HomeMy WebLinkAboutBHDC-24-8813Z
No. , � � � w �� v y F'EE.
COMMONWEALTH OF V As- 01USETTS
d_t � + 1 Board of Health, MA.
�/ APPLICATION I=OR DISPOSAL SYSTI M CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) - ❑ Complete System 0 Individual Components
Location as
Owner's Name 4
Map Parcel# 7�
Address
Lot# ,�
Telephone#
Installer's Name
Designer's Namep,�
Address W w S
Address PQ� ''SL �
• G10,'/4w l /�►
Telephone#
Telephone#
t
Type of Building C Lot Size , i sq. ft.
Dwelling -No. of Bedrooms Garbage grinder ( )
Other -Ttpe of Building No. of persons Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow :min. required; gpd Calculated design flow Design flow provided � � gpd
Plan: Date t! �D .�d0 Number of sheets .21 Re%'ision Date
Title
N fern
Description of Soil(s) xe
Soil ENalu vot Form No. Name of Soil E%ahtator %Ti/i �r l '� Date of E%ahtatson s7�+
DESCRIPTION QF REP.AIRS OR AI TERATIONS
w 16/
The undersigned agrees to in
the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to not t e the e a Certificate of Co pliance has been issued by the Board of Health.
Signed D:uc
- Inspections
1
No.,FEE -
'; COMMONWEALTH OF Mi S 1CIIUSLTTS
Board r f Health, MA.
l/ APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) - ❑ Complete System ❑ Individual Components
Location o / r �!' rl
Map/Parcel# 7 9t7
Owner's Name
Address
L.ot# Z*/
Telephone#
Installer's Name �� ,�
Designer's Name
Address Pe. x
Address 363 g/ 445
lmy
Telephone# _ V.
Telephone# �
Type of Building �S/%�T'rQ/ Lot Size "o pdy 7 sq. ft.
Dwelling - No. of Bedrooms Garbage grinder ( )
Other - Type of Building No. of persons Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow (min. required) '�d gpd Calculated design flow
Plan: Date &,1/ci > Number of sheets I -
Title f G G r/ Sl✓y/(
Design flow proNided _ __ gpd
Revision Date
Description of Soils) _ �_ - -_- -
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation D
DESCRIPTION OF REPAIRS OR AI TERATIONS
- i Z' /1,4
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 place th4systaght ppersliOts until -Certificate of Co pliance has been issued by the Board of Health.
Signed �f Date �G
Inspections
• ' • .� /.�
No, � �at � FEE � J
COMMONS& OF MASSACHUSETTS
Board of Health, J'%/a/,-,/
CERTIFICATE OF COMPLIANCE
Description of Work: ❑ Individual Component(s) ❑ Complete System
The undersigned hetlehy certify that the Sewage Disposal System; Constructed ( ), Repaired (pgraded ( ),Abandoned ( )
n
by: I'
�s.11 s - -- haat 1A
s been installedin accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. c - dated 6 c / _i� i Approved Design Flow (gpd)
_
�} n
Installer It(iuf ±� U.4 _
Designer: � /,Q+1 � ' D 11q% Inspector: Date:-. 11 . -2"_�
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
Z r �/
COMMONWEALTH Of MASSAC14USETTS
Board of Health, '� , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
FEE —
Permission is hereby ranted to; Constrict( ) Repair( } Upgrade( ) Abandon( ) an indiNRdual sewage disposal system
rr
at of W 1 n as described in the application for
Disposal System Construction Permit No. A' (-)91 , dated i_,)t/ t .
Provided: Construction shall be completed withiri-�f the date of this ppsmit. All local conditions must be met.
Form 1255 Rev 51% A.M Sulkln Co. Chadegm MA Date L t c 1 Board of Health
JC ENGINEERING, Inc.
Civil & Environmental Engineering
2854 Cranberry Highway
East Wareham, Massachusetts 02538
Ph. 508-273-0377
July 25, 2024
Mr. Jay Gardiner
Health Director
Town of Yarmouth
Health Division
1146 Route 28
South Yarmouth, MA 02664
RE: Substantial Compliance for Newly Installed Septic System Located at
22 Windjammer Road, South Yarmouth, Massachusetts
Dear Mr. Gardiner:
This letter is to certify that the new septic system located at 22 Windjammer Road was
constructed in substantial compliance with the approved design plan entitled, Proposed
Septic System Upgrade Plan, dated June 10, 2007, prepared by Darren M. Meyer, R.S. See
attached as -built plan provided by the installer (Robert B. Our Co., Inc.).
Should you have any questions or comments, please do not hesitate to contact our office.
Sincerely,
ewe
John L. Churchill, Jr., PE, PLS
President
JLC/mcp
cc: RBO
File
IM]
Town of Yarmouth
Subsurface Sewage Disposal System As -Built Information
Street Address: w I N i'? TA MMEP_ (A uc- Map: -7 7 Parcel: 10
Owner Name: I l: Permit #: tacl'
Date Installed: T - L 5 . )'OZ
New: Repair:_
Installer Name:_ p oig ew � �� co Installer Phone:
Installation of (list all components, both newly Installed and existing to remain In use):
(, S t �T r'O' l cX�C� C -�-� �6-1 c r= K l U '1� Gt1 3 �v� I
l..)b I tiX,T � 4jb—k 04-64 IkXi P — il!n. Roci-,s csv coc rcC
Leach Capacity (gpd):,3SIO Ground Water Depth (inches): _Health Inspection by: IIW,B�
I certify that this system has bige st d " r *CO -With the provisions of 310 CMR 15.00 and all local
regulations.
Installer Signature
As -built Diagram
(Print Clearly in Black/Blue Ink
and Use Straight Edge -- Label Risers and Zabel Filter)
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