HomeMy WebLinkAboutApp-Permit-ComplianceNo. FEE
4044/140NWEALTH Of MASSAC14USETTS
Board of Health, lam$ -1101371 , MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
ilication for a Permit to Construct( ) Repair( ) Upgrade(,-) Abandon( - EiComplete System ❑ Individual Components
ation
� /J
Owner's Name Q ��,�
O I ir t t_
p/Parcel#
! a
Address#
(L`Telephone#aller's
Name
[,,Address
fzC)� -�- _ (30� CU �.
Designer's Name <� �i-�
AS
QLtQ(-P ��-T0WAddress
Pephone#
S D� Gj p
elephone# O
Type of Building i
Dwelling - No. of Bedrooms
Other - Type of Building _
Other Fixtures
No. of persons
Lot Size sq. ft.
Garbage grinder ( )
Showers ( ), Cafeteri4 ( )
Design Flow (min. required) l t o gpd Calculated design flow Design flow provided Z�30 gpd
Plan: Date (,r> 0 Number of sheets Revision Date
Title
Description of Soil s)=
Soil Evaluator Form No. Name of Soil Evaluator PkL Date of Evaluation ShG
DESCRIPTION OF REPAIRS OR ALTERATIONS A IJ 640
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 t ce 2dmtem in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date �61 l AL1 J
Inspections
;45
No. 60 WDC FEE
l ®®NLT1I Of MASSACHUSETTS
�S
"s�
Board of Health, yam:/
CERTIFICATE Of COMPLIANCE
Description of Work: 0 Individual Component(s)°complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded.-., bandoned
by: !v6er-T $ . Go r C_O. -XN C-
at (0) rC•W (r1 eP r
has been installed n acc anFe w-Tig 06e roviis�si�oons of 310 CMR 15.00 (Title 5) and the pproved design plans/as-built plans relating to
application No. �9�' ��� dated Sr' :G�T i . Approved Design Flow (�pd)
<` Installer
Designer: rI1kS Inspector: Date:
The issuance of this permit shall not be construed as a gua me that the system will function as designed.
c�
o.^oc�•
a-, �y ..r .�r,�
No. R,. , P6 , 0 V ML s FEE
COMMONWEALT14 Of MASSAC14USETTS C'-4,006 90,5
Board of Health, '%ArRkA O�'C? , MA.
DISPOSAL. SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgrade ( —)"'Abandon ( ) an individual sewage disposal system
at 6> ( &eoLeA-t Ac�0 b r as described in the application for
Disposal System Construction Permit No. / r �� , dated
Provided: Construction shall be comp eted within tkreeyeat•sf the date of this permit. 9 local conditions must be met.
eArW
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown, MA Datk_^%4 _// Board of Health Tr
= No.:BOHDC-15-4065
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
Location: 67 ARROWHEAD DR,YARMOUTH, MA 02675 Owner:
MORRICE ANDREW C
Map/Parcel#: 115.93 MORRICE SUZANNE A
67 ARROWIIEAD DRIVE
YARMOUTH PORT,MA 02675
Phone:
SepNc System Installer Designer
ROBERT B.OUR STEPHEN F�AAS.PE
P.O. BOX 1539 HARWICH, MA 02643 p.0.BOX 16
Phone: SOUTH DENNIS,MA 02660
508-362-8132
Type of Buildiog:Dwelling Lot Siu: 13,504.00 Acres
DwelGng-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Fiatures:
Plan Date:06/10/2015 Number of S6eets: 1 Cafeteria:
Tit1e:SEP1IC SYSTEM DESIGN 67 ARROWHEAD DRIVE Revision Date:07/Ol/2015
Design Flow(min.required):330 gpd Calculated design ilow:330 gpd Design Flow provided:394 gpd
Description of Soi1s:SEE PLAN �
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:OS/13/2015
STEPHEN HAAS,PE
� DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK,H-20 DBOX,
18 HIGH CAPACITY INFILTRATOR UNITS W/OUT STONE:37.5'X 9.5'X 11"
, The undersigned agrees to insfall the above describetl Intlividual Sewage Disposal System in accordanee wilhlhe provisions of
TITLE 5 antl further aarees not to olace in ooeralien until a Certificate of Comeliance has heen issued hv[he Board of Neakh.
Signed Date
Inspections .
. Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
� DISPOSAL SYSTEM CONSTRUCTION PERMIT 555.00
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. MORRICE ANDREW C
MORRICE SUZANNE A
67 ARROWHEAD DRIVE
YARMOUTH PORT,MA 02675
Location: 67 ARROWHEAD DR, YARMOUTH, MA 02675
Disposal System Construction Permit No.: BOHDGIS-4065 , Dated: August 24,2015
Provided: Construction shall be completed within six months of the date of this permit. All local conditions must be met.
CONDITIONS:
1. SEPTIC DISPOSAL- REPAIR-PROPOSED 1500 GAL SEPTIC TANK, H-20 DBOX, 18 HIGH
CAPACITY INFILTRATOR UNITS W/OUT STONE: 37.5'X 9.5'X 11"
2. PLUMBING PERMIT REQUIRED
3. BOH TO INSPECT SOIL REMOVAL
4. MFC VARIANCES APPROVED: a. SETBACKS b. GROUNDWATER ADJUSTMENT
5. ZONE II MAXIMUM 3 BEDROOMS
���
Bruce . 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.
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA FeB
CERTIFICATE OF COMPLIANCE E55.00
Description of Work:Complete System
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:ROBERT B.OUR COMPANY INC.
at:67 ARROWHEAD DR,YARMOUTH,MA 02675
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-1S4065,dated 09/14/2015.
Installer: ROBERT B.OUR COMPANY INC.
Address:P.O.BOX 1539 HARWICH,MA 02643 Inspector:AMY VON HONE,R.S.
Designer: STEPHEN HAAS,PE
� V(.J`�
Bruce G. urp , MPH, R.S., CHO/Amy L.von Hone, R.S.,CHO
Health Diredar/Assistant Health Diredor
The issnance of this permit shall not be construed as a guarantee that the system will function as designed.
BOH_Disposal_Construction_CoTC.rpt