HomeMy WebLinkAboutApp-Permit-ComplianceNo. b00C 4 5-08 43 /S-- 603 79Y—FEE
COMM O LTH Of MASSACHUSETTS � q
Board of Health, _ g gA4P VT -4 , MA.
APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) UpgradePf""AbandonO - aComplete System ❑ Individual Components
Location
Owner's Name
Map/Parcel# M /.--7
Address 1-43
Lot#
Telephone#�`�
Installer's Name
Designer's Name
Address t
Address av
Telephone#1`
Telephone#,... Q
Type of Building
Dwelling - No. of Bedrooms
Other - Type of Building _
Other Fixtures
No. of persons
Lot Size sq. ft.
Garbage grinder ( )
Showers ( ), Cafeteria ( )
Design Flow (min. required) gpd Calculated design flow 5--S-V Design flow provided 77Z69pd
Plan: Date Number of sheets Revision Date
Title
Description of Soil(s) 44-Z-
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 not to place the system in opera ' until a Certificate of /Compliance has been issued by the Board of Health.
Signed rL Date_T%f
N
Inspections
Z.
No. B04DC-15-08g3 FEE � SS•U®
C®MMONWFAI.T14 OF MASSAC14USETTS %49
Board of Health, )6 MOMI , Aft
CERTIFICATE OF COMPLIANCE
Description of Work: O Individual Component(s)-Er6rnplete System.
The undersigned hereby certify that the Sewage Disposal System; Consst�ncte�d' (/+),aepaired ( ), Upgraded Abandoned ( )
by: f rd..� . 9 f
at�l1�.2.C. �., r�sx f3�►.r:
i�.x�- �O.
has been install in accordanceS—wit a provisions of 310 CMR 15.00 (Ti e 5) and the a oved design plans/as-built plans relating to
application/ o. ✓ ' l� dated :� .}App—roved Desi i /vilow •WZ(gpd)
Installer t _ . q-- ,�J� 11 iv /t_
Designer:Inspector: 14/ G/(,firClC� Date:
The issuance of this permit shall not becon�d as a guar �ee that the system will function as designed.
No. ��it C "1r?GdkFiS f— MQ i -f Aar FEE �.00
COMMONWEALTH OF MASSACHUSETTS CA -4 &0qq
Board of Health, YA?:M 0 VM , MA.
U806SN17SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgrade( V) Abandon( ) an individual sewage disposal system
at
Disposal System Construction Permit No. 4 -
Provided: Construction shall be completed withi
Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date -
Z
as described in the application for
d ted
n t�n�r—r-of the date of this permit. P local conditions must be met.
^� Board of Health
--�
• No.: BOHDC-15-0843
, Commonwealth of Massachusetts Fee
$55.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Complete System
Location: 22 MERCHANT AVE,YARMOUTH, MA 02675 Owner: �
OLSON MARTHA C TRS
Map/ParcedE: 127.18 22 MERCHANT AVE
YARMOUTHPORT,MA 02675
Phone:
SepHc System Installer Designer
CHASE&MERCHANT SWEETSER ENGINEERING
P.O. BOX 5 DENNISPORT, MA 02639 P.O.BOX 713
Phone: SOUTH DEA]NIS,MA 02660
(5081385-6900
Type of Building:Dwelling Lot Size:0.75 Acres
Dwelliog-No.oi Bedrooms:5 Garbage Grioder:
Other Type otBuilding: No.of persons: Showers:
Other Fixturos:
Plan Date: 10/23/2014 Number of Sheets: 1 Cafeteria:
TiUe:PROPOSED SEPITC DESIGN 22 MERCHANT AVENUE Revision Date:02/10/2015
Design Flow(min.rcquired):550 gpd Calculated design flow:550 gpd Design flow provided:575.96 gpd
DescripHon of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluaror: Date of Evaluation: 10/20/2014
ROBIN WILCOX,PLS
• DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-1500 GAL SEPT[C TANK,DBOX,8 HIGH CAPACITY INFILTRATORS
W/STONE:60'X 11'X 10"
: The unde�signed agrees to inatall the above deseribed Indivitlual Sewage Disposal System in accordanee wkh the provisio�of
TITLE 5 antl furfher aarees not to olace In ooeration untll a Cerlifieafe of Comoliance has heen Issued bv Na Board of Haalfl�.
Signed Date
Inspections
Commonwealth of Massachusetts
' Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00
Permission is herby granted to;
CHASE&MERCHANT INC., P.O. BOX 5, DENNISPORT,MA 02639
To perform:Upgrade an individual sewage disposal system.
Owner: OLSON MAR"I'HA C TRS
22 MERCHANT AVE �
YARMOUTHPORT,MA 02675 .
Location:22 MERCHANT AVE,YARMOUTH,MA 02675
Disposal System Construcrion Permit No.: BOHDC-1S0843,Dated: Marc6 02,2015
Provided:Construction shall be completed within six months of the date of this permit. All local conditions must be met. �
Conditions
1. REPAIR-1 S00 GAL SEPTIC TANK, DBOX, 8 HIGHCAPACIT'YINFILTRATORS W/STONE.• 60'X
11'X 10"
2. MFC VARIANCE: 1. DEPTH
�V�
Bruce G. Murphy, PH, R.S., CHO/Amy L.von Hone, R.S.,CHO
He Diredor/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 ass.00
Description of Work:Complete System
The undersigned hereby certify that the Sewage Disposal System; Opgraded
by:CHASE&MERCHANT INC.
at:22 MERCHANT AVE,YARMOUTH,MA 02675
Has been installed in accordance with the provisions of 310 CMIt 15.00(Title 5)and the approved
design plans or as-built plans relating to application No.: BOHDG1S0843,dated 06/04/2015.
Installer:CHASE&MERCHANT INC.
Address:P.O.BOX 5 DENNISPORT,MA 02639 Inspector:AMY VON HONE,R.S.
Designer. SWEETSER ENGINEERING
Conditions
1.REPAIR- 1500 GAL SEPTIC TANK,DBOX,8 HIGH CAPACITY INFILTRATORS W/STONE:
60' X11' X10"
2.MFC VARIANCE: 1.DEPTH ��, ��
�
Bruce G. M hy PH, R.S.,CHO/Amy L'.von Hone, R.S.,CHO
Health Director/Assistant Health Diredor
The issuance of this permit shall not be construed as a guara t that the system will funMion as designed.
�II BOH_Disposal_ConstrucUon_CofC.rpt