HomeMy WebLinkAboutApp-Permit-ComplianceNo. 47 �� e 0 -Ta ^ ��� 0()(.,3(5
FEE y 00
p o*loc-x.15- 2,q 8 2—COMMONWEALTH Of MASSACHUSETTS Alam
8�Board of Health, O'vTA , MA. �6 f-
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTI®N PERMIT
Application for a Permit to Construct( ) Repair(vf Upgrade( ) Abandon( ) - ❑ Complete System ndividual Components
Location
(jU �'
Owner's Name 'A 1P1i
Map/Parcel#
=h
Address l l UU (®
Lot# a
Telephone#
Installer's Name
Designer's Name pJoLa 1J CA
Address Ylo,Ro4A
ftk) I C
ddress iZAigw S\ -[
elephone# S�Telephone#
`L4 5 14 1
Type of Building
Dwelling - No. of Bedrooms
Other - Type of Building _
Other Fixtures
No. of persons
Lot Size1 i f' l sq. ft.
Garbage grinder ( )
Showers ( ), Cafeteria ( )
Design Flow (min. required) 3 3 C7 gpd Calculated design flow 0 Design flow provided ? gpd
Plan: Date L Number of sheets Revision Date
Title .+
Description of Soil(s) _
Soil Evaluator Form No.
— C O A r'-�P_ �A rj
Name of Soil EvaluatorYhd- K491-�d -0 Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS 1145140 1 � � a�� J _0 �I L �t" l, O 4-4
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 placethe tem in operation until a Certificate of Compliance has been issued by the Board of Health.
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Signed iR BQ Date %`I /I f—
Inspections
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x,57 _COMMONWEALT14®E MASSACHUSETTS 64 *00(08
Board of Health, A-9
W00 -IN MA.
CERTIFICATE Of COMPLIANCE
Description of Work:, ia-1Qividual Component(,) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired (,�, Upgraded ( ), Abandoned ( )
by: t --r v c- r o
at t Gil, C
has been installed m accordan� with th?'X` ons of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. �~ 5�, dated 7— 7`/ !. Approved Design Flow� /(gpd)
Installer C€� I SEPI _ 1,1 . �Jl
Designer: DOw)1J uwe E.ta1Gl N , Inspector:
Date:
The issuance of this permit shall not be construed as a guarpfee that the system will function as designed.
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FEE J55, 00
COMMONWEALTII Of MASSACHUSETTS c a4 ' ` °
Board of Health, YA M.00 -m " , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair(�,,� Upgrade( ) Abandon( ) an individual sewage disposal system
f
at /� I t ou Te- ( I as described in the application for
r -
Disposal System Construction Permit No. �� , dated.
Provided: Construction shall be completed within tf the date of thispermit. l local conditions must be met.
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Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date' Board of Healt1i
No.: BOHDC-15-2482
� Commonwealth of Massachusetts Fee
E55.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade- Individual Component(s)
Location: 771 ROUTE 6A,YARMOUTH, MA 02675 Owner:
VIOLET KEVIN E
Map/Parcel#: 13478 RIGALIS MARY J
771 ROUTE 6A
YARMOUTH PORT,MA 02675
Phone:
SepHc System Installer Designer
ROBERT B.OUR DOWN CAPE ENGINEERING,INC.
P.O. BOX 1539 HARWICH, MA 02643 939 ROUTE 6A
Phone: YARMOUTHPORT,MA 02675
508-362-4541
Type of Building:Dwelling Lot Size: 11,326.00 Acres
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type otBuilding: No.of persons: Showers:
� Other Fixtures:
Plan Date:OS/29/2015 Number of Sheets: 1 Cafeteria:
TitIe:TITLE 5 SITE PLAN 77l ROUTE 6A Revision Dah:
Design Flow(min.required):330 gpd Calculated design Flow:330 gpd Design Oow provided:335 gpd
Description of Soi1s:SEE PLAN
Soil Evaluator Forro No.: Name of Soil Evaluator: Date of Evaluation:OS/28/2015
DANIEL GONSALVES,SE
DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-EXISTING ]000 GAL SEPTIC TANK,DBOX,24 QUICK 4 STANDARD
INFILTRATORS W/OUT STONE:24'X 11.3'X 7"
� The undersigned agrees to install the above tlescribed Intlivitlual Sewage Disposal System in accordance wkh the provisions of
TITLE 5 and further aarees no!to olace in ooeration until a Certificate of Comoliance has been issuetl 6v the Board of Heakh.
Signed Date
Inspec[ions
� Commonwealth of Massachusetts
� Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT 3ss.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: VIOLETKEVINE
RIGALIS MARY J
771 ROUTE 6A
YARMOUTH PORT,MA 02675
Location: 771 ROUTE 6A, YARMOUTH, MA 02675
Disposal System Construction Permit No.: BOHDGIS-2482 , Dated: July 07,2015
Provided: Constrvction shall be completed within six months of the date of this permit. All local conditions must be met.
Conditions
1. REPAIR-EXISTING 1000 GAL SEPTIC TANK, DBOX, 24 QUICK 4 STANDARD INFILTRATORS
W/OUT STONE: 24'X 11.3'X 7"
2. MFC VARIANCE APPROVED: a. SETBACKS
�
Bruce . M rphy, MPH, R.S., CHO/ my 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 Fee
CERTIFICATE OF COMPLIANCE sss.00
Description of Work: Individual Component(s)
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by: ROBERT B. OUR COMPANY INC.
at: 771 ROUTE 6A, 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-15-2482, dated 07/09/2015.
Installer: ROBERT B. OUR COMPANY INC.
Address:P.O. BOX 1539 HARWICH, MA 02643 Inspector: AMY VON HONE, R.S.
Designer: DOWN CAPE ENGINEERING, INC.
Conditions
1. REPAIR-EXISTING 1000 GAL SEPTIC TANK,DBOX,24 QUICK 4 STANDARD
INFILTRATORS W/OUT STONE: 24' X 11.3' X 7"
2. MFC VARIANCE APPROVED: a. SETBACKS
�V���
Bruce G. urphy, MPH, R.S., CHO/Amy L. von Hone, R.S., CHO
Heafth 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_Construction_CofC.rpt