HomeMy WebLinkAboutApp-Permit-ComplianceNo. C9 {J T" - �s-- oo5 0 o 7 FEE - �f
COMMONWEALTH LTH ®f M ASSAC14USETTS
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`GtC Board of ealth, Yr�}�M0 VT14 , MA.
6� r�� ILICATIVr ISP ®SSI. SYSTEM CONSTRUCTION PERMIIT M,
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Application for a Permit to Construct( ) Repair( ) Upgrade NN Abandon O - ❑ Complete System 1� Individ Componnts
Location
Owner's Name -bQri se- 06L t 1%I ►1
Map/Parcel# %'7 ��
Address &t+A'6�-r6k [ r. U1.
Lot#
Telephone# 508-69 - 7 VY5
Installer's Name ► Oho , (v..�t< •
Designer's Name Aiv +r E
,�, QQ
Address �`1eti 02 9 5-
(i�? L°� FFJ
1 Address A0- 0Cx 1163 ji5,nS 026 Y1
Telephone# S07 -S® _ �-5�
Telephone# ���= 3V Z&
Type of Building /cif ie
Dwelling - No. of Bedrooms
Other - Type of Building
Other Fixtures
10 l0 7 7 sq. ft.
Garbage grinder( )
Design Flow (min. required) J55 d gpd Calculated design flow -55 0 J Design flow provided,5'85 gpd
Plan: Date 2-- 7 / Number of sheets % Revision Date
Title
Description of Soils) oA /Z" �.D�eM YSdrC�, �= i7''1�t�+t/ ^ Gf� C = t`♦fM �.�c
Soil Evaluator Form No. Name of Soil Evaluator 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 pla a the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed ��� I`ll )610Qr"4J%'1C Date
Inspections
No. /� � r I � �� -700 . "FEE -Ir�—
COMMONWEALTH LTH OF MASSACHUSETTS/'
r'e'
Board of Health, MA.
/� / *7avi-
CERTIFICATE Of COMPLIANCE f7
Description of Work: dividual Component(s) ❑ Complete System
The undersigned her YcerafY that the Sewage Disposal System; Constructed >Repaired Upgraded (if ?�Z �njj/t-4ll.� (�%v',✓I r�
-
by:
at
has been t�visions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. , dated _ Approved Design Flow (gpd)
�5
Installer v 1 . , „ _
Designer:Inspector:
-=�
'" ✓1 v:, „ ,
/-�;�;; n Date:
1
The issuance .f this permit shall
of be construed as a guarapt a
c
that the system will
function as designed.
No. 11"j � R , 61 001E FEE -1 �,.-00_
COMMONWEALTH Of MASSACHUSETTS ch *(OG�o
Board of Health, yrmtmboTo
DISPOSAL SYSTEM][ CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgrade ( y'Abandon ( ) an individual sewage disposal system
at 14 15414 r;a J -� as described in the application for
Disposal System Construction Permit No. _ , dated
Provided: Construction shall be co&p!&dwittxina4rVears of the date of this permit. /All local conditions must be met.
�
Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date4--_ - ��-Boar We"atCh
/ /di, � . - � / r 2% , .. ,
No.: BOHDC-15-1700
' . Commonwealth of Massachusetts Fee
sss.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Applicatioo for a Permit to: Upgrade-Individual Component(s)
Location: 16 SALT MARSH LN,WEST YARMOUTH, MA 02673 Owner:
GALVIN EDWARD J
Map/Parcei#: 017.110 C/O PETER GALVIN
16 SALT MARSH LN
WEST YARMOUTH,MA 02673
Phone:
Septic System Installer Designer
ROBERT B.OUR BASS RIVER ENGINEERING
P.O. BOX 1539 HARWICH, MA 02643 P.O.BOX 1163
Phone: EAST DENNIS,MA 02641
(508)385-3426
Type of Building:Dwelling Lot Size:22,215.60 Acres
Dwelling-No.of Bedrooros:5 Garbage Grinder.
Other Type otBuilding:EXISTING 6 BEDROOM.PROPOSED 2 BEDROOM No.of persons: Showers:
CONVERSION TO 1 BEDROOM.
Other Fixtures: �
Plan Date:02/09/2015 Number of Sheets: I
Cafeteria:
Tit1e:SITE PLAN 16 SALT MARSH ROAD Revision Date:
Design Fiow(min.required): 550 gpd Calcuiated design Flow:550 gpd Desigo Flow provided: 585 gpd
Descripfion of SoiIs:SEE PLAN
Soil Evaluaror Form No.: Name of Soil Evaluaror: Date of Evaluation:02/OS/2015
THOMAS MCLELLAN,P.E.
DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-EXISTING ]000 GAL SEPTTC TANK,1000 GAL PUMP CHAMBER
(WATERPROOFED),DBOX,42 INFILTRATOR QUICK 4 STANDARD PLUS UNITS W/OUT STONE:30'X 18'X 8"
. The undersigned agmes to install the above tlescribed Indivitlual Sewage Disposal System in accordance with the provislons of �
TITLE 5 and further aarees not to olace in ooeratlon until a Certificate of Comoliance has heen issued bv the 8oartl of Health.
Signed Date
Inspections
Commonwealth of Massachusetts
� Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00
Permission is herby granted to;
ROBERT B. OUR COMPANY INC., P.O. BOX 1539, HARVNCH, MA 02643
To perform:Upgrade an individual sewage disposal system.
Owner. GALVINEDWARDJ
GO PETER GALVIN
16 SALT MARSH LN
WEST YARMOUTH,MA 02673
Location: 16 SALT MARSH LN, WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.: BOHDGIS-1700,Dated:Apri122,2015
Provided: Construction shall be completed wittiin six months of the date of this permi[. All local conditions mus[be met.
Conditions
1. REPAIR-EXISTING 1000 GAL SEPTIC TANK, 1000 GAL PUMP CHAMBER(WATERPROOFED),
DBOX, 42 INFILTRATOR QUICK 4 STANDARD PLUS UNITS W/OUT STONE: 30'X 18'X 8"
2. BOH TO INSPECT SOIL REMOVAL
3. MFC VARIANCE: 1. GROUNDWATER SEPARATIDN '
4. EXISTING 6 BEDROOM DWELLING TO BE CONVERTED TO TOTAL 5 BEDROOM ,
Bruce G. urphy, 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 F�
CERTIFICATE OF COMPLIANCE sss.00
Description of Work:Individaal Component(s)
The undersigned hereby ceRify that the Sewage Disposal System; Upgraded
by:ROBERT B. OUR COMPANY INC.
at: 16 SALT MARSH LN,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.: BOHDC-1S1700,dated OS/OS/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-EXISTING 1000 GAL SEPTIC TANK, 1000 GAL PUMP CHAMBER
(WATERPROOFED),DBOX,42 INFILTRATOR QUICK 4 STANDARD PLUS UNITS W/OUT
STONE: 30' X 18' X 8"
2.BOH TO INSPECT SOIL REMOVAL
3.MFC VARIANCE: 1.GROUNDWATER SEPARATION
4.EXISTING 6 BEDROOM DWELLING TO BE CONVE T TO TOTA EDROOM.
Bruce . urphy, MPH, R.S., CHO/ my L. von Hone, R.S.,CHO
Health Director f Assistant Health Diredor
The issuance of this permit s6a11 not be co�strued as a guarantee that the system will function as designed.
BOH_Disposal_Construdion_CofC.rpt