGINEERING,INC. '
P.O. BOX 704 MARSTONS MILLS, MA 939 ROUTE 6A
02648 YARMOUTHPORT,MA 02675 �
Phone:
(508)362-4541
Type of Building:Dwelling Lot Size:0.18 Acres
Dwelling-No.of Bedrooms:3 Garbage Grinder:
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Ot6er Type of Building:DUPLEX(2 BEDROOM/1 BEDROOIvn No.of persons: Showers: ,
Other Fia�tures:
Plan Date: 11/03/2014 Number of Sheets: 1 Cafeteria• '
Tit1e:TITLE 5 SITE PLAN 279 WOOD ROAD Revision Date: 12/16/2014 . i
Design Flow(min.required):330 gpd Calculated design flow:3 gpd Design flow provided:349 gpd ,
Description of Soi1s:SEE PLAN
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Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation: 10/30/2014 `
DA1�IIEL GONSALVES,SE
_ DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-TWO COMPARTMENT 1500 GAL SEPTIC TANK,DBOX, 16 HIGH �
CAPACITY H-20 INFILTRATORS W/OUT STONE:50'X 5.66'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 Comoliance has 6een issued bv the Board of Heakh. '
Signed Date �
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Inspections �
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Commonwealth of Massachusetts f
° Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT $55.00
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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. ',
Owner: POLIQUIN KENNETH R '
POLIQUIN R&BOYLE L S ',
65 VERNON CENTER HEIGHTS ',
VERNON,CT 06066 '
Location:279 WOOD RD,SOUTH YARMOUTH,MA 02664
Disposal System Construction Permit No.: BOHDC-140666,Dated:January 13,2015 .
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Provided: Construction shall be completed within six months of the date of this permit. All local conditions must be met. ;
CondiNons '
1. REPAIR-TWO COMPARTMENT 1 S00 GAL SEPTIC TANK, DBOX, 16 HIGH CAPACITY H-20
INFILTRATORS W/OUT STONE: SO'X 5.66'X 11"
2. MFC VARIANCE: 1. SETBACKS '
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Bruce . M hy, MPH, R.S.,CHO/Amy L.von Hone, R.S.,CHO f
Health 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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