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HomeMy WebLinkAboutApp-Permit-ComplianceNo. Q l O -k COMMONWEALTH LTH ®F MASSACHUSETTS a Board of Health, lbw- , MA. If APPLICATION F®I, DISPOSAL S STEM[ �® TRUCTION PERMIIT Application for a Permit to Construct( ) Repair( ) Upgrade Abandon() - Complete system ❑Individual Components Location �"r (� +�® Owner's Name ffiffiCIA e JJg Map/Parcel# Address �� �'(Lo i)© , Lot# F 6 Telephone# Q - —3(Ab Installer's Name O r -r . o V (Z- CO - Designer's Name Riass 6 Ve- ,)'e 0 Address yi.� 39 H (l l409- Address Z6 , G3 Telephone# s3o Telephone# 6 - -3L)ab Type of Building Dwelling - No. of Bedrooms Other - Type of Building _ Other Fixtures Design Flow (mien. required) 330 gpd Calculated design flow Plan: Date (O ?� Number of sheets y Title Description of Soil(s) _ Soil Evaluator Form No. Lot Size coo sq. ft. arbage grinder ( ) No. of persons Showers ( ), Cafeteria ( ) Design flow provided Revision Date gpd DESCRIPTION OF REPAIRS OR PC"," K A- 61 ia-i Soo 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 pi a the sys operation until a Certificate of Compliance has been issued by the Board of Health. Signed + Q Date i 7 I� t r Inspections y i No. -&H-DC A 5 .»Ol*"T COMM ON LTII ®E MASSACHUSETTS 7 9 Board of Health, Yl n, AM , MA. 7. /r U t CERTIFICATE Of COMPLIANCE Description of Work: ,❑ Individual Components) ,, <omplete System °- - The undersigned hereby certify that the Sewage bisposal'System;,' Constructed ( ), Repaired ( ), Upgrades, Abandoned by: C- at �� �j �- O t% Kry has been instal ed iri accordai�e wee tl�fe �rovisions of 310 CMR 15.00 (Title 5) and thg proved design plans/as-built plans relating to application No. % dated / / �. , Approved Design Flow (gpd) Installer CN'Yrt-iSTW t 11 () �j (Z+ /1 Designer:(?9ASS iVOL E„{,){�MEERAM&Olnspector: CSU Date: -/—�'S The issuance of this permit shall not be construed as a guar a that the system will function as designed. nC.('^OC .:3 n C..; C, C?�' e:1 COC't'..:0�:r".—nii.a0..000`0eC"^'"C 11`1r.? 000 C -e- . 0V C, <: No.: BOHDC-15-0457 Commonwealth of Massachusetts F� E55.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERNIIT Appiication for a Permit to: Upgrade-Complete System Location: 37 WITCHWOOD RD, SOUTH YARMOUTH, MA 02664 Owner: JENNER KAREN A TR Map/Parcel#: 068.195 WITCHWOOD ROAD REALTY TRUST 37 WITCHWOOD RD SOUTH YARMOUTH,MA 02664 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 Buiiding:Dwelling Lot Size: 12,197.00 Acres Dwelling-No.of Bedrooms:3 Garbage Grinder. Other Type of Building: No.of persons: Showers: Other Fixtures: Plan Date:06/19/2015 Number of Sheets: 1 Cafeteria: Tit1e:SITE PLAN 37 WITCHWOOD ROAD Revision Date: Design Flow(miarequired):330 gpd Calculated design flow:330 gpd Design Oow provided:349 gpd Description of SoiIs:SEE PLAN Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:06/18/2015 TH DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,2- 500 GAL PRECAST CHAMBERS W/4'STONE:25'X 12.8'X 2' The untlersigned agrees to install the above deseribed Intlividual Sewage Disposal System in accordance wlth the provisions of TITLE 5 and further aarees not to olace in ooeration until a Certificate of Comolianee has heen iasued hv the eoartl of Health. Signed Date Inspections Commonwealth of Massachusetts � Board of Health, Yarmouth, MA Fee DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00 Permission is herby granted to; ROBERT B. OUR COMPANY INC., P.O. BOX 1539, HARWICH, MA 02643 To perform:Upgrade an individual sewage disposal system. Owner: JENNER KAREN A TR WITCHWOOD ROAD REALTY TRUST 37 WITCHWOOD RD SOUTH YARMOUTH,MA 02664 Location: 37 WITCHWOOD RD, SOUTH YARMOUTH,MA 02664 Disposal System Cons4action Permit No.: BOHDC-15-0457,Dated:July 21,2015 Provided:Construction shall be completed within six months of the date of this permit. All local conditions mus[be met. l ��-�C%�1�� Bruce G. y, 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 555.00 Description of Work: Complete System The undersigned hereby certify that the Sewage Disposal System; Upgraded by:ROBERT B.OUR COMPANY INC. at:37 WITCHWOOD 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.: BOHDGIS-0457,dated 07/23/2015. 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. Murphy, MPH, R.S., CHO/Amy L. von Hone, R.S., CHO `' Health Diredor/Assistant Health Diredor / The issuance af this permit shall not be construed as a guarantee that the system will function as designed. BO H_Disposal_Construdion_CofC.rpt