HomeMy WebLinkAboutApp-Permit-ComplianceNo. bo � ^ 19 rn 87 L/G"a� / l &614! '3 FEE 4
COMMONWEALTH OF MASSACHUSETTS e a4s
Board of Health, L=Oyrli , MA.
ICATI®N F®I, DISPOSAL SYSTEM CONSTRUCTI®N PERMIT
Application for a Permit to Construct() Repair() Upgrad Abandon () - omplete System ❑ Individual Components
Location IlleOwner's
Name
Map/Parcel#
Address
Lot#
Telephone#�"�
Installer's Name G
Designer's Name s'
Address �� (. !J.
Address 157a lev,)(
Telephone#
Telephone#
Type of Building
Dwelling - No. of Bedrooms
Other - Type of Building
Lot Size sq. ft.
Garbage grinder ( )
No. of persons Showers( ), Cafeteria ( )
Other Fixtures
Design Flow (min. required) gpd Calculated design flow :5� 6 Design flow provided _ 3 gpd
Plan: Date Number of sheets Revision Date
Title
Description of Soil (s) _
Soil Evaluator Form No.
Name of Soil Evaluator
DESCRIPTION OF REPAIRS OR ALTERATIONS
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 es to not to place the system in operation until a Certificate of Compl' ce lW been issued by the Board of Health.
Signed ��'1A,--R7f���b (�E!�/%/�/ Date
n
No.
Description of Work:
The undersiened het
by: ".�
at
has been insts
application N
Installer( r
i ^e
` r' �EE � `jam . CO
COMMONWFAL114 Of MAS$ $SETTS 4 9- ,c
Board of Health, } ,
c}} - MA.
CERTIFICATE Of COMPLIANCE
❑ Individual Component(s) Complete System
>y certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded. -Abandoned ( )
icc`Srdance with"ffie'ro-6sions of 10 CMR 15.00 (Title 5) JfiA thee a roved design plans/as-built plans relating to
dated / Approved Design Flow (gpd)
Designer: !�� -Ld�Ll t,�ZC�• Inspector: �� " Date: aT
The issuance of this permit shall not a construed as a guaranj a tha&e system will function as designed.
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No. ia ;)t,_ �.�J ��a� ��t a i 'T �.i. {>i� FEE , G(i
COMMONWEALTH OF MASSACHUSETTS al*- 943
Permission is hereby
at
Board of Health, 7ARtgo �,r, MA.
➢DISE®SAI. SYSTEM CONSTRUCTION PERMIT
to; Construct( ) Repair( ) U
( ) an individual sewage disposal system
in the application for
Disposal System Construction Permit No. Z dated /
Provided: Construction shall be compl of the date of this permit.1All local conditio�rys)tnust be met.
Form 1255
Rev. 5/96 A.M. Sulkin co. Chagdeslown,MA Date 6 ! > Board of Health
No.:BOHDC-15-2387
� Commonwealth of Massachusetts Fee
$55.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Applicatioo for a Permit to:Upgrade-Complete System
Location: 148 RUN POND RD, SOUTH YARMOUTH, MA 02664 Owner:
VARETIMOS LAMBRINI TR
Map/Parcel#: 034.10 � R P R REALTY 7RUST
4 JANNOR WAY
WEST YARMOUTH,MA 02673
Phone:
Septic System Installer Designer
CHASE&MERCHANT EAS SURVEY.INC.
P.O. BOX 5 DENNISPORT, MA 02639 P.O.BOX 1729
Phone: SANDWICH,MA 02563
(5081888-3619
Type ot Building:Dwelling Lot Size:8,712.00 Acres
Dwelling-No.otBedrooms:3 Garbage Grinder:
Other Type otBuilding: No.of persons: Showers:
Other Fixtures:
� Plan Date:06/29/2010 Number of Sheets: 1 Cafeteria:
TitIe:SITE SEPTIC PLAN 148 RiIN POND ROAD Revision Date:08/08/2014
Design Flow(min.required):330 gpd Calculated design flow:33 gpd Design Flow provided:335 gpd
Description of Soi1s:SEE PLAN
Soil Evsluator Form No.: Name of Soil Evaluator: Date of Evaluation:OS/19/2010
EDWARD STONE,PLS
- DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIA-PROPOSED 1500 GAL SEPTIC TANK,DBOX,24 QUICK 4
INFILTRATOR STANDARD UNITS W/OUT STOIVE:21.3'X 34'X 8"
7he undersigned agrees to install the above described Indlvidual Sewage Disposal System in accordance wkh the provisions of
� 717LE 5 and further aarees not to olace in ooeration unNl a Certlflcate of Comollance has heen lasued 6v the Board of HeaMh.
Signed Date
Inspections
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA F�
DISPOSAL SYSTEM CONSTRUCTION PERMIT 555.00
Permission is herby granted to;
CHASE&MERCHANT INC., P.O. BOX 5, DENNISPORT, MA 02639
To perform:Upgrade an individual sewage disposal system.
Owner: VARETIMOS LAMBRINI TR
R P R REALTY 7RUST
� 4 JANNOR WAY
� WEST YARMOUTH,MA 02673
Location: 148 RiIN POND RD,SOUTH YARMOUTH,MA 02664
Disposal System Construction Permit No.: BOHDGIS-2387,Dated:June 11,2015
Provided: Construction shall be comple[ed wi[hin six months of the date of this permit. All local conditions must be me[.
Conditions
1. REPAIR-PROPOSED I500 GAL SEPTIC TANK, DBOX, 24 QUICK 4INFILTRATOR STANDARD
UNTfS W/OUT STONE:21.3'X 34'X 8"
2. BOH TO INSPECT SOIL REMOVAL
3. BUILDING PERMITS REQUIRED FOR ANY RENOYATIONS OF ILLEGAL BEDROOMS/LIYING
SPACE IN BASEMENT �
��C�l �G��
Bruce G. urp y, MPH, R.S., CHO/Amy L.von Hone, R.S., CHO
Health Direc[or/Assistant Health Diredor
The issuance of this permit shall not be construed as a guarantee that the system will functian as designed.
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
CERTIFICATE OF COMPLIANCE sss.00
Description of Work:Complete System
The undersigned hereby certify that the Sewage Disposal System; Upgraded
i by:CHASE&MERCHANT INC.
at: 148 RUN POND RD, SOUTH YARMOUTH,MA 02664
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.: BOHDG1S2387,dated 09/15/2015.
Installer:CHASE&MERCHANT INC.
Address:P.O.BOX 5 DENNISPORT,MA 02639 Inspector:AMY VON HONE,R.S.
Designer:EAS SURVEY,INC.
Conditions
1.REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,24 QUICK 4 INFILTRATOR
STANDARD UNITS W/OUT STONE:21.3'X 34'X 8"
2.BOH TO INSPECT SOIL REMOVAL
' 3.BUILDING PERMITS REQUIRED FOR ANY RENOVATIONS OF ILLEGAL
BEDROOMS/LIVING SPACE IN BASEMENT �! ,• -
U�-�/
Bruce G. Murp , M H, 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 desigued.
BO H_Disposal_Construction_CofC.rpt