HomeMy WebLinkAboutApp-Permit-ComplianceNo. FioNDC^t J- j3 Ld i K I,5— o(�) Ljq 9 ! $ 5,-oo
FEE Jt&1-00-
COMMONWEALTH Of MASSACHUSETTS Ci,46G(00
Board of Health,�i�a—mo VTI , MA.
3
APPLICATION FOP, DISPOSAL'
SYSTEM CONSTRUCTION PERMIT
A lication for a Permit to Construct( Repair( UpgradeN) 'Abandon( - 0 Complete System
00
❑ Individual Components
ocation %i1
owner's Namecj-Q -T'pU n-5
Map/Parcel# So / /q i
Address b4 A kckeel es X-11,
Lot#
Telephone# S—O 8-- 2jfp,5 _ 72 0 9
Installer's Name ROlec-q-J3,
Our L,-0 z^r .
Designer's Name &45 et ver F, -
Address,,
24 6 uj
f1
iii/. (Jl•.
Address
P,O.a� I1 3. Laennti5 t�2lo z(I
Telephone# v�'-�'QQ,
05
Telephone#
Type of Building es')de^
Dwelling - No. of Bedrooms Z
Other - Type of Building
Lot Size sq. ft.
1 3 6( Garbage grinder ( )
No. of persons Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow (m/in. required) -320 gpd Calculated design flow 2 Design flow provided 3f/q gpd
Plan: Date 7"2 -LS Number of sheets Revision Date
Title 70 LrnAq klrj
Description of Soil(s) l'r-
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 t to place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
SignedM 16AIL60.:f K. Date q -10 -L5 -
Inspections
W
No.s- vy
COMMONWEALTH OE MIASSACIIUSETTS FEE
Board of Health,_,
CERTIFICATE Of COMPLIANCE
Description of Work: U Individual Component(s) AXomplete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded (Abandoned ( )
at i Y 6rSflC ic��
has been installedli}a aC04Ei n -P; vW"eyprCisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. 14_ dated Approved Design Flow (gpd)
Installer
lar= i J1 - j - Wt— :1C V 1
Designer:, ,Inspector: /') i t� r'1/�0� Date: _ ?--
v 5 7 �T
The issuance of this permit shall not belconstrued as a guaranXe at the syste( ,tion as designed.
No. - 1 CJ KO(3 �R 1 �. FEE
U/ COMMONWEALTH Of MASSACHUSETTS
Board of Health, , MA.
DISPOSAL SYSTEM[ CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgrade(p<) Abandon( ) an individual sewage disposal system
at
as described in the application for
Disposal System Construction Permit No. rr _. , dated
Provided: Construction shall be comp`Tetie&4thfn(�hreee of the date of this permit. All local conditions must be met.
.y��� 1 i
form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestawn, MA Date i - i . BOar�OT "H�alih
No.:BOHDGIS-1699
Commonwealth of Massachusetts FeB
• $55.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERNIIT
Applicatioo for a Permit to:Upgrade-Complete System
Location: 70 LONG POND DR, SOUTH YARMOUTH, MA 02664 Owner:
WEST ALTON H
Map/ParCel#: 050.191 WEST ROSEMARIE
70 LONG POND DR
SOUTH YARMOUTH,MA 02664-4164
Phone:
Septic System Installer Designer
ROBERT B.OUR BASS RIVER ENGINEERING
P.O. BOX 1539 HARWICH, MA 02643 P.O.BOX ll63
Phone: EAST DENNIS,MA 02641
(508)385-3426
Type of Building:Dwelling Lot Size:30,056.40 Acres
Dwelling-No.of Bedrooms:2 Garbage Grinder:
Other Type of Building: No.of persoos: Showers:
Other Fiatures:
Plan Date:04/02/2015 Number of Sheets: 1 Cafeteria:
Tit1e:SI1'E PLAN 90 LONG POND DRIVE Revision Date:
Design Flow(min.required):330 gpd Calculated design ilow:330 gpd Design flow provided:349 gpd
Description of SoiIs:SEE PLAN
Soil Evaluator Form No.: Name otSoil Evaluator: Date of Evaluation:04/Ol/2015
T
� DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,2-500 GAL H•20
PRECAST 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
� 71TLE 5 and further aarees not to olace in ooeretlon until a Certificate of Comollance has been issued hv the Boartl of Meakh.
Signed Date
Inspections
i
Commonwealth of Massachusetts
' Board of Health, Yarmouth, MA FeB
DISPOSAL SYSTEM CONSTRUCTION PERMIT us.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. WEST ALTON H
WEST ROSEMARIE
�� 70 LONG POND DR ,
SOUTH YARMOUTH,MA 02664-4164
, Location: 70 LONG POND DR,SOUTH YARMOUTH,MA 02664
Disposal System Construction Permit No.: BOHDC-1�1699,Dated: Apri121,2015
Provided: Construction shall be completed within six months of the date of this permit. All bcal conditions must be met.
Conditions
1. REPAIR-PROPOSED 1 S00 GAL SEPTIC TANK, DBOX, 2-S00 GAL H-20 PRECAST CHAMBERS
W/4'STONE:2Y X 12.8'X 2'
�
2. EXISTING 2 BEDROOM DWELLIlVG, DESIGN FOR MINIMUM 3 BEDROOM
, � /��
t,er
v
Bruce G. Murphy, H, R.S., CHO/Amy L.von Hone, R.S., CHO
Healt Director/Assistant Health Diredor
T6e issuance of this permit shall not be construed as a guarantee that the system will function as designed.
,
I
� Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
ICERTIFICATE OF COMPLIANCE sss.00
i
Description of Work:Complete System
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:ROBERT B.OUR COMPANY INC.
at:70 LONG POND DR, SOUTH YARMOUTH,MA 02664
Has been installed in accordance with the provisions of 310 CMR 15.00(TiUe 5)and the approved
design plans or as-built plans relating to application No.: BOHDC-15-1699,dated 04/30/2015.
Installer:ROBERT B.OUR COMPANY INC.
Address:P.O.BOX 1539 HARWICH,MA 02643 Inspector:AMY VON HONE,R.S.
Designer: BASS RIVER ENGINEERING
Conditions
1.REPAIR-PROPOSED I500 GAL SEP'I'IC TANK,DBOX,2-500 GAL H-20 PRECAST
CHAMBERS W/4' STONE:25' X 12.8'X 2'
2.EXISTING 2 BEDROOM DWELLING,DESIGN FOR MINI 3 BEDRO( /,�
9��//�OO/kM��
Bruce G. M , MPH, R.S., CHO/Amy L.vo� Hone, R.S.,CHO
Health Director/Assistant Health Diredor
T6e issuance of this permit shall not be construed as a guarantee that the system will function as designed.
BOH_Disposal_Construdion_CofC.rpt