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HomeMy WebLinkAboutApp-Permit-ComplianceNo. I Z� 61—P7 -K- I-6-- M3, FOY FEE Ay �� COMMONWEALT14 Of M ASSAC14USETTS cj+g7 -,�s Board of Health, 1 %ASM 0 OF& APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMI1� Application for a Permit to Construct( ) Repair( ) Upgrade (p Abandon( ) - 0 Complete System Individual Components Location Owner's Name Map/Parcel# -5-/ /d�3 Lot# Address A !liq Telephone# Installer's Name Designer's Name Address®� Address Telephone# Telephone# Type of Building Dwelling - No. of Bedrooms Other - Type of Building _ No. of persons Lot Size sq. ft. Garbage grinder ( ) Showers ( ), Cafeteria ( ) Other Fixtures Design Flow (min. required) >� gpd Calculated design flow Design flow provided gpd Plan: Date Number of sheets Revision Date Title Description of Soil(s) d e24 ydl 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 aees to not to place the system in operation until a Certificate of om liance been issued by the Board of Health. Signed Date _ Inspections No.6®0)C - 5-17-3^7 EE tssyao COMMONWEALTH Of MASSACHUSETTS ,�w,� cA - & e Board of Health, Y o VT3+ , MA. ,k CERTIFICATE OF COMPLIANCE ,�f ti Description of Work: Individual Component(s) ❑ Complete System The undersigned hereby certify that the Sewage Disposal SSyystem;_ Constructed( ), Repaired ( ),Upgraded (4, Abandoned ( ) at has been instalfe'cfin`accoraance W'itlithero'*isions of 310 CMR 15.00 (Title 5) a�fd e a proved design plans/as-built plans relating to application No. �! _ -2 dated '✓' --' ! .Approved Design Flow (gpd) Installer % ,� �7 °d' ,2_.-e 4-. ---✓ JDate: C _ Designer: Inspectr: �S _ The issuance of this permit shall not be cpi strued as a gudrantee that the system will function as designed. ]'JOr, {_maQ I--,; Ll .. ., No. `�� 7 �- 0 C� �!' n+t*�` FEE a. 00 COMMONWEALTH OF MASSACHUSETTS c-4 9 7 3 3 Board of Health, y 6AM ©U rbc , AIA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby�granted to; Construct( ) Repair( ) Upgrade(:---" Abandon( ) an individual sewage disposal system at % /��ti",�� .3, r . `i A// vd ems, as described in the application for Disposal System Construction Permit No. _� , dated' 6-uo�r-�S-� i� - ? Provided: Construction shall be completed within threSB the date of this perrn%All local conditions must be met. at�dof HealthForm1255 Rev.5/96 A.M. Sulkin Co. Charlestown,MA DateB %:' No.: BOHDGIS-1237 • Commonwealth of Massachusetts F� 555.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to:Upgrade-Individual Component(s) Location: 211 PLEASANT ST, SOUTH YARMOUTH, MA 02664 Owner: SEELEY,GARY P Map/Parcel#: 051.13 SEELEY,SANDRA M 2l lB OFF PLEASANT ST SOUTH YARMOUTH,MA 02664 Phone: Septic System Installer Designer CHASE&MERCHANT STEPHEN HAAS,PE P.O. BOX 5 DENNISPORT, MA 02639 P.O.BOX 16 Phone: SOUTH DENNIS,MA 02660 (5081362-8132 Type otBuilding:Dwelling Lot Size:0.73 Acres Dwelling-No.of Bedrooms:4 Garbage Grinder: OtherType ofBuilding: No.of persons: Showers: Other Fixtures: PlanDate: ]0/30/2014 NumberofSheets: l Cafeteria: TitIe:SEPTIC SYSTEM DESIGN 211B PLEASANT STREET Revision Dah: � Design Flow(min.requirod):440 gpd Calculated design ilow:440 gpd Design How provided:444 gpd Description of SoiIs:SEE PLAN Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:OS/09/2001 STEPHEN HAAS,PE - DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-ADD 2 HIGH CAPACITY INFILTRATORS W/3.5'STONE TO EXISTING LEACH FACILITY:TOTAL 7 HIGH CAPACITY IIVFILTRATORS W/STONE:50'X 10'X 10" The undersignetl agrees to insfall the above described Individual Sewage Disposal System in accordanee with the provislons of • TITLE 5 and fuRher aarees not to olace in ooeration until a Certificate of Comoliance has 6een issued bv the Hoartl of Mealth. Signed Date Inspecrions 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: SEELEY,GARY P SEELEY,SANDRA M 211B OFF PLEASANT ST SOUTH YARMOUTH,MA 02664 Location:211B PLEASANT ST, SOUTH YARMOUTH,MA 02664 Disposal System Coustruction Permit No.: BOHDC-15-1237,Dated: March 04,2015 Provided:Construction shall be completed within six months of the date of this permit. All Iocal conditions must be met. Coudifions 1 REPAIR-ADD 2 HIGH CAPACITY INFILTRATORS W/3.S'STONE TO EXISTING LEACH FACILITY. TOTAL 7 HIGH CAPACITY INFILTRATORS W/STONE: 50'X 10'X 10". .�;������ Bruce G. Nkfrph ,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. Commonwealth of Massachusetts Board of Health, Yarmouth, MA FeB CERTIFICATE OF COMPLIANCE 555.00 Description of Work: Individual Component(s) The undersigned hereby certify that the Sewage Disposal System; Upgraded by:CHASE&MERCHANT INC. at:211B PLEASANT ST,SOUTH YARMOUTH,MA 02664 Has been installed in accordance with the provisions of 310 CMR I5.00(Title 5)and the approved design plans or as-built plans relating to application No.: BOHDC-1S1237,dated OS/06/2015. Installer:CHASE&MERCHANT INC. Address:P.O. BOX 5 DENNISPORT,MA 02639 Inspector:AMY VON HONE,R.S. Designer: STEPHEN HAAS,PE Conditions 1REPAIR-ADD 2 HIGH CAPACITY INFILTRATORS W/3.5' ST E TO EXISTING LEACH FACILITY: TOTAL 7 HIGH CAPACITY INFILTRATORS W/ :��XJ01 X 10". C/ � Bruce G. 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 will function as designed. BOH_Disposal_Construdion_CofC.rpt