HomeMy WebLinkAboutApp-Permit-ComplianceNo.F70T1 Vim-� `�'J'���ZJ '". `"�r�fl��' �j�/� 4-� / � P� �}Q�J �.y FEE ^�
X4AXjATTlr A ITS ®ir NIASSAC11US'rTTS
Board of Health, , MA.
Ac"41APP .ICATI®N FOR DISPOSAL SYSTEM CON TRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade(�bandon() - Complete System ❑ Individual Components
Location
t
Owner's Name
Map/Parcel# %%% 3
Address
Lot#
Telephone#
Installer's Name
Designer's Name
Address ���
Address 196 3 1
Telephone#
Telephone#
Type of Building
Dwelling - No. of Bedrooms
Other - Type of Building _
Other Fixtures
Design Flow (min. required) 3- gpd Calculated design flow Design flow provided __ gpd
Plan: Date Number of sheets Revision Date
No. of persons
Lot Size
sq. ft.
_ Garbage grinder ( )
Showers ( ), Cafeteria ( )
Title
Description of Soil(s)
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 agrgets to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed �-��'' 17��b �=o <� Date
Inspections V/ 7/1
FEE
` . �-
Board of Health, Y /� 2m 0 lif , Mtl.
CERTIFICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) 4kComplete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded (t} Abandoned ( )
by: t�
at ( 7
has been instA�d i accordance Wit t provisions of CMR 15.00 (Title() and the approved design plans/as-built plans relating to
application No. ��` dated _ / Approved Design Flow 4,;-1 (gpd)
Installer 9� "� 1� IY^dG,O'dl'di1 Ov ' "�
4
Designer: `?•[Jl r e'er { 7' Inspector: / Date:
The issuance of this permit shall not be c nstrued as a guarante that the system will function as designed.
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No. VC �C� E AeZC.A+A0T FEE 55���
5 —2 COM MON LT14 OF MASSACHUSETTS
Board of Health, Y&MO VT's! , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgrades( Abandon( ) an individual sewage disposal system
at �xt"�,✓w'-9li,e4 42 - /. %f: as described in the application for
Disposal System Construction Permit No. ! , daied 3--f -/!5.-
Provided:
.Provided: Construction shall be completed within thret yum othe dai of this permit. All local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown; MA Date -7 ' � �� pard of H tyil
No.: BOHDGIS-1238
• Commonwealth of Massachusetts Fe•
sss.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMTP
Application for a Permit to:Upgrade-Complete System
Location: 8 NEWBURY ST,WEST YARMOUTH, MA 02673 Owner:
GROVES DAVID I
Map/Parcedf: 028.93 GROVES SANDRA B
204 PINE ST
RAYNHAM,MA 02767-ll49
Phone:
Septic System Installer Designer
CHASE&MERCHANT SWEETSER ENGINEERING
P.O. BOX 5 DENNISPORT, MA 02639 P.O.BOX 713
Phone: SOUTH DENNIS,MA 02660
(5081385-6900
Type of Building:Dwelling Lot Siu:030 Acres
Dwelling-No.of Bedrooms:2 Garbage Grinder:
Other Type of Building: No.of persoos: Showers:
Other Fistures:
Plan Dah:0t/23/2015 Number of Sheets: 1 Cafeteria:
Tit1e:PROPOSED SEPTIC DESIGN 8 NEWBURY STREET Revision Date:02/23/2015
Desigo Flow(min.required):330 gpd Calculated design Oow:330 gpd Desigu ilow provided:351 gpd
Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator. Date of Evaluation:Ol/22/2015
ROBIN WILCOX,PLS
• DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-2000 GAL SEPTIC TANK, 1000 GAL PUMP CHAMBER,DBOX,4 HIGH
CAPACITY INFILTRATORS W/STONE:36'X ll'X t0"
The undersigned agrees to InsWll the above deseribetl Individual Sewage Disposal System in accordance with the provisions of
' TITLE b and further aarees not to olate in ooeration until a Certificate of Comoliance has heen issued bv the Board of Neakh.
Signed Date
Inspections
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA F�
DISPOSAL SYSTEM CONSTRUCTION PERMIT ass.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: GROVES DAVID I
GROVES SANDRA B
204 PINE ST
RAYNEIAM,MA 02767-1149
Location: 8 NEWBURY ST, WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.: BOHDC-15-1238,Dated: March 04,2015
Provided: Construction shall be completed within six months of the da[e of this permit. All local condi[ions must be me[.
Conditions
1. REPAIR-2000 GAL SEPTIC TANK, 1000 GAL PUMP CHAMBER, DBOX, 4 HIGH CAPACITY
INFILTRATORS W/STONE: 36'X Il'X 10"
2. BOH TO INSPECT SOIL REMOVAL
3. ELECTRICAL PERMIT REQUIRED
4. PLUMBINGPERMIT'REQUIRED
5. MF'C VARIANCE.• 1.ADJUSTED GROUNDWATER 2. TANK/PUMP CHAMBER INVERTS ABOVE
GROUNDWATER
6. MAXIMUM EXISTING 2 BEDROOM WITHOUT FURTHER REVIEW BY BOH
, Bruce G u hy, MPH, R.S., HO/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.
I
i�
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
CERTIFICATE OF COMPLIANCE ass.00
Description of Work: Complete System
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by: CHASE& MERCHANT INC.
at: 8 NEWBURY ST, 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.: BOHDGIS-1238,dated 04/24/2015.
Installer:CHASE&MERCHANT INC.
Address:P.O. BOX 5 DENNISPORT,MA 02639 Inspector:AMY VON HONE,R.S.
Designer. S WEETSER ENGINEERING
Conditions
1.REPAIR-2000 GAL SEPTIC TANK,1000 GAL PUMP CHAMBER,DBOX,4 HIGH CAPACITY
INFILTRATORS W/STONE:36'X 11' X 10"
2.BOH TO IN5PECT SOIL REMOVAL
3.ELECTRICAL PERMIT REQUIRED
4.PLUMBING PERMIT REQUIRED
5.MFC VARIANCE: 1.ADJUSTED GROUNDWATER 2.TANK/PUMP CHAMBER INVERTS
ABOVE GROUNDWATER
6.MAXIMUM EXISTING 2 BEDROOM WITHOUT FURTHE VIE�Wy 'BY B H
�w
Bruce G. rp , MPH, 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 guarantee that the system will function as designed.
BO H_Disposal_Construction_CofC.rpt