HomeMy WebLinkAboutApp-Permit-ComplianceNo.
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COMMONWEALTHSS C
Board of Health, yAgffi 11 J U , MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTI®N PERMIT
Application for a Permit to Construct(V/ Repair( ) Upgrade( ) Abandon( ) - l`7 Complete System ❑ Individual Components
Location -?73 U k 1 QS ALJ
Owner's Name k, hexT . JLc '
Map/Parcel#
StT2 Sp, 1, .. 2 9, %0 2
Address P030, Vd (-v
Lot# 5
&4"10
Telephone# 509.. SOL-- a,T
Installer's Name ��, r- our 17n e- ,
Designer's Name S -k
Address 214
breaf+e-r-e\ M.
Address 0
Telephone#
.9-69- ` oq-,1o5
Telephone# 4.2 - / J7
Type of Building ?UiS i he� :5 5 T-^AV3+C 1'GL r aur' �Q� SD�J $ y� Lot Size 2 7 o J O sq. ft.
Dwelling - No. of Bedrooms Garbage grinder( )
Other - Type of Building No. of persons Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow (min. required) 3. gpd Calculated design flow 360! Design flow provided 3`% 6 gpd
Plan: Date Number of sheets Fl Revision Date _ Ig "
Title 373 0,4 idsS "
Description of Soil(s)3-2" -I ^ VX,-, ,S"
Soil Evaluator ;Form No. Name of Soil Evaluator Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to noLt place ithe system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed 0,gr l . J /x. Date q -3 -IS
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No.
j ---' COMA O LTII ®f SSACHUSETTS,� �r� •'� � 'coo 3�
Board of Health, , MA. o� ' "�,a�' f
CERTIFICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) VIComplete System
The undersigned hereby certify that the Sewage Disposal System; Constructed (' Repaired ( ), Upgraded ( ), Abandoned ( )
by: l�f• 16.
at ��---
has been installed'i1'�co rice �1hth Bions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. �c:, - .iA�', dated jr'' Approved Design Flow (gpd)
Installer Ro 6>.,t-� IR . ()u -r LFA,__ A1�^ /+ it fl e c s7ye7e4 39 f ai h llfi
Designer: 5,h- ahk `^► Inspector: T'"% l� r9 ,�' /✓ Date:
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
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/�- -- -> COMMONWEALTH OF MASSACHUSETTS Viz-. 4 onr 9.3�
Board of Health, V%M ip I MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT ;
Permission is hereby granted to; Construct(, Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system
at tea.Palk as described in the application for
Disposal System Construction Permit No. dated
Provided: Construction shall be comp F6d �thir?'tljjrjae of the date of this permit.. All local conditions must be met.
49
Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date 4 Board of Health
No.: BOHDC-15-4468
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to: New Construction - Complete System
Location: 373 WHITES PATH, SOUTH YARMOUTH, MA 02664 Owner:
OUR ROBERT B CO INC
Map/Parcel#: 110.8 PO BOX 1539
HARWICH, MA 02645-6539
Phone:
Septic System Installer Designer
ROBERT B. OUR STEPHEN HAAS. PE
P.O. BOX 1539 HARWICH, MA 02643 P.O. BOX 16
Phone: SOUTH DENNIS, MA 02660
508-362-8132
Type of Building: Other Type of Building Lot Size: 27,443.00 Acres
Dwelling - No. of Bedrooms: Garbage Grinder:
Other Type of Building: FACTORY (INDUSTRIAL AND STORAGE) AND No. of persons: 15 Showers:
OFFICE USE
Other Fixtures:
Plan Date: 05/28/2015 Number of Sheets: 1
Title:SITE PLANOF LAND 373 WHITES PATH Revision Date: 09/18/2015
Design Flow (min.required): 300 gpd Calculated design flow: 300 gpd Design flow provided: 348 gpd
Description of Soils:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation: 07/30/2015
STEPHEN HAAS, PE
Fee
$110.00
Cafeteria:
DESCRIPTION OF REPAIRS OR ALTERATIONS: SEPTIC DISPOSAL - NEW - PROPOSED 1500 GAL H-20 TWO COMPARTMENT
TANK, H-20 DBOX, 2 - 500 GAL H-20 PRECAST LEACH CHAMBERS W/ 4' STONE: 25'X 12.8'X 2'
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of
TITLE 5 and further agrees not to place in operation until a Certificate of Comoliance has been issued by the Board of Health.
Signed
Inspections
Date
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT $110.00
Permission is herby granted to;
ROBERT B. OUR COMPANY INC., P.O. BOX 1539, HARWICH, MA 02643
To perform: New Construction an individual sewage disposal system.
Owner: OUR ROBERT B CO INC
PO BOX 1539
HARWICH, MA 02645-6539
Location: 373 WHITES PATH, SOUTH YARMOUTH, MA 02664
Disposal System Construction Permit No.: BOHDC-15-4468 , Dated: September 21, 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 - NEW - PROPOSED 1500 GAL H-20 TWO COMPARTMENT TANK, H-20 DBOX, 2 - 500
GAL H-20 PRECAST LEACH CHAMBERS W/ 4' STONE: 25'X 12.8'X 2'
2. ZONE II MAXIMUM 305 GPD FLOW ALLOWED FOR SITE
Bruce G.
MPH, R.S., CHO /Amy L. von Hone, R.S., CHO
Director / Assistant Health Director
,The issuance of this permit shall not be construed as a guarantee that the system will function as designed.