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HomeMy WebLinkAboutApp-Permit-ComplianceNo. 'bJ- r t(. "qqo FEE 170 Od e4H-Dc-1,,S—qo 6 3 COMM® LTH OF MASSACHUSETTS C"00 I o(' /37-/k6 Board of Health, 0 MA. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon( ) - 0"C0mplete System ❑ Individual Components Location 151 Nordl KC611i Owner's Name rA rcP C (30 a 1A e Map/Parcel# Address l5^ No m V6 Lot# Telephone# (p +' -- D. Installer's Name R 613 t� CN Designer's Name Address P.6 `� % $ 3 � Address RID R ( bP-A3 PIS, OQ Telephone# - tyi Telephone# s6r 3 &;;LA) Type of Building ®PL/1/% A, b Lot Size sq. ft. Dwelling - No. of Bedrooms Garbage grinder ( ) Other - Type of Building No. of persons Showers ( ), Cafeteria ( ) Other Fixtures Design Flow (min. re uired) lh gpd Calculated design flow r->— Design flow provided -� gpd Plan: Date 1 l 1 Number of sheets Revision Date Title Description of Soil (s) _ Soil Evaluator Form No. DESCRIPTION OF REPAIRS OR,AITERATIONS t Cis n �t is 1� • (�J �'� i,.ir,>D �c� -r IV N 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 the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed � iL� Dated 6h Inspections No.- �� + COMMONWEALTH OF MASSACHUSETTS FEE . 0 Board of Health, Y&9tt+0vrA , MA. 00 CERTIFICATE Of COMPLIANCE Description of Work: ElIndividual Component(s) ,®'"Complete System CK The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), UpgradeAbandoned ( ) by: RC)" r -T 2 1) v 2 C ['1 'X w C- at 157!) Nd r7k A4,ai i Ste, v AaAAOV � has been installedin acc`or`d nce with thepprovisions of 3_10 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to �'� dated ` ,►. A roved Design Flow -1— d i o - s application No. � � PP g (gP) 3 13 ,"c- Installer UU14- Designer: S-'iz 44A5 Inspector: 1�'S Date: The issuance of this permit shall not be construed as a guarantee that the system will function as designed. ?-=: i'.;, Cr;t:+r' "��; <i __:)+.: CCI ..;_. 1.. i'. �':)+. /; (_ ,.,,�.U+•��'i^I:JnC C•-+J�: _.r�inrr Ci�l+:�.CL+ L(. :;O O No -9014 -VC.- I S -4 0 s FEE it? • COMMONWEALT14 OF MASSACHUSETTS Board of Health, . yk m- O ont , MA. ➢FISPOSAI. SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( ) Upgraded') Abandon( ) an individual sewage disposal system at 1S © r -7 A 1446 1 .AJ as described in the application for Disposal System Construction Permit No.dated `l Provided: Construction shall be completed within xhfie�rs of the date of this perrriit, All local conditions must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadlestown, MA Date —� f � i� Board of Health �=-i'" � , r' �'�� (+.✓��!' No.: BOHDGIS-4063 Commonwealth of Massachusetts Fee E55.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to: Upgrade-Complete System Location: 157 NORTH MAIN ST, SOUTH YARMOUTH, MA 02664 Owner: CLOUGHERTY EDWARD V Map/Parcel#: 080.14 20 PLEASANT VALLEY CIR WEST ROXBURY,MA 02132-1225 Phone: Septic System Installer Designer ROBERT B. OUR STEPHEN HAAS.PE P.O. BOX 1539 HARWICH, MA 02643 P.O.BOX 16 Phone: SOUTH DENNIS,MA 02660 508-362-8132 Type of Building:Dwelling Lot Size: 1Q890.00 Aaes Dwelling-No.otBedrooms:3 Garbage Grioder: Other Type of Building: No.of persons: Showers: Other Fixtures: Plan Date:08/11/2015 Number of Sheets: 1 Cateteria: Tit1e:SEPTIC SYSTEM DESIGN 157 NORTH MAIN STREET Revision Dah: Design Flow(min.required):330 gpd Calculated design Flow:330 gpd Design tlow provided:393 gpd Description of SoiIs:SEE PLAN Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:OS/OS/2015 STEPHEN HAAS,PE DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTTC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK,H-20 DBOX, 1S HIGH CAPACITY INFILTRATORS W/OUT STONE:37.5'X 9.5'X 11" The undersignetl agrees to install the above described Individual Sewage Dfsposal System in accordance with the provisions of TITLE 5 and further aarees not to olace in ooeration until a Certificate of Comoliance has heen iasued bv the Board of Mealth. Signed Date Iuspectious Commonwealth of Massachusetts Board of Health, Yarmouth, MA Fee DISPOSAL SYSTEM CONSTRUCTION PERMIT ass.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. CLOUGHERTY EDWARD V 20 PLEASANT VALLEY CIR WEST ROXBURY,MA 02132-1225 Location: 157 NORTH MAIN ST, SOUTH YARMOUTH, MA 02664 Disposal System Construction Permit No.: BOHDC-15-4063 , Dated: August 31,2015 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 INFILTRATORS W/OUT STONE: 37.5'X 9.5'X 11" 2. MFC VARIANCE APPROVAL: a. DEPTH ��V(�� �� Bruce G. Murph PH,M R S., CHO Amy L. van Hone, R.S., CHO ` alth Director/Assistant Health Director The issuance of this permit shall not be construed as a guarantee that the system will function as designed.