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HomeMy WebLinkAboutApp-Permit-ComplianceNo.—'C)C)4 'C�� ` FEE Y `J3.00 COMMONWELTH Or MASSACHUSETTS Board of Health, � VJ , M. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTI®N PERMIT Application for a Permit to Construct( ) Repair("Upgrade( ) Abandon( ) - ❑ Complete System Wdividual Components Location �io+l-e Owner's Name Map/Parcel# 1,3q 1 P Address zLn 6A 7S Lot# Telephone# Installer's NamebDr�olb4; �'(�(�_ Designer's Name Address iC) [� Addressg�c�, •� ©�' !cM Telehone# _Telephone# ,moiler- ; 7?0 Type of Building Dwelling - No. of Bedrooms Other - Type of Building _ No. of persons Lot Size �zno sq. ft. Garbage grinder ( ) Showers ( ), Cafeteria ( ) Other Fixtures Design Flow (min. required),-, 30 gpd Calculated design flow :3 -30 Design flow provided gpd Plan: Date—MnP 1302 4 Number of sheets Revision Date , "-/m Title Description ofSoil (s) _ Soil Evaluator Form No. Name of Soil OF REPAIRS OR ALTERATIONS of Evaluation The undersigned agrees to ins abo described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to a the in in operation until a Certificate of Com fianc e has been issued by the Board of Health. Signed Date`-'/ ( y No. !3Q44bc, "C.>U�� FEE f . GU COMMONWEALTH Of MASSACHUSETTS C14 <<�� � Z Board of Health, A V -MQ U 1 l k , MA. hh IJ�aX. S � ry CERTIFICATE Of COMPLIANCE Description of Work: y1vidividual Component(s) ❑ Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired (if Upgraded ( ), Abandoned ( ) by: �1�) �{ ...���^-� -f,-�� ftp` has been installed`i�ifa" (o; rd�tiil e-1 ih tprovisions 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. / dated /'? Approved Design Flow (gpd) InstallerJ(4C' / Designer:241 Inspector: Date: The issuance of this permit shalrnot be constr ed as a guar tee that the system will function as designed. No. Bole -1-0 tFEE SJ . i)(; COMMONWFALT14 OF MASSACHUSETTS CL4 9q 62 - Board of Health, ypA &M O Ulm DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( Upgrade ( ) Abandon( ) an individual sewage disposal system at Y() _ Cr. a t.' _0 1 )"1) (1 as described in the application for Disposal System Construction Permit No./ / , dated Y-So1&- - 4-PU S— Provided: Construction shall be completed within thye-, =4 of the date of this perm t. All local conditions must be met. /�7 J Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown, MA Date -9 -/4- Board of Health No.:BOHDC-14-0095 Commonwealth of Massachusetts F� - 555.00 � Board of Health, Yarmouth, MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to:Upgrade-Individual Component(s) Location: 53 WHISTLER LN,YARMOUTH, MA 02675 Owner Map/Parcel#: 134.16 Name: CLARK SANDRA A Address: 53 WHISTLER LN YARMOUTHPORT, MA 02675 Phone: Septic System Installer Name: BORTOLOTTI CONSTRUCTION INC. Address: P.O. BOX 704 MARSTONS MILLS, MA 02648 Phone: 5087719399 Type of Building:Dwelling Lot Size: 1.09 sq.ft. Dwelling-No.of Bedrooms:3 Garbage Grinder: Other Type of Building: No.of persons: Showers: Cafeteria: Other Fiatures: Plan Date:06/13/2014 Number of Sheets: 1 Title:TIT1.E 5 SITE PLAN 53 WHIS7'[,ER LANE Revision Dah: Design Flow(min.required):330 gpd Calculated design Oow:330 Design/1ow provided:349 gpd gpd Description of Soi1s:SEE PLAN Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:OS/2U2014 � DANIEL GONSALVES ' DESCRIPTION OF REPA[RS OR ALTERATIONS:EXISTING 1000 GAL SEPT[C TANK H-20 DBOX 2-500 GAL H-20 PRECAST CHAMBERS WITH 4'STONE �� 25'X12.83'X2' The unde�signed agrees to install the above deseribetl Indlvldual3ewage Disposal System in aecordance wkh the provlslons of TITLE 5 and fuRher aprees not to Dlaee in operafion unfil a Certifieate of Complianee has been iasuetl bvlhe Board of Heallh. Signed Date Inspections ' Commonwealth of Massachusetts ; Board of Health, Yarmouth, MA. Fee DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00 Permission is herby granted to;ROBERT BORTOLOTTI Address: P.O.BOX 704 MARSTONS M[LLS,MA 02648 To perform:Upgrade an individual sewage disposal system. Owner: CLARK SANDRA A 53 WHISTLERLN YARMOU"I'HPORT,MA 02675 Location:53 WHISTLER LN,YARMOUTH,MA 02675 Disposal System Construction Permit No.: BOHDG140095,Dated: August O5,2014 Provided: Construction shall be completed within six months of the date of this permit. All(ocal conditions must be me[. Condi6ons D-Box and Leachrng installation only MFC Yariances- 1. Setbacks 2. Depth ofLeach Facrlity L�C.a[x"f' Bruce G. urp y, MPH, 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. Commonwealth of Massachusetts ' Board of Health, Yarmouth, MA. F� I� CERTIFICATE OF COMPLIANCE ass.ao Description of Work:Individual Component(s) The undersigned hereby certify that the Sewage Disposal System; Upgraded by:BORTOLOTTI CONSTRUCTION INC. at: 53 WHISTLER LN,YARMOUTH,MA 02675 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-140095,dated 09/OS/2014. Installer:BORTOLOTTI CONSTRUCTION INC. Address:P.O. BOX 704 MARSTONS MILLS,MA Inspector:AMY VON HONE 02648 Designer.DOWN CAPE ENGINEERING,INC. Conditions D-Box and Leachin¢installation onlv MFC Variances- 1.Setbacks 2.Deoth of Leach Faciliri Bruce G. rphy, MPH, R.S., CHO/Amy L.von Hone, R.S.,CHO , �� Health Director/Assistant Health Diredor The issuance of this permit shall oot be construed as a guarantee that the system will function as designed. , i i BOH_Disposal_Construdion_CofC.rpt II