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No.
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COMM® LT1I ® SS CIIUSETTS��
Board of Health,
PPLICATI®N FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair(X) Upgrade( ) Abandon( ) - ❑ Complete System Xl Individual Components
Location 93 MERCHANT AVENUE
Owner's Name DARLENE DAVID, TRUSTEE
Map/Parcel# 136-107
Address 93 MERCHANT AVENUE, Y.P.
Lot#
Telephone#
Installer's Name
Designer's Name THE BSC GROUP, INC.
Address Z / Lr
Address 349 ROUTE 28, W. YARMOUTH. MA 02673
Telephone# O —6.,r4",
Telephone# 508-778-8919
Type of Building RESIDENTIAL Lot Size
Dwelling - No. of Bedrooms 2
Other - Type of Building No. of persons
17,235 sq. ft.
Garbage grinderNONE
Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow (min. required) 220 gpd Calculated design flow Design flow provided 336 gpd
Plan: Date JUNE 9, 2015 Number of sheets 1 Revision Date
Title SEPTIC SYSTEM REPAIR, 93 MERCHANT AVENUE, YARMOUTH PORT
Description of Soil(s) SEE PLAN
Soil Evaluator Form No. Name of Soil Evaluator KIERAN HEALY Date of Evaluation MAY 21, 2015
DESCRIPTION OF REPAIRS OR ALTERATIONS
REPLACEMENT OF LEACHING AREA AND "D" BOX
The undersi agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further at
ees t to tem in operation until a Certificate of Compli ce has been issued by the Board of Health.
Signed Date TLSO
d /
oo
L� FEE !
/ � s COMM® LTII Of MASSAC14USETTS e6
Board of Health, 0 , MA. /� t
CERTIFICATE Of COMPLIANCE
Description of Work: dividual Component(s) onent(s) ❑ Complete System "✓ %
P
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( )> Upgraded..< -<Abandoned ( )
by: 1���-t�YG/dL�✓/1%l�
at 93 MERCHANT AVENUE
has been installedV�cc rdan 4th e pros ns of 310 CMR 15.00 (Title 5) and t e rapproved design plans/as-built plans relating to
application No. dated S `'/��' / Approved Design Flow iD (gpd)
Installer
Designer: f 2S l Inspector: Date:
The issuance of this permit shall not be construed as a guar tee that the system will function as designed.
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FEE
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COMMONWEALTH OF MASSACHUSETTS r^
Board of Health, 6gma l}i"* 1111M.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair ( ) Upgrade, ,<Abandon ( ) an individual sewage disposal system
at 93 MERCHANT AVENUE as described in the application for
Disposal System Construction Permit No. I C 1 h �, dated �j�'
Provided: Construction shall be compl�tei� ii t re5e Zof t e iae of this perm-, Vlocal conditions m t be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. ChadeMown, MA [ Date 6 Board of Health
No.:BOHDC-15-2963
Commonwealth of Massachusetts FeB �
$55.00
Board of Health, Yarmouth, MA ,
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-
Location: 93 MERCHANT AVE,YARMOUTH, MA 02675 Owner:
DAVID DARLENE M TR
Map/ParceW: 136.107 MERCHANT AVENUE REAL1'Y TRUST
93 MERCHANT AVEN[JE
YARMOUTH PORT,MA 02675-2238
Phone:
Septic System Installer Designer
R.E.LARRIMORE BSC GROUP,INC.
112 MAIN STREET HARWICH, MA 349 ROUTE 28,UNIT D
02645 WEST YARMOUTH,MA 02673
Phone: 508-778-8919
Type of Building:Dwelling Lot Size: 19,166.00 Acres
Dwelliog-No.of Bedrooms:2 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Fixtures:
Plan Dah:06/09/2015 Number of Sheets: 1 Cafehria:
Tit1e:SEPT[C SYSTEM REPAIR 93 MERCHANT AVEN[JE Revision Date:06/25/2015
Desigo Flow(min.rcquired):220 gpd Calculated desigo flow:220 gpd Design Ilow provided:336 gpd
Description of SoiIs:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator. Date o(Evaluation:OS/21/20t5
KIERAN HEALY,P.L.S. •
DESCRIPTTON OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPA[R-EXISTING]000 GAL SEPTIC TANK,DBOX,24
HIGH CAPACITY QUICK 4 UNITS W/OUT STONE:24'X 1133'X 1 I" �
The unde�signetl agrees to install the above descrl6ed Intlivitlual Sewage Dfsposal System in aeeordance wkh the provisiona of
TITLE 5 and fuMer aarees not to olaee in ooeration untll a CeRifitate of Comollance has been issued 6v the Bonrd of Heakh.
Signed Date
Inspections
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT ass.00
Permission is hereby granted to;
R.E. LARRIMORE, 112 MAIN STREET, HARWICH, MA 02645
To perForm: Upgrade an individual sewage disposal system.
Owner: DAVID DARLENE M TR
MERCHANT AVENUE REALTY TRUST
93 MERCHANT AVENUE
YARMOUTH PORT,MA 02675-2238
Location: 93 MERCHANT AVE, YARMOUTH,MA 02675
Disposal System Construction Permit No.: BOHDGIS-2963 , Dated: August 10,2015
Provided: Construction shall be completed within six months of the date of this permit. All local conditions must be met.
CONDITIONS:
1. SEPTIC DISPOSAL- REPAIR-EXISTING 1000 GAL SEPTIC TANK, DBOX, 24 HIGH CAPACITY
QUICK 4 UNITS W/OUT STONE: 24'X 11.33'X 11"
2. BOH TO INSPECT SOIL REMOVAL
3. MFC VARIANCE APPROVALS: a. GROUNDWATER b. SIEVE ANALYSIS OF SUITABLE SOIL c.
WETLAND SETBACK
V C3�
Bruce . Mu hy, 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 wili function as desigaed.
I
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA F�
CERTIFICATE OF COMPLIANCE 555.00
Desaiption of Work:
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:R.E.LARRIMORE
at:93 MERCHANT AVE,YARMOUTH,MA 02675
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-1S2963,dated 08/25/2015.
Installer:R.E.LARRIMORE
Address:l 12 MAIN STREET HARWICH,MA 02645 Inspector:AMY VON HONE,R.S.
Designer:BSC GROUP,INC.
��U���.�
Bruce G. Murphy � , R.S., CHO/Amy L.von Hone, R.S.,CHO
�Health Diredor/Assistant Health Director
The issuance of this permit shall not be construed as a guarant�that the system will function as designed.
BOH_Disposal_Construdion_CofC.rpt