HomeMy WebLinkAboutApp-Permit-ComplianceNo. DOWDC -15- T FEE 16y • 00
COMMONWEALTH Of MASSACHUSETTS &496177
Board of Health, yAgm 1111.1 , AA.
APPLICATION FOP, DISPOSAL SYSTEM[ CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade(11--Abandon- Complete System ❑ Individual Components
Location
t �
Owner's Name
Map/Parcel# 1W 92, 00 '722
Address 3 ..7- k Y
Lot#
Telephone#
Installer's Name OCA
Designer's Name (X--
) t
AddressA6
Address43( o b 7p/
Telephone# .� ���
Telephone#d�=
Type of Building
Dwelling - No. of Bedrooms
Other - Type of Building
3
No. of persons
Lot Size sq. ft.
Garbage grinder ( )
Showers( ), Cafeteria ( )
Other Fixtures
Design Flow (min. required) 8 gpd Calculated design flow Design flow provided 2�) ...... gpd
Plan: Date Number of sheets Revision Date
Title
Description of Soil(s) ,Q_.o4
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 operatio until a Certificate of Compliance has been issued by the Board of Health.
Signed Date 3 !
Inspections
No. IJD�J�^'��fZI� - FEE c�,C
COMMONWEALT14 Of MASSACHUSETTS
Board of Health, 1Sr( m 0 VT" , MA.
CERTIFICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) O Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded (� )', Abandoned( )
by: C :-- .G'
at r7
has been install a"cccofda6c� with�e provisio s of 310'CMR 15.00 (Title 5) and the alXroved design plans/as-built plans relating to
application No. % ��`12 dated > 2-1 S Approved Design Flow r (gpd)
Installer L
Designer: iti'iOIjMJ5&J-�, ! N) C Inspector: -� Date: l� y
The issuance of this permit shall not be construed as a guaran6that the system will function as designed.
'On��O01.`JDlti....Cooe.. 'ot _3'noc GJ0 1_, .O 0(.C�..0 .�=O J�JooGGo�c
No. bol c— 15-2-I qLjC&
SC + M4YLC rt3 (
+w -r FEE 4�'�Yl 60
COMMONWEALTH EALTH ®E MASSACHUSETTS 7
Board of Health, 7A W 0 QT* , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgrade (t..-) Abandon ( ) an individual sewage disposal system
at
Disposal System Construction Permit No. dated'
Provided: Construction shall be
Form 1255 Rev. 5196 A.M. Sulkin Co. Charlestown, MA
plete within thpof the d
Date �Boardof Hea
H
as described in the application for
local conditions must be met.
No.:BOHDC-15-2144
Commonwealth of Massachusetts F�
sss.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Complete System
Location: 32 MASSACHUSETTS AVE,WEST YARMOUTH, MA Owner:
02673 RICCI BONNIE J
Map/Parcel#:022.390 20 GATEWAY RD,#82N
YONKERS,NY 10703
Phone:
Septic System Installer Designer
CHASE&MERCHANT MEYER& SONS,INC.
P.O. BOX 5 DENNISPORT, MA 02639 P.O.BOX 981
Phone: EAST SANDWICH,MA 02537
(5081360-3311
� Type of Building:Dwelling Lot Size:4,356.00 Acres
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building: . No.of persons: Showers:
Other Fistures:
Plan Date:OS/07/2015 Number of Sheets:2 Cafeteria:
Title:SEPTIC SYSTEM REPAIR PLAN 32 MASSACHUSETTS AVE. Revision Date:
Desigo Flow(roin.required):330 gpd Calculated design Oow:330 gpd Desigo flow providM:350 gpd
DescripNon of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator. Date of Evaluatioo:04/16/2015
DARREN MEYER,R.S.
DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR- 1500 GAL SEPTIC TANK,DBOX H-2Q 16 HIGH CAPACITY
INF[LTRATORS H-20 W/OUT STONE:25'X 11.32'X ll"
. The untlersignetl agrees to insfall the above described Individual Sewage Dlsposal System in accordance wNh the provisions of
TITLE 5 and fuMer aarees nM to olace in ooeratian until a Certificate of Comoliance has 6een issued hv the Board of Meakh.
Signed Date
Inspections
3 Commonwealth of Massachusetts
� Board of Health, Yarmouth, l�lli Pee
DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00
Permission is herb ranted to•
Y8
CHASE&MERCHANT INC., P.O. BOX 5, DENNISPORT,MA 02639
To perform:Upgrade an individual sewage disposal system.
Ownec RICCI BONNIE J
20 GATEWAY RD,#82N
YONKERS,NY 10703
Location:32 MASSACHUSETTS AVE, WEST YARMOUTH,MA 02673
� Disposal System Cocistruction Permit No.: BOHDC-1S2144,Dated: May 21,2015
Provided: Cons[ruc[ion shall be completed within six months of the date of this permit. All local conditions must be met.
Conditions
1. REPAIR-I500 GAL SEPTIC TAN1� DBOX H-2Q 16 HIGH CAPACI7'Y INFILTRATORS H-20 W/OUT
STONE:25'X 11.32'X 11"
2. MFC YARIANCES: 1. SETBACKS 2. WATERLINE
, Bruce . Murphy, MPH, R.S., CHO/Amy L.von Hone, R.S.,CHO
Health Director/Assistant Health Director
The issuance of this permit shall not be constraed as a guarantee that t6e system will function as designed.
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA F�
CERTIFICATE OF COMPLIANCE 855.00
Description of Work:Complete System
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:CHASE&MERCHANT INC.
at:32 MASSACHiJSETTS AVE,WEST YARMOUTH,MA 02673
Has been installed in accordance with the provisions of 310 CMK 15.00(Title 5)and the approved
design plans or as-built plans relating to application No.: BOHDGIS-2144,dated 06/08/2015.
Installer.CHASE&MERCHANT INC.
Address:P.O.BOX 5 DENNISPORT,MA 02639 Inspector:AMY VON HONE,R.S.
Designer.MEYER&SONS,INC.
Conditions
1.REPAIR- 1500 GAL SEPTIC TANK,DBOX H-20, 16 ffiGH CAPACITY INFILTRATORS H-20
W/OUT STONE: 25'X 1132'X 11"
2.MFC VARIANCES: 1. SETBACKS 2.WATERLINE �
�
Bruce G. Murp , PH, R.S., CHO/Amy L.von Hone, R.S.,CHO
Health Director/Assistant Health Diredor
The issuance of this permit s6a11 not be construed as a guarantee that the system will functioo as designed.
BOH_Disposal_ConsVuc[ion_CofC.rpt
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