HomeMy WebLinkAboutApp-Permit-ComplianceNo. 0 `j' % I /h FEE
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COMMONWEALTH OF MASSACHUSETTS
Board of Health, ) AAW 0 T , MA.
APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTI®N PERMIT
Application for a Permit to Construct( ) Repair( ) Upgraded Abandon( ) - WComplete System ❑ Individual Components
Location
�? Hll RO/
Owner's Name 96W/t/ I
Map/Parcel#
Address
Lot# 3
Telephone#
Installer's Name
t C' � 17 �(' �
Designer's Name d
Address �'17
41 ,
Address 1/A fl" o,
Telephone#
Telephone# 7 a jP
Type of Building ? Lot.size sq. ft.
Dwelling - No. of Bedrooms J Garbage grinder ( )
Other - Type of Building No. of persons Showers ( ) , Cafeteria ( )
Other Fixtures
Design Flow (min. required) 7? �� gpd Calculated design flow
Plan: Date y / S� / Number of sheets
Title
Description of Soil (s) _
Soil Evaluator Form No.
DESCRIPTION OF
W
S(ee pl4
Name of Soil Evaluator
OR ALTERATIONS
l
Design flow provided .3 gpd
Revision Date
L Date of Evaluation
-�; Ile
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to notit place the tem in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed � � Date �� �r zJ
Inspections
., t' ^� l • !" _-
. � FEE
/ e.._. COMMONWEALTH Of MASSACHUSETTS S-8 (1
�1
Board of Health, yA9-M01i1-rA , MA.
CERTIFICATE Of COMPLIANCE
Description of Work: Ll Individual Component(s) L�fiComplete System
The undersigned hereby certify r the Sewage '$posal Syste Constructed ( ), Repaired ( )> Upgrade, Abandoned( )
by: i t7�I I� f
at 9' /� ®aC - - -
has been installed$i acct daAc? witli'the provisions of 310 CMR 15.00 (Title 5) and t approved design plans/as-built plans relating to
application No. % chatted old Approved Design Flow (gpd)
Installer Al ilk i', 1, /30 f ' .1 4,
Designer: A LA 1-a aid Y4 Inspector: �' � f % �.�! L�.�� � Date:
�T
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
UCi�C):J!UG UUCIUC�OGOOU:!IJOJ000G.TJ')O�6U((J00000(`GC'l:CCC C, 00 0 J"Ct
No. � �� U "" l G7 `p' 6psye� FEE " v
C®MMONWEAETII Of MASSACRUSETTS
Board of Health, y/hP-1CJ11'T�-1 , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgrade()) Abandon( ) an individual sewage disposal system
at as described in the application for
Disposal System Construction Permit No. dated
Provided: Construction shall be completed within the date of this per it. All local conditions must be met.
form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown, MA Date --2 et' -P? Board of Health
No.: BOHDC-15-1842
• Commonwealth of Massachusetts Fee
$55.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to: Upgrade-Complete System
Location: 8 LENOX RD,WEST YARMOUTH, MA 02673 Owner:
HEDLUND HAROLD G
Map/ParceW: 023.126 HEDLUND GERD M
8 LENNOX RD
WEST YARMOUTH,MA 02673
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:
(508)775-9700
Type of Building:Dwelling Lot Size: 16,552.80 Acres
Dwelling-No.of Bedrooms:3 Garbage Grinder. .
Other Type of Building: No.of persons: Showers: �
Other Fixtures: ��
Plan Dah:04/l3/2015 Number of Sheets: 1 '�
Cafeteria: '�.
Tit1e:SITE PLAN FOR 8 LENOX ROAD Revision Date: ��
Design Flow(min.required):330 gpd Calculated design Flow:330 gpd Design tlow provided:367 gpd '�
Descrip[ion o(SoiIs:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:04/OS/2015
RONALD J.CADILLAC,RS �.
DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR- 1500 GAL SEPTIC TANK,DBOX,21 ARC 36 LP CI IAMBERS W/
STONE:35'X 8.5'X 3.8"
ihe untlersigned agrees to install the above descNbetl Individual Sewage Disposal System in accordance wkh the provisions of
TITLE 5 and further aarees not to olace in ooeration untll a Certlficale of Comoliance has heen issued bv the 8oard of Health.
Signed Date
Inspections
Commonwealth of Massachusetts
� Board of Health, Yarmouth, MA FeB
DISPOSAL SYSTEM CONSTRUCTION PERMIT 555.00
Permission is herby granted to;
BOSETTI SEPTIC SYSTEMS, 199 CHURCH STREET, EAST HARWICH, MA 02645
To perform:Upgrade an individual sewage disposal system.
Owner. HEDLUND HAROLD G
HEDLUND GERD M �
8 LENNOX RD
WEST YARMOUTH,MA 02673
Location: 8 LENOX RD,WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.: BOHDC-1S1842 ,Dated:Apri124,2015
Provided:ConsVuction shall be completed within six months of the date of this permit. All(ocal conditions must be met.
Conditions
1. REPAIR-I500 GAL SEPTIC T,9NK, DBOX, 21 ARC 36 LP CHAMBERS W/STONE: 35'X 8.S'X 3.8"
2. MFC YARIANCES. l. GROUNDWATER SEPARATION 2. 6"COVER OYER SEPTIC TANK
Bruce G. Mu y, PH, R.S., CHO/Amy L.von Hone, R.S.,CHO
ealth Director/Assistant Health Direc[or �
The issuance of this permit shall not be construed as a guaraotee that the system will function as designed.
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
CERTIFICATE OF COMPLIANCE sss.00
IDescription of Work:Complete System
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:BOSETTI SEPTIC SYSTEMS
at: 8 LENOX RD, 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-1S1842,dated 04/27/2015.
Installer:BOSETTI SEPTIC SYSTEMS
Address:199 CHURCH STREET EAST HARWICH,MA Inspector:AMY VON HONE,R.S.
02645
Designer:RONALD J.CADILLAC,PLS,RS,PC
Conditions
1.REPAIR- 1500 GAL SEPTIC TANK,DBOX,21 ARC 36 LP CHAMBERS W/STONE:35'X 8.5'
X 3.8"
2.MFC VARIANCES: 1.GROUNDWATER SEPARATION 2.6" O�VnE,R SE IC TANK
(J�L
Bruce G. Murph , M , R.S., CHO/Amy L.von one, R.S., CHO
Health Director/Assistant Health Director
The issuance of this permit shall not be construed as a guarante at the system will function as designed.
BOH_D isposal_Construction_CofC.rpt