HomeMy WebLinkAboutApp-Permit-ComplianceNo. FEE Uy
COMM O LTH OF M ASSAC14USETTS
Board of Health, YA@M01MJ , MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIIT
Application for a Permit to Construct( ) Repair (O Upgrade() Abandon() - ❑ Complete System ❑ Individual Components
Location
T -fu iv L
Owner's Name �/`�'1240 r7 Z I
Map/Parcel#
A? 3 � � �
Address yl 61
Lot#Telephone#
lC1 SS10-
Installer's Name
C �`
Designer's Name
Addressdear-
S� �/e ddress
Telephone#
8, 31 g.�Zrj�j
Telephone#
Type of Building Lot Size sq. ft.
Dwelling - No. of Bedrooms Garbage grinder ( )
Other - Type of Building No. of persons Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow (min. required)
Plan: Date
Title
Description of Soil(s)
Soil Evaluator Form No.
gpd Calculated design flow
Number of sheets
DESCRIPTION OF REPAIRS OR ALTERATIONS
Name of Soil Evaluator
Design flow provided
Revision Date
Date of Evaluation
gpd
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further a � s ton t to place thee i p ation until a Certificate of Compliance hqs been issued by the Board of Health.
Signed a V 1 l' Date Z
Inspections
No.b6RD_i` -o(otc)
t ,
COMMONWEALT14 Of MAS
FEE 155,0
c P 7�
Board of Health, yLAA�'10a11i
CERTIFICATE Of COMPLIANCE /5-dO �qr/ �c 4_
Description of Work: .S'individual Component(s) ❑ Complete System q, (,�� "1171
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded (,o Abandoned ( )
by:�) f f-j2T' iF:l t �S IMC
at 1rz.a (JAI A9 b
has been installed a9&daf _Mdegrovisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No., dated 1- 4 � . Approved Design Flow (gpd)
Installer
Designer: ( ZZ � Inspector: Date: ! r 3
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
.c__:I_:ovt,ocOc_ c0c(IL
No._�1�-r1(G l�%�tLl` �✓jy��l-.lja �N� FEE --
f
COMMONWEALT14 OF MASSACHUSETTS 7
Board of Health, )$AgMOU I`•4 , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgrade (_�- Abandon( ) an individual sewage disposal system
at 2__q 6 e y.} Uts) Q r as described in the application for
Disposal System Construction Permit No. -.I;�, dated
Provided: Construction shall be completes i in tb 4o+ears of the date of this permit All local conditiomust be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown, MA Date //" /4 -�-/4 Board of /Health (/
� No.: BOHDC-14-0610
Commonwealth of Massachusetts Fee
` L55.00
Board of Health, Yarmouth, MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to: Upgrade-
Location: 24 BRAUN RD,WEST YARMOUTH, MA 02673 Owner
Map/Parcel#: 03829 Name:
MANZI BRIAN M
MANZI MARYANN J 26 JEFFREY LN
Phone:
Septic System Installer
Name:
ROBERT CHILDS INC.
Address:
P.O. BOX 1431 SOUTH DENNIS, MA
02660
Phone:
Type of Building:Dwelling Lot Size:026 Acres
Dwelling-No.of Bedrooros:3 Garbage Grioder:
Other Type of Buildiog: No.of persons: Showers: Cafeteria:
Ot6er Fixtures:
Plan Date: 10/20/2014 Number of Sheets: 1
Tide:SITE PLAN 24 BRAUN ROAD Revision Date:
Design Flow(mio.required):330 gpd Calculated design ilow:330 gpd Design tlow provided:330 gpd
Descripfion of Soils:
Soil Evaluator Form No.: Naroe of Soil Evaluator: Date of Evaluation:
_ DESCRIPTION OF REPAIRS OR ALTERATIONS:RELOCATE&UPGRADE 1500 GAL SEPTIC TANK FOR SUNROOM ADDITION
The undersigned agrees to inatall the above described Individual Sewage Disposal System in accordance with fhe provislons of
TITLE 5 antl further aarees not to oWce in ooeratlon unfil a Certificate ot Comoliance has 6een'ssued hvlhe Board of NeaMh.
Signed Date
Inspections
Commonwealth of Massachusetts
° Board of Health, Yarmouth, MA. F�
DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00
Permission is herby granted to;CHARLES CHILDS Address:P.O.BOX 1431
SOUTH DENNIS,MA 02660
To perform:Upgrade an individual sewage disposal system.
Owner: MANZI BRIAN M
M.4NZI MARYANN J
26JEFFREY LN
BERLIN,CT 06037
Location:24 BRAUN RD,WEST YARMOUTH,MA 02673
Disposai System Construction Permit No.: BOHDC-14-0610,Dated:November 14,2014
Provided:Construc[ion shall be wmpleted within six months of the date of this permi[. All local conditions must be met.
Conditions
1. Relocate and insta111500 gal Septic Tankfor Sunroom Addition
Bruce G. rph , MPH, R.S., CHO/Amy L.von Hone, R.S., CHO
Health Directo�/Assistant Health Diredor
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.