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HomeMy WebLinkAboutApp-Permit-ComplianceCOMMONWEALTH Of MASSACHUSETTS FEE Ck*55 Board of Health, MA. APPLICATION FOR DISP®SSI. SYSTEM ®NSTRIJCTI®NEI�NIITr ,•,,.-� Ap lication for a Permit to Construct( ) Repair( ) UpgradebandonO - ❑Complete System Individual Components 4 ocation Owner's Name 1<012Wqx ap/Parcel# —by/,�� 7 aS / Address �1 Lot# Telephone# Installer's Name /Vilorp Designer's Name e Address , 01 1 lm Address 6q,/3-71�� Telephone# ® Telephone# 3ZF Z °x- '- Q Type of Building Lot Size sq. ft. Dwelling - No. of Bedrooms �lT� Garbage grinder ( ) Other - Type of Building No. of persons Showers ( ) , Cafeteria ( ) Other Fixtures Design Flow (min. required) Z- 7-0 gpd Calculated design flow Design flow provided 7j gpd Plan: Date / / Number of sheets Revision Date Title / - - Description of Soil(s) _ Soil Evaluator Form No. Name of Soil Evaluator 3eV, 4 Date of Evaluation The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees ton t to plbce the peration until a Certificate of Compliance has been issued by the Board of Health. Signed Date 7- 1Le-1.' Inspections :2'f --f No. to to C 3 COMMONWEALTH SS S 64 Board of Health, YMZMO 07-H' , MA. CERTIFICATE © COMPLIANCE � 1 Description of Work: ®'Individual Component(s) ❑ Complete System The undersigned hereby certify that the Sewa i Disposal Syste Constructed ( ), Repaired ( ), Upgraded (<Ikbandoned ( ) by: 60 Ir at 7.0 Kaa.3' - r�`x has been installe K arccordancc ith pro��,7srons of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. r ' J`^' > dated _. C7Approved Design Flow -3-37-16 (gpd) Installer Designer: �� Inspector: %� C��I -� Date: The issuance of this permit shall not be construed as a guar imfee tha the system will function as designed. c, F-3-3 C-01)0 1:9-09^ t. 0. 0Jo J 0(6t; Ci00060:6,—C:'O-C,,-z5bo0-C6k�+ sC ,0:0,?LO:�.: No. 620 C'""1S-s6%iiFEE. 1,D.; ­ COMMONWEALTH U�. Of MASSACHUSETTS y Board of Health, TN- ny� , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct Repair (LX Upgrade ( ) Abandon ( ) an individual sewage disposal system at b�-J�'f�',t� /� as described in the application for Disposal System Construction Permit No. , dated 7 Provided: Construction shall be competed within thEac.= of the date of this permit. All local conditi, s must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown, MA Date 7 l lBoard of Health > %E l 7 No.: BOHDC-15-0691 Commonwealth of Massachusetts Fee $55.00 � Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to: Upgrade-Individual Component(s) Location: 206 FOREST RD, SOUTH YARMOUTH, MA 02664 Owner: WATTS KELLY ANN Map/Parcel#: 058.245 206 FOREST RD SOUTH YARMOUTH,MA 02664 Phone: Septic System Installer Designer BOSETTI SEPTIC JC ELLIS DESIGN 199 CHURCH STREET EAST P.O. BOX 2152 HARWICH, MA 02645 BREWSTER,MA 02631 Phone: 508-385-2228 Type of Building:DwelLing Lot Size: 13,939.00 Acres Dwelling-No.oY Bedrooms:2 Garbage Grinder. OtherTypeofBuilding: No.ofpersons: Showers: Other Fiztures: Plan Date:06/10/201 I Number of Sheete: I Cafeteria: Tit1e:SEPTIC SYS'TEM UPGRADE PLAN Revision Date: Design Flow(min.required):220 gpd Calculated design flow: 330 gpd Design ilow provided:337.4 gpd Description of SoiIs:SEE PLAN Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:06/09/2011 JASON ELS,IS,R.S. DESCRIPTIOIV OF REPAIRS OR ALTERATIONS:REPAIR-EXISTING ]000 GAL SBPTIC TANK,DBOX,LEACH FIELD:38'X 12'X 0.5' � The undenignetl agrees to install the above describetl Intlivitlual Sewage Disposal System in accordance with the provisions of TITLE 5 and further aarees nnt to olace in ooeretion until a Certificate ot Comoliance has been issued 6v the Boartl of Health. Signed Date I�spections - Commonwealth of Massachusetts . Board of Health, Yarmouth, MA Fee DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00 Permission is herby granted to; BOSETTI SEPTIC SYSTEMS, 199 CHURCH STREET, EAST HARWICH, MA 02645 To perform:Upgtade an individual sewage disposal system. Owner: WATTS KELLY ANN 206 FOREST RD SOUTH YARMOUTH,MA 02664 Location:206 FOREST RD, SOUTH YARMOUTH,MA 02664 Disposal System Construction Permit No.: BOHDC-15-0691 ,Dated: July 14,2015 Provided: Construction shall be completed within six months of the date of this permit. AII Iocal co�ditions must be met. COnditlO�S 1. REPAIR-EXISTING 1000 GAL SEPTIC TANK, DBOX, LEACH FIELD: 38 X 12'X 0.5' Bruce G. Mur �y,�H, RS., CHO/Amy L.von Hone, R.S., CHO ealth Director/Assistant Health Diredor The issaance of this permit shall not be construed as a guarantee tha[the system will function as designed. Commonwealth of Massachusetts Board of Health, Yarmouth, MA Pee CERTIFICATE OF COMPLIANCE ass.00 Description of Work:Individual Componeot(s) The undersigned hereby certify that the Sewage Disposal System; Upgraded by:BOSE'CCI SEPTIC SYSTEMS at:206 FOREST 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.: BOHDG1�0691,dated 07/24/2015. Installer:BOSETTI SEPTIC SYSTEMS Address:199 CHURCH STREET EAST HARWICH,MA Inspector.BRUCE MiJRPHY and AMY VON HONE 02645 Designer:JC ELLIS DESIGN Conditions 1.REPAIR-EXISTING 1000 GAL SEPTIC TANK,DBOX,LEA :38'X ' .5' i��� Bruce G. Murp , M , R.S., CHO/Amy L.von Hone, R.S., CHO Health Director/Assistant Health Direc[or The issuance of this permit shall not be construed as a guarantee that the system will function as designed. BOH_Disposal_Construc[ion_CofC.rpt