HomeMy WebLinkAboutApp-Permit-ComplianceNo. s zg _ 1(0 - �� 301
FEE 5115, 60
/5;- -2-77 COMMONWEALTH OF MASSACHUSETTS CA -46"065,
Board of Health, YQLrr2j- , MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade �Abandon( ) - aComplete System 0 Individual Components
Location 9 ,5 V j' ^ J
Owner's Name J -
Map/Parcel# Ll
tt
Address Q Su l j 1'VG�1 jj � VOL,&v
Lot# is
Telephone# So F- 3 (vo -3 851
Installer's Name goi
Designer's Name 15,4SVt Ve �r�C:
Address 2q 66 °W We-,54em
Address P.Q,17 2 50,,d w 6'Y µ'.
Telephone#
Telephone# .6 2- 7 -3 6, p a
Type of Building fe ft e n n a -j Lot Size 110 13130 sq. ft.
Dwelling - No, of Bedrooms Garbage grinder( )
Other - Type of Building No. of persons Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow (mina required) 660 gpd Calculated design flow
Plan: Date 7" S —I.$, Number of sheets Z
Title `11 5 V i 1
Description of Soil (s) _
Soil Evaluator Form No.
DESCRIPTION OF REPAIRS OR ALTERATIONS
Name of Soil Evaluator
Design flow provided 46 7 gpd
Revision Date
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 not to place thepsystem in operation until a Certificate of Compliance has been issued by the Board of health.
Signed �i ROI�� o8yr`Q. Date 11-13-AS—
Inspections
No. 80bp(-( -5 I L O .00
COMMONWEALTH OF MASSAC14US ETTS ���AEE r'koo) 095 -
Board of Health, YAR , MA.
CERTIFICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded V*), Abandoned ( )
at e
has been instal . �i c'cott 'ce �t � rovisions of 310 CMR 15.00 (Title 5) an!d t e- a'proved design plans/as-built plans relating to
application No. of ,dated 1�=-11�Approved Design Flow (gpd)
Installer . T _
Designer: 6A Sb�-Sv'-Vo .r M•C. Inspector: Date:
The issuance -of this permit shall not be construed as a guar a that the system will function as designed.
No. � � � 51 2LO R , 6 . Ougg- Co, kQ C. FEE t , ` 6€'
-->-74 COMMONWEALTH Of MASSAC14USETTS UL--*-60?OR5
Board of Health, YO (MI , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgrade(V) Abandon( ) an individual sewage disposal system
at 91 va-n ge) as described in the application for
Disposal System Construction Permit No./Ci —�- f% dated% ;:_t2
Provided: Construction shall be co�J,eted within *h 7 ,r-
p .,� of the date of this permit All local conditions must be met.
Form 1255 Rev. 5/96 A.M.Sulkln Co. ChadWown,MA Date// r `�� -/,,/'-Board of Health �//
No.:BOHDGIS-5926
Commonwealth of Massachusetts Fee
$55.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Complete System
Location: 99 SULLIVAN RD,WEST YARMOUTH, MA 02673 Owner:
KATZ STEVEN M
Map/Parcel#: 047.58 99 SULLIVAN RD
WEST YARMOUTH,MA 02673
Phone:
Septic System Installer Designer
ROBERT B.OUR EAS SURVEY,INC.
P.O. BOX 1539 HARWICH, MA 02643 P.O.BOX 1729
Phone: SANDWICH,MA 02563
5085094058 508-888-3619
Type of Building:Dwelling Lot Size: 10,890.00 Sq.Ft.
Dwelling-No.of Bedrooms:6 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Fixtures:
Plan Date:07/08/2015 Number of Sheets:2
Cafeteria:
Tit1e:SITE&SEWAGE REPAIR PLAN 99 SULLIVAN ROAD Revision Date:
Design Flow(miarequired):660 gpd Calculated design flow:660 gpd Design flow provided:667 gpd
Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:06/04/2015
EDWARD STONE,PLS
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED H-20 1500 GAL SEPTIC TANK,H-20
DBOX,4-500 GAL PRECAST H-20 CHAMBERS W/4'STONE: 13'X 50'X 2'
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 Comoliance has been issued 6v the Board of Health.
Signed Date
Inspections
� Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT $55.00
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: KATZ STEVEN M
99 SULLNAN RD
WEST YARMOUTH,MA 02673
Location:99 SULLIVAN RD,WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.: BOHDC-15-5926,Dated:November 30,2015
Provided: Construction shall be completed within six months of the date of this permit. All local conditions must be met.
CONDITIONS:
SEPTIC DISPOSAL-REPAIR-PROPOSED H-20 1500 GAL SEPTIC TANK, H-20 DBOX,4-500 GAL PRECAST
H-20 CHAMBERS W/4'STONE: 13'X 50'X 2'
1.SEPTIC DISPOSAL-REPAIR-PROPOSED H-201500 GAL SEPTIC TANK, H-20 DBOX,4-500 GAL
PRECAST H-20 CHAMBERS W/4'STONE: 13'X 50'X 2'
� \ �
Bruce G. MUrphy, 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 Fee
CERTIFICATE OF COMPLIANCE $55.00
Description of Work:Complete System
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:ROBERT B.OUR COMPANY INC.
at:99 SULLIVAN 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.: BOHDGIS-5926,dated 12/16/2015.
Installer:ROBERT B. OUR COMPANY INC.
Address:P.O.BOX 1539 HARWICH,MA 02643 lnspector:AMY VON HONE,R.S.
Designer:EAS SURVEY,INC.
Conditions
1.SEPTIC DISPOSAL-REPAIR-PROPOSED H-20 1500 GAL SEPTIC TANK,H-20 DBOX,4-
500 GAL PRECAST H-20 CHAMBERS W/4' STONE: 13'X 50'X '
� �
Bruce G. Murph , M H, R.S., CHO/Amy L.von Hone, R.S., CHO
, /� Health Director/Assistant Health Director
v
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
BOH_Disposal_Construction_CofC.rpt