HomeMy WebLinkAboutApp-Permit-Compliance 31,r, Q-2I-vo2,'1
No. ICAV. 20' OSC)2 ' Z r J1—
FEE 55 I
20- I I COMMONWEALTH WEALTH OF MASSACHUSETTS
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Board of Health, Yarmouth, M.4
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
MIT
Application for a Permit to Constmct()Repair()Upgrade 4 Abandon()-ii6 Complete System❑Individual Components
1 ,2 j(42,14_,4. C __,,,ow4 Owner's Name��, .�,'c�u.e�C D)op2 2(�.t�t2C�
Location �'X'�'„� U
Map/Parcel# S Address/CVO AhA,iwe Old. $7, ime-/yt/4 62/s
Lot# / 2 Telephone#am 7 ' -5-- cc---3
Installer's Name r (o !// tri ,�C Designer's Name Co/��4s� pp Wiz¢Jrtms Cy
Address �F'�� % �/1dtM ia�a3(�4/i Address 2,S�s �F si,",ic1c"t/tzuw, �} CJ. 3'7y
Telephone# L. �_V/'7/ -9 3?? Telephone# 5c,s.00-.23 3
Type of Building Lot Size 54)v0 sq.ft.
Dwelling-No.of Bedrooms A Garbage grinder( )
Other-Type of Building No. of persons Showers(),Cafeteria()
Other Fixtures
Design Flow(min.required) A a gpd Calculated design flow Designflow provided o?S I gpd
Plan:ryDate i-23- av Number of sheets ) Revision Date 6-3-a U
Title PittA1- 145 SutSwl.,oea 2t- CfZ-Liiiitif su� L/p rvIlL. a3GLk1 R 4J$ /
a,Description of Soil(s) r SntA 7 1i- J 00
Soil Evaluator Form No. Name of SoilEvaluator / Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS Jt-4.,,,m,(L ae-ef 1Akk U 410 I s i5 '-(b 6207,J4214(,.(,�'JA
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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 toem in operation until a Certificate of Compliance has been issued by the Board of Health.
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Signeer Date // l-P0
Inspections
No. Z 0 t-E- FEE
COMMONWEALTH OF MASSACHUSETTS Nc
Board of Health, Yarmouth, M4 'sl�71' 4JI/
DISPiOSAL SYSTEM CONSTRUCTION PERI i , ,r1.te-v '; -
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Permission�'s1 hereby granted to; Construct O Repair() Upgrade{4 Abandon() an individual sewage'disposal system .' s
3 La.l�o M as described in the application for
Disposal System Construction mit No 20'- b , dated
Provided Co truction shall be complleteddwwithin t ee ye e date of this permit. All local conditions must be met.
Date I Board of Health u ( —_
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
CERTIFICATE OF COMPLIANCE $55.00
Description of Work: Complete System; Approved gpd: 281 gpd
The undersigned hereby certify that the Sewage Disposal System; Repair-minor
by: BORTOLOTTI CONSTRUCTION INC.
at: 23 LAKE RD EAST, WEST YARMOUTH, MA 02673
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-20-0502, dated 02/05/2021.
Installer: BORTOLOTTI CONSTRUCTION INC.
Address:P.O. BOX 704 MARSTONS MILLS, MA 02648 Inspector: Mallory Langler
Designer: Collins Civil Engineering
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Bruce G. Murphy, MPH, R.S., CHO/Mallory R. Langler, R.S.
Health Director/Assistant Health Director
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.