HomeMy WebLinkAboutApp-Permit-ComplianceNo. ��� ✓' Z��S3 `� */� I - b `v�d� / FEE 7 ��
Board of Health, 14i -M d f/`th MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTI�1�� ���I
Application for a Permit to Construct( ) Repair( ) Upgradej,l Abandon( ) - O/Complete System ❑ Individual Components
Location 76rk 14ri A- iV C
Owner's Name
Map/Parcel# I ��
Address
Lot#
Telephone#
Installer's Name Za
Designer's Nameg-',, /
Address 152 t6' k5 90d
Address ISO %C' �GJ l Srist ��v�
Telephone# 5&g033 v g g Uy
- elephone# jalg -$957- qz �6 a
Type of Building 7/-,/
Dwelling - No. of Bedrooms
Other - Type of Building
Id i
Other Fixtures
Design Flow (min. required) 3,50
Plan: Date/
D / 1 6?/ 1 S
Title �OL,iOSP fe/®�tC e-4
Description of Soil(s)
C
Lot Size�/ 04I U sq. ft.
Garbage grinder ( )
No. of persons Showers( ), Cafeteria ( )
gpd Calculated design flow 3 / Design flow provided 3 1- 5 gpd
Number of sheets _ I Revision Date
to 50,W
v/-/, 4y`P
Soil Evaluator Form No. Name of Soil Evaluator 7/(d� AIC6444 Date of Evaluation &110115
7 - a 7U 1
DESCRIPTION OF REPAIRS
he undersigned a s to ins a above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees t of to a the system in operation until a Ce •fic of mpl'ance has been issued by the ealth.
Signed �jN OF MA q
R{ cy,
Inspections LZ -7 - fid NSKI =+
No-) .booy - IC3- 2%41 9
JA
COMMONWEALTH OF MASSACHUSETTS.)
Board of Health,(�! `� MA.
C EPTIf�TE OF COMPLIANCE
0 KNA L
J/
,FEE"
U1�1�/ c ii o C, I
Description of Work: ❑ Individual Component(s) Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgradecj,�, Abandoned ( )
by: U� at 7S"
has been installed in Icor/d c`e *ith tlfe Ifr6M-si6ns of;1,0 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. ��l , dated Approved Design Flow 3�i/ C�(gpd)
Installers/%�1�i
Designer: 6G,,J 1--' Inspector: Date:
The issuance of this permit shall not be construed as a guar that the system will function as designed.
COMMONWEALTH F MASSACHUSETTS
Board of Health, _hI! / MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
1
FEE " V
C. _* 1� 00
Permission is hereby gra�n�teed to; Construct( ) Repair( ) Upgrade ) Abandon ( ) an individual sewage disposal system
at 2 /"YZ
as described in the application for
Disposal System Construction Permit No. r� dated
h
Provided: Construction shall be completedwtthin t��rs o� 'the da�q p of this permit:,,
local conditions, must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Boston, MA Date r. (. 6 '%� Board of Health) i
No.: BOHDC-15-2475
Commonwealth of Massachusetts Fee ,
555.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to: Upgrade-Complete System
Location: 75 RITA AVE,SOUTH YARMOUTH, MA 02664 Owner:
PERONE ANTHONY S
Map/Parcel#: 089.165 PERONE MILDRED
75 RITA AVE
SOUTH YARMOUTH,MA 02664(979
Phone:
SepHc System Installer Designer
R.J.BEVILACQUA ATLANTIC DESIGN ENGINEERS,INC.
P.O. BOX 628 FORESTDALE, MA P.O.BOX 1051
0z� SANDWICH,MA 02563 '
Phone: (5081888-9282 �
Type of Building:Dwelling Lot Size: 10,019.00 Acres
DwelGng-No.ot Bedrooms:2 Garbage Grinder:
Other Type of Building: No.of persoos: Showers:
Other Fixtures: �
Plan Date:O6/10/2015 Number of Sheets: 1
Cafeteria:
TitIe:PROPOSED SEP7'IC DESIGN PLAN FOR 75 RITA AVE. Revision Date:
Design Flow(min.required):220 gpd Calculahd design flow:220 gpd Design 11ow provided:330 gpd
Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:06/10/2015
SCOTT MCGANN,SE �
DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-1500 GAL H-20 SEPTTC TANK,H-20 DBOX,2-500 GAL H-20 PRECAST
CHAMBERS W/4'STONE:25'X 12'X 2'
7he untlersigned agrees!o insfall the above describetl Individual Sewage Disposal System in aecordance wkh the provisions of
TITLE 6 and fuRher aarees not tn olace in ooeration undl a CertlFlcafe of Comoliance has heen Issued hvlhe Boartl of Heakh.
Signed Date
Inspections
Commonwealth of Massachusetts
Board of Health, Yarmouth, l�ili Fee �
DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00
Permission is herby granted to;
R.J. BEVILACQUA CONSTRUCTION, P.O. BOX 628, FORESTDALE, MA 02644
To perform:Upgrade an individual sewage disposal system.
Owner: PERONE ANTHONY S
PERONE MILDRED .
75 RITA AVE
SOUTH YARMOUTH,MA 02664-1979
Location: 75 RITA AVE, SOUTH YARMOUTH,MA 02664
Disposal System Construction Permit No.: BOHDG1S2475,Dated:June 18,2015 ,
Provided: Construc[ion shall be completed within six months of the date of this permit. All local conditions must be me[. ��''�
Conditions
1. REPAIR-I500 GAL H-20 SEPTIC TANK, H-20 DBOX, 2-500 GAL H-20 PRECAST CF7AMBERS W/
4'STONE:25'X 12'X 2'
2.ALL H-G(�C'UMPONENTS,(PER SEPTIC DESIGN �
- �.,��� /'"�G�I��A" �-/a—/�'V�� ��� �
��pG�� �'�r't€y �l�°'� ` ,
�'��'v' �. Bruce G. Murphy, PH, R.S., CHO/Amy L.von Hone, R.S., CHO
Nealth Director/Assistant Health Diredor
1
The issuance of t6is permit shall not be construed as a guarantee that the system will fuuction as designed.
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA F�
CERTIFICATE OF COMPLIANCE sss.00
Description of Work: Complete System
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by: R.J.BEVILACQUA CONSTRUCTION
at:75 RITA AVE,SOUTH YARMOUTH,MA 02664
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.: BOHDGIS-2475,dated 06/23/2015.
Installer.R.J.BEVILACQUA CONSTRUCTION
Address:P.O. BOX 628 FORESTDALE,MA 02644 Inspector:AMY VON HONE,R.S.
Designer:ATLANTIC DESIGN ENGINEERS,INC.
CondiHons
1.REPAIR- 1500 GAL H-20 SEPTIC TANK,H-20 DBOX,2-500 GAL H-20 PRECAST
CHAMBERS W/4' STONE:25' X 12'X 2'
2.ALL H-20 COMPONENTS PER SEPTIC DESIGN /� �
� (.��1
Bruce G. M rphy, 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.
BOH_Disposal_Construdion_CofC.rpt �