HomeMy WebLinkAboutApp-Permit-ComplianceNo. �IkDC-J��'Y� "vO FEES
COMMONWEALTH Of MASSAC114USETTS
Board of Health, 4TH/2t QQT1 , MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application fora Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System ❑ Individual Components
Location
Lee
ROOK �b
Owner's Name ey a-�y N K NE
Map/Parcel#
�� -
(�
Address 6-P WZ& l LCt100 D D/2 6iZADCrEWATI
Lot#
Telephone#
Installer's Name
Designer's Name. yf- 50N5 INC,
Address
-n 21,�G�
Address P.0, BOA 961 Gi, 5410-DWLC Z�Z
-3L1
Telephone#
6- e8
Telephone# '-D8-346--331
Type of Building
Dwelling - No. of Bedrooms
Other -Type of Building _
Other Fixtures
Design Flow (min, required.) gpd Calculated design flow
Plan: Date Number of sheets
_ Lot Size sq. ft.
J ) Garbage grinder ( }
No. of persons Showers ( ), Cafeteria ( )
Design flow provided IZZ, 'gpd
Revision Date
Title
Description ofSoil (s)
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS %/%5 �� m /U�Cc% o P.dG' i[. 57
t1_5* -'
The undersigned agrees to ins the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees t e tem in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date
Inspections
KA
No. _p®%i DC-tS �7�� FEE
/ _ Z C®�9[�'IOI��LTI� OF MASSACHUSETTSf ,
Board ofHealth,�i2!*Y}nt17�7-� , MA.
CERTIFICATE -Of COMPLIANCE
Description of Work: ❑ Individual Component(s) ❑ Complete System
The titndersigp6d hereby Yertify that the Sewage Disposal Systema.; Constructed ( ),Repaired (G�Upgraded ),Abandoned(
by: a� i t C !. C
at94tfiAla5(< 11
has been installe ��Kd�6-,?,th7the rovisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. dated =�� _c , dated - �Z Approved Design Flow ::�//� - Z {gpd)
Installer ✓ r J
Designer: ` ' °�5 Inspector: L/ Date:
The issuance of this permit shall not be construed as a gu tee that the system will function as designed.
No. $ FEE.
Ix
Board of Health, oe.)? , .AIA.
DISPOSAL' SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair04 Upgrade( ) Abandon( ) an individual sewage disposal system
at _ y�,veR-�y 4� �� as described in the application for
Disposal System Construction Permit No. %� )-6 �-dated
Provided: Construction shall be com leted within the ree-ys�f t(hpe date of this permit l local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown, MA Date ,4 A Board of Heal �74 17
No.: BOHDC-15-5758
• Commonwealth of Massachusetts Eu oo ,
Board of Health, Yarmouth, MA ,
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERNIIT
Application for a Permit to:Upgrade-Complete System ,
Location: 8 BEAVER BROOK RD,WEST YARMOUTH, MA 02673 Owner: �..
NEVARASEVELYN M �.
Map/Parcel#: 058.360 50 TRAIL WOOD DR
BRIDGEWATER,MA 02323
Phone:
Septic System Installer Designer i
RODNEY FISHER MEYER&SONS.INC.
440 MAIN STREET HARWICH, MA P.O.BOX 981 'I
02645 EAST SANDWICH,MA 02537 '
Phone: 508-360-3311 '
5082462800
i
I
�
I
Type of Buildiog:Dwelling Lot Size:9,148.00 Sq.Ft. '
Dwelling-No.of Bedrooms:2 Garbage Grinder. ..
Other Type of Building: No.of persons: Showers:
Ot6er Fiatures: I
Plao Date: 10Y16/2015 Number of Sheets:2 Cafehria: �
Tit1e:SEPTIC SYSTEM REPAIR PLAN 8 BEAVER BROOK ROAD Revision Dah: �
• Design Flow(mio.required):220 gpd Calculated design 11ow:220 gpd Desigo flow provided:342.25 gpd �
Descrip8on of SoiIs:SEE PLAN �.
• Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluatioo: 10/Ol/2015 �.
DARREN MEYER,R.S.
DESCRIPTION OF REPAIRS OR AL7'ERATIONS:SEPTIC DISPOSAL-REPAIK-PROPOSED I500 GAL SEPTIC TANK,DBOX H-20,
2-500 GAL PRECAST CHAMBERS W/4'STONE:25'X 12.5'X 2'
The undersigned agrees to insWll the above deseribed Intlividual Sewage Dlsposal System in accortlance with the provisions of
TITLE 5 and furM�er aarees not to olace in ooeration until a Certiflcate M Camoliance has heen Issued bv the Board of Heakh.
Signed Date
Inspections
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee 'i
DISPOSAL SYSTEM CONSTRUCTION PERMIT s55.°° '
Permission is herby granted to;
RODNEY FISHER SEPTIC SERVICE,440 MAIN STREET, HARWICH, MA 02645
To perform:Upgrade an individual sewage disposal system. I
Owner: NEVARAS EVELYN M �
50 TRAIL WOOD DR
BRIDGEWATER,MA 02323 �.
Location: 8 BEAVER BROOK RD,WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.: SOHDC-IS5758,Dated:November 16,2015 '
Provided: Construction shall be completed wi[hin six months of the date of this permit. All local conditions mus[be met. ''��..
CONDITIONS: ��..
1.SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK, DBOX H-20,2-500 GAL PRECAST I�I
CHAMBERS W/4'STONE:25'X 12.5'X 2' � I
�
Bruce . M hy,MPH, R.S., CHO/Amy L.von Hone, R.S.,CHO
Health Director/Assistant Health Director
f
T6e issuance of this permit shall not be construed as a guarantee that the system will function as designed. ;
I
II
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA F�
CERTIFICATE OF COMPLIANCE sss.00
DescripNon of Work:Complete System
The undersigned hereby certify that the Sewage Disposal System;Upgraded
by:RODNEY FISHER SEPTIC SERVICE
at: 8 BEAVER BROOK 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-1S5758,dated 11/24/2015.
Installer:RODNEY FISHER SEPTIC SERVICE
Addtess:440 MAIN STREET HARWICH,MA 02645 Inspector:AMY VON HONE,R.S.
Designer:MEYER& SONS,INC.
Conditions
1.SEPTIC DISPOSAL-REPAIIt-PROPOSED 1500 GAL SEPTIC TANK,DBOX H-20,2-500
GAL PRECAST CHAMBERS W/4' STONE:25'X 12.5' X 2' �/�'�
(y�
Bruce . rphy,MPH, R.S.,CHO/Amy L.von Hone, R.S.,CHO �
Health Diredor/Assistant Health Director '
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
BO H_Dispasal_Construction_CofC.rpt