HomeMy WebLinkAboutApp-Permit-ComplianceNo. /,�- / <�5 FEE
/�"7 Z COMMONWEALT14 OF MASSACHUSETTS TIQ
Board of Health, yam 6 i�T1� , MA. - 000 3
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade Abandon( ) - Complete System ❑ Individual Components
Location ''ZLI DeZbrVo r d
Owner's Name 1P I, +(T- rr eT1 I -O `5w—)
Map/Parcel# 3 9 8
Address 3q Sa.&)Mj Il L.n / ���� AA�Q.
Lot# S
Telephone# 33f- %q il-193
Installer's Name ,q- �+ -I-r�
Designer's Name 't:3#45'ver VG'S
Address 2Lf 6 r^ +d_ C>\
Address AV, I[j J i� D- C An IS
Telephone# S0S_-5--09' 10,56
Telephone#
Type of Building Lot Size sq. ft.
Dwelling - No. of Bedrooms Garbage grinder ( )
Other - Type of Building No. of persons Showers ( ) , Cafeteria ( )
Other Fixtures
Design Flow (min. required) -3 310 gpd Calculated design flow 3 `-1 R Design flow provided 3y R gpd
Plan: Date LS Number of sheets % Revision Date
Title 2
Description of Soil(s)'/'t ^ 0-4?x "Y So.Ad - %7* a d ix. he 64--d
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed I� rte& Lgcr 8 "Ooca, Date 7- 17 -LS'
Inspections
No. FEE IQ
��- 7 z - COMMONWEALTH Of MASSACHUSETTS
Board of Health, �AW 6 LM4 , MA.
CERTIFICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) 10 Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded, Abandoned ( )
by: 12•ppPCT & Bu -r (0. rr C- -
at ZK L'1- 12x1
has been installek accordance with the provisions of 310 CMR 15.00 (Title 5) and thea proved design plans/as-built plans relating to
application No.
�ea 7Z -- dated 7-.> 0 Approved Design Flow 'l'`� (gpd)
Installer f-0 b�er-T U + otX- CO .:reC • / tire) r✓'i
Designer: /7a $S k 1 UP..0 G5nq Inspector: v l Date: - 12
The issuance of this permit shall not be construed as a guar tee that the system will function as designed.
No. FEE U -D
COMMONWEALTH OF MASSACHUSETTS
Board of Health, A iZMO l) 1 A , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is herebygrantedto; Construct( ) Repair( ) Upgrade N/' Abandon( ) an individual sewage disposal system
at 2•f % bfyr,2 as described in the application for
Disposal System Construction Permit No. / ` 7.� , dated
Provided: Construction shall be completed withi;+,ears of the date of this permit. All local conditions must be met.
b�uaf
Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date 71`�- - / Board of Healthy'
No.:BOHDC-15-1955
. Commonwealth of Massachusetts Fee
555.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERNIIT
Application for a Permit to:Upgrade-Complete System
LocaHon: 24 DEEP BROOK RD,WEST YARMOUTH, MA 02673 Owner:
LOISEL PAUL R
Map/ParceW:058.348 . LOISEL IANET L
24 DEEP BROOK RD
WEST YARMOUTH,MA 02673
Phone:
Septic System Installer Designer
ROBERT B.OUR BASS RIVER ENGINEERING
P.O. BOX 1539 HARWICH, MA 02643 P.O.BOX 1163
Phone: EAST DENNIS,MA 02641
508-385-3426
Type of Buildiog:Dwelling Lot Siu:5,712.00 Acres
Dwelling-Na of Bedrooms:2 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Fiztures:
Plan Date:06/16/2015 Number of Sheets: 1 Cafeteria:
Title:SI1'E PLAN 24 DEEP BROOK ROAD Revisioo Date:
Design Flow(min.required):220 gpd Calculahd design tlow:330 gpd Desigo Flow provided:349 gpd
Descriptioo of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date oCEvaluation:06/11/2015
THOMAS MCLELLAN,P.E.
� DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED ]500 GAL SEPTIC TANK,DBOX,2-
500 GAL PRECAST CHAMBERS W/4'STONE:25'X 12.8'X 2'
The undersignetl agrees to insfall the above described IndNidual Sewage Disposal System in aeeordance with the provislons of
T1TLE 6 and further aarees not to olaee in ocention until a CeMiFeate of Comolianee has been issued bv the eeard of Fleakh.
Signed Date
Inspections
- Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
� DISPOSAL SYSTEM CONSTRUCTION PERMIT $55.00
Permission is hereby granted to;
ROBERT B. OUR COMPANY INC., P.O. BOX 1539, HARWICH, MA 02643
To perform: Upgrade an individual sewage disposal system.
Owner: LOISEL PAUL R
LOISEL JANET L
24 DEEP BROOK RD
WEST YARMOUTH,MA 02673
I,ocation: 24 DEEP BROOK RD, WEST YARMOUTH, MA 02673
Disposal System Construction Permit No.: BOHDC-15-1955 , Dated: JiJLY 28,2015
Provided: Construction shall be completed within six months of the date of this permit. All local conditions must be met.
CONDITIONS:
1. REPAIR-PROPOSED 1500 GAL SEPTIC TANK, DBOX, 2-500 GAL PRECAST CHAMBERS W/4'
STONE: 25'X 12.8'X 2'
W
Bruce G. Mu y, PH, R.S., CHO/Amy L. von Hone, R.S., CHO
ealth Director/Assistant Health Director
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 FeB
CERTIFICATE OF COMPLIANCE 555.00
Description of Work:Complete System
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:ROBERT B. OUR COMPANY INC.
at:24 DEEP BROOK 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-1S1955,dated 08/12/2015.
Installer:ROBERT B. OUR COMPANY INC.
Address:P.O.BOX 1539 HARWICH,MA 02643 Inspector:AMY VON HONE,R.S.
Designer:BASS RIVER ENGINEERING
Bruce G. Mur y, PH, 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_Constructlon_CofC.rpt