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HomeMy WebLinkAboutApp-Permit-ComplianceT1 tc �� %J 1 'fG i9Qc q' off—* ✓ 1-,izk FEE 1-55,AO No. �or>�a e —��-3857 5 ; j fflMMONWEALTH Of MASSAC UIT C (�,,Health, YA(11©lid+ , MA. APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade (/ Abandon( ❑ Complete System ,al dividual Components ocation X1.3 /4% t„ mo g Owner's Name W I` d 1►4LAA- 0" ap/Parcel# `! q i Z ® Address 143 /K&A9W &-po k AJ. ot# 9 Telephone#SoV --Zq2- o 7-73 tstaller's Name x e Designer's Name g P -N per^ ddress rjLj V.lcA ,,t Address AO- FwY,1dl' .s 02&W Telephone# 9- 15-01?- bis13Telephone# Type of Building �S'�GIC-�.n '(�1 Lot Size ��, �% 3 sq. ft. Dwelling - No. of Bedrooms Garbage grinder ( ) Other - Type of Building No. of persons Showers( ), Cafeteria ( ) Other Fixtures Design Flow (min. required) 3 30 gpd Calculated design flow 333 L/ Design flow provided � gpd Plan: Date /- Z6' % `cam Number of sheets % Revision Date Title Description of Soil(s) Z Soil Evaluator Form No DESCRIPTION OF REPAIRS OR ALTERATIONS Name of Soil Evaluator 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 to n t to place thesystemin operation until a Certificate of Compliance has been issued by the Board of Health. Signed �, LAi A ka 8, & a--& . TiY: Date D - IF -S Inspections 1011 Z511s - No. �, — s_ �sl COMMON LTH Of MASSACHUSETTS N �g �/�� rI ��6` ch- �60"a1 Board of Health, � LV\An 11}} , MA. or- W/16/is' CERTIFICATE Of COMPLIANCE ��-gib / fi1F r" Description of Work:-EKdividual Component(s) ❑ Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( 6pgarAed ���`, Abandoned ( ) by: 1 ka� a , 0 yi- Z:P,4 . has been installed rp?ke application No. Installer Rs4" Z with 0% rrovisions of 310 CMR 15.00 (Title 5) and thea proved design plans/as-built plans relating to dated Approved Design Flow (gpd) Designer: , �`,¢< K'tb�E-`— r Inspector: �.. ;; � A—/ � Date: The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. 4614 =15 38S-7 P. G. 0 U (2_ C-9 r FEE le�" COMMONWEALTH Of MASSACHUSETTS ak-4-00(901 Board of Health, Y" to 01 M4, , MA. DISPOSAL SYSTEM][ CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( ) Upgrade (v/) Abandon( ) an individual sewage disposal system at -!4-3 AVA6rzin as described in the application for Disposai System Construction Permit No. dated A) Z �/ Provided: Construction shall be cplet' ecd witlhtn t re of the date of this perm -t. N1 local conditions must be met. Form 1255 Rev. 5/96 A.M. Sulki ; Co. Chadestawn, MA Date/G /) Board-oAfealth / %I �� �� 7 /S //,/ ��1C:L�� )s � /�Ye 1A///✓%//i/ :> ' � /P�i�s �✓ra' � i`�O! !il„ � No.:BOHDC-15-3851 • Commonwealth of Massachusetts F� sss.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT , Application for a Permit to:Upgrade-Individual Component(s) � Locatioo:43 MEADOWBROOK RD,WEST YARMOUTH, MA 02673 Owner: OBOYLE WILLIAM A Map/Parce�k:049.120 OBOYLE MARIANNE 43 MEADOWBROOK 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: EST DENNIS,MA 02641 508-385-3426 Type of Buildiog:Dwelling Lot Size: iQ890.00 Acres Dwelling-No.of Bedrooms:3 Garbage Grinder: Other Type of Building: No.of persons; Showers: Other Fiatures: Plao Date:07/28/2015 Number of Sheets: l Cafeteria: Tit1e:SITE PLAN 43 I�ADOWBROOK ROAD Revision Date:09/30/2015 Design Flow(min.required):330 gpd Calculated design flow:330 gpd Design Flow provided:334 gpd Descriptioo of Soi1s:SEE PLAN Soil Evaluator Form No.: Name of Soil Evaluator. Date of Evaluation:06/11/2015 THOMAS MCLELLAN,P.E. DESCRIPTION OF REpAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REppIR-EXISTING 1500 GAL SEPTIC TANK,PROPOSED 1000 GAL WATERPROOFED PUMP CHAMBER,DBOX,24 QUICK 4 STANDARD INFILTRATORS W/OUT STONE:34'X 9'X 8" The untlersigned agrees W inspll the above tlescribetl Individual Sewage Disposal Syatem in aceortlance with the provisiona of , TITLE 5 and further aarees not to olace in ooeratlon until a Certiflcate of Comnllance has 6een issued 6v the Board of Health. Signed Date Inspections • Commonwealth of Massachusetts Board of Health, Yarmouth, MA DISPOSAL SYSTEM CONSTRUCTION PERMIT sss o0 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. OBOYI,E WILLIAM p OBOYLE MARIANNE 43 MEADOWBROOK RD WEST YARMOUTH,Mq 02673 Location:43 MEADOWBROOK RD, WEST YARMOUTH,MA 02673 Disposal System Construction Permit No.: BOHDC-1S3851 ,Dated:October 02,2015 Provided:Construction shall be comple[ed within six months of the date of this permit. All local conditions must be me[. CONDITIONS: 1. SEPTIC DISPOSAL-REPAIR-EXISTING 1500 GAL SEPTIC TANK, PROPOSED 1000 GAL WATERPROOFED PUMP CHAMBER, DBOX, 24 QUICK 4 STANDARD INFILTRATORS W/OUT STONE: 34'X 9' X 8" 2. BOH TO INSPECT SOIL REMOVAL 3. MFC VARIANCE APpROVALS:a. GROUNDWqTER ADJUSTMENT b. SETBACKS c. DRAINAGE WETLAND , SETBACK U�. Bruce G. M hy, PH, R.S., CHO/Amy .von Hone, R.S., CHO ealth Director/Assistant Health Director The issuance of this permit sha11 not be construed as a guarantee that the system wi11 function as designed, Commonwealth of Massachusetts Board of Health, Yarmouth, MA Fee CERTIFICATE OF COMPLIANCE 555.00 Description of Work:Individual Component(s) The undersigned hereby certify that the Sewage Disposal System; Upgraded by:ROBERT B.OUR COMPANY INC. at:43 MEADOWBROOK 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-15-3851,dated 10/16/2015. Installer:ROBERT B.OUR COMPANY INC. Address:P.O.BOX 1539 HARWICH,MA 02643 Inspector:PHILIP RENAUD Designer:BASS RIVER ENGINEERING � Bruce G. Murp , H,R.S., CHO/Amy L.von Hone, R.S.,CHO Heaith Director/Assistant Health Director The issuance of this permit shall not be construed as a guarant that the system will function as designed. BOH_Disposal_Construction_CofC.rpt