HomeMy WebLinkAboutApp-Permit-Compliancea tL C-4S-lai< / v q FEE `P+�100
No.
/6MMONWEALM Of MASSACHUSETTS
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APPLICA ION FOR DISPOSAL SY TEM CONSTRUCTI®N PERMIT
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Application for a Permit to Construct(�.4/Repair( ) Upgrade( ) Abandon() - U Complete System ❑ Individual Componeiits
Location Ll po e f N,
Owner's Name
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Map/Parcel#
Address
Lot# 9 4
Telephone#
1
Installer's Name A%; ke �f tt,
Designer's Name /` 0'
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Address9 f F �, ISE
Address
Telephone# 0,9-/ 2-
Telephone#
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Type of Building
Dwelling - No. of Bedrooms
Other - Type of Building _
Other Fixtures
Design Flow (min. required) YZ%d gpd Calculated design flow
Plan: Date / Z' , 3- 141 Number of sheets f
Lot Size 75--71 sq. ft.
Garbage grinder ( )
No. of persons Showers( ), Cafeteria ( )
Design flow provided gpd
Revision Date
Title
Description of Soil(s) see ,vJa t^
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation /l r " 3 �/ / V
DESCRIPTION OF REPAIRS OR ALTERATIONS / h f A / / li ew j e� "1i (6Y
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The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to not to ace the sy�stem ✓°peration until a Certificate of Compliance has been issued by the Board of Health.
Signed A�� /, 44 " Date -I- - 4,7 " /s
No. -4S t o �s
®M[NI®NI.TII OF NI
FEE �J `✓ .
Board of Health, �/�t R WIb V
CERTIFICATE Of COMPLIANCE
Description of Wgrk: ❑ Individual Component(s) tComplete System 6, � C
. &.vr -/6 - 54 -1-7 _.
The undersigned hereby certify thattheSewage Disposal System; Constructed ( ), Repaired ( ), Upgraded ( ),
by:
at - - Gf �,'--- - -/-) ° A erl, v
y
hasllke Kh Tstalled 16161cG&hance kith `Etfe f(rovisions of 310 CMR 15.00 (Title 5) and t ie a roved design plans/as-built plans relating to
application No. /'/X dated Approved Design Flow (gpd)
Installer
Installer i v .( Go f ! I
Designer: K,>" C 4Z Of i'f'/e- Inspector: Date:
The issuance of this permit shall not be construed as a guarai tee that the system will function as designed.
No. 5oi4Dc–t5-10qS--
COMMONWEALTH OF MASSACHUSETTS
Board of Health, V Ae -M 0 U"T' , MA.
*,DISPOSAL SYSTEM CONSTRUCTION PEIZMIT
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Permission is hereby granted to; Construct( Repair( ) Upgrade( ) Aban n( )-an individual sewage disposal s4LM*(0 13
at 4ip 0, !� r �• h "'` as described in the application for
Disposal System Construction Permit No. dated/' �•
Provided: Construction shall be completed within three-y�of the date of t'F`i'si p't , All local con i •ons must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date �� Bard of Health
/or
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No.:BOHDC-15-1045
Commonwealth of Massachusetts Fee
$110.00
' Board of Health, Yarmouth, MA
; APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:New Construction-Complete System
Location: 46 DOHERTY LN,WEST YARMOUTH, MA 02673 Owner:
MANGER PAUL K
Map/Parcel#: 015.9 MANGER NANCY S
BETHMOUR ROAD
BETHANY,CT 06524
Phone:
Septic System Installer Designer
BOSETTI SEPTIC RONALD J.CADILLAC,PLS.RS,PC
199 CHURCH STREET EAST P.O.BOX 258
HARWICH, MA 02645 WEST YARMOUTH,MA 02673
Phone:
(5081775-9700
Type of Building:Dwelling Lot Size:0.16 Acres
Dwelling-No.of Bedrooms:4 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Fistures:
Plan Date: 12/03/2014 Number of Sheets:2
Cafeteria:
Title:SIT'E PLAN FOR 46 DOHERTY LANE Revision Date:02/06/2015
Design Flow(min.required):440 gpd Calculated design flow:440 gpd Design flow provided:444 gpd
Description of Soils:SEE PLAN ,
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evatuation:06/13/2014
RONALD J.CADILLAC,RS
DESCRII'TION OF REPAIRS OR ALTERATIONS:NEW-2000 GAL MONOLITHIC TWO COMPARTMENT SEPTIC TANK WITH
500 GAL SECOND COMPARTMENT PUMP CHAMBER,PERC-RITE DRIP DISPERSAL LEACH FIELD(DEMOLITION OF EXISTING 2
BEDROOM DWELLING AND CONSTRUCTION OF NEW 4 BEDROOM DWELLING)
The undersigned agrees to install the above described Individual Sewage Disposal System in accoMance 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 HeaRh.
Signed Date
Inspecrions
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�
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee '
DISPOSAL SYSTEM CONSTRUCTION PERMIT $110.00
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; Permission is herby granted to;
! BOSETTI SEPTIC SYSTEMS, 199 CHURCH STREET, EAST HARWICH, MA 02645
I
To perform:New Construction an individual sewage disposal system.
Owner: MANGER PAUL K
MANGER NANCY S
BETHMOUR ROAD
i BETHANY,CT 06524
I
� Location:46 DOHERTY LN,WEST YARMOUTH,MA 02673
�
� Disposal System Construction Permit No.: BOHDC-15-1045,Dated:February 17,2015
i Provided:Construction shall be completed within six months of the date of this permit. All local conditions must be met.
; Conditions
! 1. BOHAND ENGINEER TO INSPECT AND CERTIFYSOIL REMOVAL, WALL PLACEMENT,
` SYSTEMINSTALLATION
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2. NEW-2000 GAL MONOLITHIC TWO COMPARTMENT SEPTIC TANK WTlH S00 GAL SECOND
COMPARTMENT PUMP CHAMBER, PERC-RITE DRIP DISPERSAL LEACH FIELD(DEMOLITION
OF EXISTING 2 BEDROOM DWELLING AND CONSTR UCTION OF NEW 4 BEDROOM DWELLING)
3. PERC-RITE DRIP DISPERSAL SYSTEM BOHAPPROYAL LETlER TO BE RECORDED AT
BARNSTABLE COUNTY REGISTRY OF DEEDS
4. OPERATIONAND MAINTENANCE AGREEMENT FOR MINIMUM 1 YEAR W17'H CERTIFIED "`
PERC-RITE OPERATOR REQUIRED
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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.