HomeMy WebLinkAboutApp-Permit-Compliancern
5
0
d
H `ti
t7
O
O
d
r
cn '+,
z
W
d cn v
�H
ro
o.
CD
fD
o
a
0
d
H `ti
t7
O
O
d
r
z
W
�H
CD
fD
o
a
1
CD
a
d
am
,o
O
a
cL
`
Oy
rD rD
a
a.
y
..1
y
z
G
o
rD
l�
°
2,
10
ID
c
y
H
Y
0
r
z
W
Ski
1
CD
a
d
am
,o
O
a
cL
Oy
rD rD
0
y-
z9
y
..1
y
z
A)
rD
l�
LLfi
No.:BOHDGI4-0488
Commonwealth of Massachusetts Fee
$55.00
Board of Health, Yarmouth, MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Repair-minor-Individual Component(s)
Location: 72 VNiITE CEDAR RD,WEST YARMOUTH, MA 02673 Owner
Map/Parcel#: 009.7 Name:
KRISTOFF BRETT C TR
Address:
KRISTOFF 2012 EXEMPT FAMILY TR 35
FATHER PETERS LN
Phone:
Septic System Installer
Name:
BORTOLOTTICONSTRUCTIONINC.
� Address:
P.O. BOX 704 MARSTONS MILLS,
MA 02648
! Phone:
Type of Building:Dwelling Lot Size: 1.28 sq.ft.
. Dwelling-No.of Bedrooms:6 Garbage Grinder:
Other Type of Building: No.of persons: Showers: Cakhria:
Other Fictures:
Plao Date: Number of Sheets:
TiUe: Revision Date:
Design Flow(min.required):660 gpd Calculated design ilow:660 Design Flow provided:880 gpd
gpd
Description o[Soils:
Soil Evaluator Form No.: Name o[Soil Evaluator. Date of Evaluation:
DESCRIPTION OF REPAIRS OR ALTERATIONS:REPLACE EXISTING I500 GAL SEPTIC TANK W/A 2 COMPARTMENT
, 2500 GAL SEPTIC TANK TO EXISTMG DBOX AND LEACH FACILITY
7he unde�signed agrees to install the above described Intlividual Sewage Disposal System in accortlanee wkh the provisiona
of TITLE 5 and further aprees not to place in operation uMil a CertHieate of Compliance has been issuetl by the Board of Health.
Signed Date
Inspections
, , �
Cammanwealth of Massachusetts
Board of Health, Yarmouth, MA. F�
DISPQSAL SYSTEM CQNSTRUCTIQN PERMIT sss.00
Permission is herby gtanted to;ROBERT BQRTOLOTTI Address:P.O.BOX 704
MARSTONS MILLS,MA 02648
To perforrn: Repair-minor an individual sewage disposal system.
i
Owner: KRISTOFF RRETT C TR
� KRISPOFF 2012 EXEMPT FAMILY 1R
� 35 FATHER.PETERS LN
�� . NEW CANAAN,CT 06844
, Location:72 WHITE CEDAR RD,WEST YARMOUTH,MA 02673
Disposal Syseem CanstrucEian Permit No.: Bt1HBC-t40488,Dated:October 27,2014
� Pravided:ConsWction shall be eompleted within six months of the date of this permit. All lacal eonditaons must be met.
Conditions
l. Replace existing septic tank with a 2500 ga12 Compartment H-20 Tank to existing Dbox and Leach
� Facility
� 2. Maximum 6 Bedroom Dwelling(lot serviced by private well)per BOHApprova101/Od/2014. Any
' furure additions or alrerarions to he revrewed by BQK
'�I
Bruce G.RAu hy, PH,R.S.,CHO t Amy L.von Hone,R.S.,CHO
ealth Director/Assistant Health Director
T6e issuance af this permit s6a11 not be rnnstrued as a gnarantee thai the system will funetioo as designed.
Commonwealth of Massachusetts
Board of Health, Yarmauth, MA. Fee
CERTIFICATE 4F COMPLIANCE Ss�A°
Description of Work:Individual Component(s)
The undersigned hereby certify that the Sewage Disposal System; Repair-minor
by:BORTQLOTTT C4NSTRUCTION INC.
at:72 WHITE CEDAR RI?,WEST YARMQUTH,MA 42b73
Has been instaped in accordance with the provisions of 3]0 CMR 15.Q0(Title 5)and the approved
design plans or as-built plans relating to application No.: BOHDC-14-0488,dated 12/10/2014.
Installer:BORTOLQTTI CONSTRUCT[ON INC.
Address:P.d.BdX 104 MAR5TdNS MILLS, MA Inspector:AMY VON HONE,R.S.
02648
Designer.
Cooditioos
1.�eolace existin�sentic tank with a 2500 eai 2 Camoartment H-20 Tank ta exisrioe Dbox and Leach Facilitv
2.Maximum 6 Bedroom Dwelline llat serviced bv private welll oer BOH Aaoraval p1/06l2014. Anv foture additi�
alterations to be reviewed bv BOA. �` >� � ,e����-!
v �
�, Bruce G. u hy, MPH, R.S., CHO/Amy L.von Hone, R.S., CHO
iHealth Di�ector t Assistant Health DireIXor
j T6e issnance of this permit shall not be coostrued as a guarantee that t6e system wiil fuaction as designed.
BOH Disposal_Gonstrudion CofC.rpt