HomeMy WebLinkAboutApp-Permit-ComplianceNo. 4 /�\ e� 4 �l✓� J' �FEE �r
COMMONWEALTH Of MASSACHUSETTS
Board of Health, )1fLM O UTM
APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade Abandon() - Complete System U Individual Components
Location to 3totpn
Owner's Name
Map/Parcel# 076. 10
Address tPCILD CA
Lot#
Telephone# cb2!7-7
Installer's Name -r hD
Designer's Name
Address1 ka mu Ln
Address
Telephone# 5 6tZ -
Telephone# f
Type of Building U--, Lot Size 2� sq. ft.
Dwelling - No. of Bedrooms Garbage grinder ( )
Other - Type of Building No. of persons Showers ( ), Cafeteria ( )
Other Fixtures --��--��
Design Flow (min. required) 0 gpd Calculated design flow Design flow provided gpd
Plan: Date Z Q �1 Number of sheets Revision Date
Title
Description of Soil(s) t '
Soil Evaluator Form No. Name of Soil Evaluator Df15QY1/j�Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS
The undersi a agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further a t n to pla a the to ation until a Certificate of Co p 'ance has been issued by the Board of Health.
Signed Date
7 Lo f
_ Inspections
No. 60 i DC - S-- 131 FEE 4S--5- 00
COMMONWEALTH Of MASSAC14USETTS Z-3 (off
Board of Health, YL�f(Lm C)U-1 M , MA.
CERTIFICATE OF COMPLIANCE
Description of Work: ❑ Individual Component(s) U Complete System
The unsigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired ( ), Upgraded.(. ( )
by: !�.� _*,i-cto i U n
at rc4 o- Gf t 1 , _ . _ `
has been installec-inyacco darjce with the px�visi sof 310 CMR 15.00 (Title 5) and athod design plans/as-built plans relating to
applicationFr ��7 �� dated %` .��� Approved Design Flow(gpd)
Installer i Lf /
+ Designer: --Dbw l r- Inspector:. i LA Date:
Tn� ssiuwce of this permit shall not be construed as a guarantee that the system will function as designed.
No. vClt}�C�L�-Oi3� '✓ B eX60VA--no�,j FEE S? Oa
COMMONWEALT14 Of MASSACHUSETTS � 3 (oc
Board of Health, 1'AV 10y -M , AIA,
DISPOSAL SYSTLM CONSTRUCTION PERMIT
Permis16
sion is hferebygr(anted to; Construct( ) Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system
at { GC i 7t GP l ! L i C,�r1 as described in the application for
Disposal System Construction Permit No. �7 ��J� , dated 7
Provided: Construction shall be completed within t��f of this per t All local cond'. 'ons must be met.
form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown, MA Date 7 dr�Boarfod of Health
No.: BOHDC-15-0135
• Commonwealth of Massachusetts FeB
555.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SY5TEM CONSTRUCTION PERMIT
Application For a Permit to:Upgrade-Complete System
LocaHon: 76 CAPT BACON RD, SOUTH YARMOUTH, MA 02664 Owner:
PEREIRA EDWARD M JR
Map/Parcel#: 078.105 PEREIRA CELESTE L
76 CAPT BACON ROAD
SOUTH YARMOUTH,MA 02664
Phone:
Septic System Installer Designer
B&B EXCAVATION DOWN CAPE ENGINEERING.INC.
14 TEABERRY LANE FORESTDALE, 939 ROUTE 6A
MA 02644 YARMOUTHPORT,MA 02675
Phone: 508-362-4541
Type otBuilding:Dwelling Lot Size: 11,761.00 Acres
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Fixtures:
Plan Date:OS/28@O15 Number of Sheets: 1 Cafeterie:
Title:T[7ZE 5 SITE PLAN 76 CAPTAIN BACON ROAD Revision Dah:
Design Flow(min.required):330 gpd Calculated design Flow:330 gpd Design Flow provided:349 gpd
Description of 5oi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:OS/20/2015
DANIEL GONSALVES,SE
DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,2-500 GAL PRECAST
CHAMBERS W/4'STONE:25'X 12.83'X 2'
� The unAe�signetl agrees to install the above deseribed Intlivitlual Sewage Disposal SysMm in accortlance with!he provisions of
TITLE 5 and further aareea not to olace in ooerotion until a Certificate of Comoliance has been issued bv the Boartl of Heakh.
Signed Date
lnspections
Commonwealth of Massachusetts
� Board of Health, Yarmouth, MA FBe
DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00
Permission is herby granted to;
8 8 B EXCAVATION, 14 TEABERRY LANE, FORESTDALE, MA 02644
To perform: Upgrade an individua] sewage disposai system.
Owner: PEREIRA EDWARD M JR
PEREIRA CELESTE L
76 CAPT BACON ROAD
SOUTH YARMOUTH,MA 02664
Location: 76 CAPT BACON RD,SOUTH YARMOUTH,MA 02664
Disposal System Construction Permit No.: BOHDGIS-0135,Dated:July 08,2015
Provided:Construction shall be completed within six months of the date of this permit. All local conditions must be met.
Conditions
1. REPAIR-PROPOSED 1 S00 GAL SEPTIC TANK, DBOX, 2-500 GAL PRECAST CHAMBERS W/4'
STONE: 25'X 12.83'X 2'
2. ZONE II MAXIMUM 3 BEDROOMS
3. MFC YARIANCEAPPROVAL:a. GROUNDWATER SEPARATION
U
Bruce G. rph ,MPH, R.S., CHO/Amy L.von Hone, R.S.,CHO
Health Director/Assistant Health Diredor
T6e 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 Fee
CERTIFICATE OF COMPLIANCE $55.00
Description of Work: Complete System
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:B&B EXCAVATION
at:76 CAPT BACON RD,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.: BOHDG1S0135,dated 07/16/2015.
Installer:B&B EXCAVATION
Address:l4 TEABERRY LANE FORESTDALE,MA Inspector:AMY VON HONE,R.S.
02644
Designer. DOWN CAPE ENGINEERING,INC.
Conditions
1.REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,2-500 GAL PRECAST CHAMBERS
W/4'STONE:25' X 12.83' X 2'
2.ZONE II MAXIMUM 3 BEDROOMS
3.MFC VARIANCE APPROVAL: a.GROUNDWATER SEP `I�ON
�, .
Bruce G. u y, MPH, R.S., CHO/Amy L. vo Hone, R.S.,CHO
Health Diredor/Assistant Health Diredor
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
BO H_Disposal_Construdion_CofC.rpt