HomeMy WebLinkAboutBHDC-24-11 Disposal SystemDavid B. Mason, RS, CSE
28 Powder Hill Road
Barnstable, MA 02630
TO: Yarmouth Health Department
FROM: Dax id B. Mason, RS, CSE
DATE: April 17. 2024
SUBJECT: 48 Williams Road, West Yarmouth, MA
The septic system installed at the subiect location by
Ellis Brothers Construction was installed per the plan and the
allowances indicating compliance with the State Title V
requirements.
The septic design plan as approved by the Yarmouth Health
Department met the requirements of Title V and the Yarmouth
Board of Health Regulations. The installation of' components
meets the requirements of the design plan.
This certification shall not act as a guarantee that the system will
operate as designed as such is dependent on the type of use,
maintenance and what is disposed in the system by the owner.
APR 7 9 2024
HEALTH DE'PT
TOWN OF YARMOUTH 161 J
SEWAGE PLAN REVIEW CHECKLIST��.?
Location: A.M. Lot_ _ T Zone of Contribution: In Out _
n Acreage
Street: G( �� j���,,.,,,f �K {� Commercial: - Residential -
Village: ��
Floor Plan: # Bedrooms: -
Owner: �l r Installer: _
Address: Phone:
Phone: -
Builder: Engineer: OCA U% t 9 Address: Phone:
Phone:-
.
RECEIVED
Town of Yarmouth APR 16 2024
Subsurface Sewage Disposal System As -Built Information
HEALTH Darr
Street Address: i Map: Parcel:
�u—o17
Owner Name: Permit #: 13
Date Installed: ' r — ! ( - g$1 New: Repair:
Installer Name: i+s%�D� Pf „._ Installer Phone: SO o 3
i
Installation of (list all components, both newly installed and existing to remain in use):
W / �a o & ST loco glvM P /-/-,Ro A- 6 -3 h--g� k
(NlcKq &-05 9tcret C410AC+rycgA.1,56,0 /6 X 5-0"c13fiF66 57`-N(54 / ,J66
Leach Capacity (gpd): Ground Water Depth (inches): Health Inspection by:
As -built Diagram
(Print Clearly in Black/Blue Ink and Use Straight Edge -- Label Risers and Zabel Filter)
11 V'c
�0l15�
I 3, 3
A
B
C
D
E
F
G
1
2
3
gTf
4
! a.
S
6
No. 1, • 2ki ' 1 1 7— -
2—q • kv FEE
COMMONWEALTH OF MASSACHUSETTS
C! a' Board of Health, 041-tW , MA.
APPLICATION FOR DISPO L SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construe( ) Repairm/upgrade( ) Abandon( ) - 0 Complete System O Individual Components
Location -&X94V1A tW-6
4V&L
w,,*W
Owner's Name �Q
Map:' Parcel# 7a C7
Address
Lot#
a ,
Telephone#
Installer's Name c—,S ��Os� �✓�
��jv
Designer's Name
Address
1/
Address
Telephone# �j %
G2 �pZ
Telephone#
Type of Building / okwe io
Dwelling - No. of Bedrooms
Other - Tvpe of Building ���✓ /3/n�� K.G A
Other Fixtures
Design Flow (min. required) gpd Calculated design flow
Plan: Date _7 On~''� Number of sheets —
Title
Description ofSoil (s) _
Soil Evaluator Form No.
DESCRIPTION OI
.Q�-5 �o
f
OR ALTERATIONS
No. of persons
0%
Lot Size % / 2 sq. ft.
Garbage grinder
Showers ( ), Cafeteria ( )
Design flow pro%ided
Re,,isson Date
Soil Evaluator �:8 y!!'9�Soi✓ Date of Evaluation
gpd
The undersigned ees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to a t�e syste in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed e, Date RECEIVED
Inspections
A► I
-- - Hr--ALTH DEPT—
N.. fir, 2 � 1 � � 2y 1 t� FEE
it
COMMONWEALTH OF MASSAC14USETTS
.t p�Ll 011 Board of Health,t� —, MA.
0
APPLICATION FOR DISPOS L SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair (v6pgrade( ) Abandon( ) - D Complete System D Individual Components
Location /////1l'f'! 5 nG� [t �J12Iy�. ter!!
Owner's Name efll'M�
Map; Parcel# a
Address L�� f�%� i 2t✓ 07
Lot# r
/
Telephone#
Installer's Name C
Designer's Name
%ti��Sc�/t✓ _ _ ___
Address
Address 2 �� f ! u r ,,� t
Telephone# CJ
—2
Telephone# -ID -;) 7-
Type of Building
Dwelling - No. of Bedrooms
Other - Type of Building —
Other Fixtures
i c?'e�vum G
Design Flow (min. required)--gpd Calculated design flow
Plan: Date Number of sheets
Title rt��� �i % �G` ja,1'5t /yl
r
Description of Soils) J�7t
Soil Evaluator Form No.
No. of, persons
s
Lot Size � 17.2 sq. ft.
_ Garbage grinder
Showers( ), Cafeteria ( )
Design flow provided - gpd
Revision Date
Soil Evaluator .�• I /!/l So'� Date of Evaluation
DESCRIPTION OF REPAIRS ORAITERATIONS /Ij<G (�rnl��/��it.�S %cam t� //✓S,/��� �`
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
' further agrees t to p1pee the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed !.� if Date
Inspections
No. COMMONWEALTH OF MASSACLIUSETTS FEE 11
Board of Health, MA.
CERTIFICMW OF COMPLIANCE
Description of Work: D Individual Component(s)
The undersigned hereby certify that the Sewage Di:
by:at e
D Complete System
sal System; Constructed ( ), Repaired (V< Upgraded ( }, Abandoned ( )
has been installed in accordance with the pro\ions of 31Q CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. , dated JLt Approved Design Flow f& I (gpd)
Installer
Designer: '17A s. t)/,/ Inspector_ Date:_
The issuance of this permit shall not be construed as a guarantee that the system will. function as designed.
i 1
No. q {` 1
—• .mom®® .�®-��:
FEE
j COMMONWEALTH OF MASSACHUSETTS
Board of Health., �/� 2 J'►^ vtr� /t� MA.
DISPOSAL SYSTE","VI CONSTRUCTION PERMIT
Permission is herebygranted to; Construct( ) Repair( Upgrade( ) Abandon( ) an indiNidual sewage disposal system
at
MS
Disposal System Construction Permit No.
dated /- P. J k �-
as described in the application for
Provided: Construction shall be completed within three years of the date :offthis ermit. All local conditions must be met.
Form 1255 Rev.5/96 A.M Sulkin Co. Chaeesbm MA Date ;' r } «� Board of Health