HomeMy WebLinkAboutApp-Permit-ComplianceNo. J C)
00 RDC -{5_ 4µ3C) COMMONWEALTH OF MASSACHUSETTS
Board of Health, Qn , MA.
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FEE �� r
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tlo ,moi /nd APPLICATION F®I, DISPOSAL SYSTEM CONSTRUCTI®N PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade(,I--Abandon O -10 Complete System ❑ Individual Components
Location St C 1J
Owner's Name V jj
O W IA}®
Map/Parcel# 3
Address C'Lfrb
Ld 5, fA
Lot# L/
Telephone#
Installer's Name R® E -f R U Q
C Designer's Name
Rive,r
&aijee
Address !) !S
AddressP. 0, z X
C l�
Telephone# 56'VS'—
Telephone# r.
Type of Building
Dwelling - No. of Bedrooms
Other - Type of Building
Lot Size � L1 � d sq. ft.
Garbage grinder (
No. of persons Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow (min. required) % %t� gpd Calculated design flow Design flow provided --3-4gpd
Plan: Date ��`� Number of sheets Revision Date
Title
Description of Soil(s) _
Soil Evaluator Form No.
C 1-1Lf1 N
Name of Soil Evaluator Q(AW 110 P% 14404! Date of Evaluation �� B
DESCRIPTION OF REPAIRS OR ALTERATIONS
1000 C
C % PUMP
Cti lA
A P- C--
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The undersigned agrees to insta,11 the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to not to c e syste ' operation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date
Inspections
No. E>09 "`� " J FEE
A;` 2 � � COMMONWEAI,T14 Of MASSACHUSETTS
Board of Health, Y�AM Oy714 , MA. 7 I V0 aos
CERTIFICATE OF COMPLIANCE
Description of Work: ❑ Individual Component(s) _gL.Gemplete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded , Abandoned ( )
by: —R ,06e r -1 9.501L C O`X A) C..
at
has been installeWin eccord`al ce wi't he pi-Yisio_ns of 310 CMR 15.00 (Title 5) and thea proved design plans/as-built plans relating to
application No. / "'. dated 7 r Approved Design Flow (gPd).
Installer
Designer: ,f4510 5`� 1 Inspector:
Date: 141>,11
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
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No. 60 � Dc � � � � .. I FEE 5: , 00
COMMONWEALTH OF MASSACHUSETTS
Board of Health,/1r)U i , MA.
DISPOSAL SYSTLM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgrade (—+--71&ndon( ) an individual sewage disposal system
at .�1+ j C j 5E 116 4. AJ as described in the application for
Disposal System Construction Permit No. /j- rH�" , darted 41'
Provided: Construction shall be comp/2e 4i thre rAf the date of this permit. Al local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown, MA Date r -� /-Board of Health
No.:BOHDC-15-4430
' Commonwealth of Massachusetts Fee
ass.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Complete System
Location: 51 MELGO LN, SOUTH YARMOUTH, MA 02664 Owner:
BONVINO LOUIS A
Map/Parcel#: 033.369 5 FOiJNTAIN ST
MILFORD,MA 01757-370'7
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 Building:Dwelling Lot Size:24,394.00 Acres
Dwelling-No.of Bedrooms:2 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Fixtures:
Plan Date:08/15/2015 Number of Sheets: 1 Cafeteria•
Tit1e:SIT'E PLAN 51 MELGO LANE Revision Date:
Desigo Flow(min.required):220 gpd Calculated design flow:220 gpd Design flow provided:334 gpd
Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:07/30/2015
THOMAS MCLELLAN,P.E. '
� DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL WATERPROOFED SEPTIC
TANK, 1000 GAL WATERPROOFED PUMP CHAMBER,DBOX,24 QUICK 4 STANDARD INFILTRATORS W/OUT STONE:26'X 12'X
. g��
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of
TITLE 5 and further aarees not to olace in ooeration until a Certificate of Comollance has been issued bv the Board of Health.
Signed Date
Inspections
� Commonwealth of Massachusetts
' Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT $55.00
Pernussion is herb ranted to;
Yg
ROBERT B. OUR COMPANY INC., P.O. BOX 1539, HARWICH, MA 02643
To perform:Upgrade an individual sewage disposal system.
Owner: BONVINO LOITIS A
5 FOUNTAIN ST
MILFORD,MA 01757-3707
Location:51 MELGO LN,SOUTH YARMOUTH,MA 02664
Disposal System Construction Permit No.: BOHDC-15-4430,Dated: September 25,2015
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 WATERPROOFED SEPTIC TANK, 1000 GAL
WATERPROOFED PUMP CHAMBER, DBOX,24 QUICK 4 STANDARD INFILTRATORS W/OUT STONE:26'X 12'
X 8"
2. ELECTRICAL PERMIT REQUIRED
�
v�
Bruce G. M ph ,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.
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4
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I
� Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
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: 51 MELGO LN, 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.: BOHDC-15-4430,dated 10/13/2015.
Installer:ROBERT B.OUR COMPANY INC.
Address:P.O.BOX 1539 HARWICH,MA 02643 Inspector:PHILIP RENAUD
Designer:BASS RIVER ENGINEERING
�V������
Bruce G. M hy, PH, 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.
BO H_Disposal_Construction_CofC.rpt