HomeMy WebLinkAboutApp-Permit-ComplianceYARMOUTH HEALTH DEPT.
Board of Hecft4 TE 2Q , MA.
APPLICATION FOP, DI M ?Mm TRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade (/Abandon( ) - Complete System u Individual Components
Location / 6 e r�C o AI �T . d /�!%L �/
Owner's Namee�Q�- zl `le,(
Map/Parcel# Q, /S
Address 7 6 /9Co �l % 30' /�R V:?/�
Lot#
Telephone# y- ,a - ol� 63
Installer's Name 1AYt%6 hrG�7�/%� ��[,
Designer's Name
Address 30 AMOS 1pl 1?C, /0X//7///J p/Z /
-
Address � ?/K/1—/'0
Telephone# 0 - L6 .rte - oq
Telephone# O �` �/3
Type of Building , Lot Size sq. ft.
Dwelling - No. of Bedrooms Garbage grinder ( )
Other - Type of Building / No. of persons 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)
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 tem in operation until a Certificate of Compliance/n has been issued by the Board of Health.
Signed - Date
Inspections
QQom�. j ..
FEE • dQ
COMMONWFALT14 Of MASSACHUSETTS
Board of Health, y,q! f%/ ���`� , MA.
f
CERTIFICATE OF COMPLIANCE
Description of Work: ❑ Individual Component(s) -;J-fZ iplete System1/ /
rf The undersigned hereby certify that the'Sewage Disposal System; Constructed (? ), Repaired ( ), UpgradedrAbandoned ( )
by:
at
has been installe n accor�a ce;th e provisions of 310 CMR 15.00 (Title 5) and th ap roved design plans/as-built plans relating to
applicationNo. / dated i +
� ��/ ) . Approved Design Flow (gpd)
(/ ft
Installer { I / f^ �?C/) %/i T%i'
Designer://(V ,'?%L) r/J /h i!( /' /f %` i Inspector: �..� tom! l Date: P
The issuance of this permit shall not be construed as a guar i ,,at the system will function as designed
No. ��{-�DC' �S" `T�O�3 C1SC f /1')941.3T� FEE
COMMONWFALT14 OF MASSACHUSETTS C4 9/5 3
Board of Health, �%�/ ' �1 I o J%/� ' , MA.
DISPOSAL SYSTEM'][ CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgrade(4ZAbandon( ) an individual sewage disposal system
at(, l)fi'% �. J / / C- e -T J GU i`'_- ( f? , /)I t% `) %1-0 as described in the application for
Disposal System Construction Permit X10. datedVthe
��
Provided: Construction shall be completed wt n th�i o3ateof this perAll local Gond}-tions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Boston, MA Date 0 Board o§1- e
No.:BOHDC-15-4508
� 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: 46 DEACON ST, SOUTH YARMOUTH, MA 02664 Owner:
GIARD JEREMY L
Map/Parcel#: 113.23 GIARD MARY JESSICA
46 DEACON ST
SOIJ'1'HYARMOUTH,M.4 02664
Phone:
Septic System Installer Designer
CHASE&MERCHANT MORAN ENGINEERING ASSOC.,LLC
P.O. BOX 5 DENNISPORT, MA 02639 P.O.BOX 183
Phone: SOUTH HARWICH,MA 02661
508-432-2878
Type of Building:Dwelling Lot Size: 14,810.00 Acres
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building: No.otpersons: Showers:
Other Fiatures:
Plan Date:06/10/2015 � Number of Sheets:2 Cafeteria:
Tit1e:SITE&SEWAGE PLAN 46 DEACON STREET Revision Date:
Design Flow(mio.required):330 gpd Calculated desigo flow:330 gpd Desigo flow provided:430 gpd
Descriptioo otSoils:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluatioo:06/]0/2015
RICK NDD,R.S.
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTTC DISPOSAL-REPAIR•PROPOSED I500 GAL SEPTIC TANK,DBOX,10
CULTEC 180 UNITS W/OUT STONE IN TRENCH CONFIGURATTON:2 ROWS 32.65'X 3'X 1.17'
The untlersignetl agrees W i�rofall the above deseribetl Intlivitlual Sewage Diaposal System in accordance with Ne provlsions of
T1TLE 5 antl furfher aarees not to olace in ooeration until a CerfifieaM of Comolianee has been issuetl bv the 8esrd of Heskh.
Signed Date
Inspections
, Commonwealth of Massachusetts
Board of Aealth, Yarmouth, MA Fee
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: GIARD JEREMY L
GIARD MARY JESSICA
46 DEACON ST
SOUTH YARMOUTH,MA 02664
Location:
Disposal System Construction Permit No.: BOHDC-15-4508,Dated:October 09,2015
Provided:Construction shall be wmpleted within six months of the date of this permit. All local conditions must be me[.
CONDITIONS:
1. SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK, DBOX, 10 CULTEC 180 UNITS W/OUT
STONE IN TRENCH CONFIGURATION:2 ROWS 32.65'X 3'X 1.17'
2.ZONE II MAXIMUM 3 BEDROOMS
G�-�C
Bruce G. Mu hy, PH, R.S., CHO/Amy L.von Hone, R.S., CHO
ealth Director/Assistant Health Director
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 Fee
CERTIFICATE OF COMPLIANCE sss.00
Description of Work: Complete System
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by: CHASE&MERCHANT INC.
at: 46 DEACON ST, 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.: BOHDC-15-4508, dated 10/29/2015.
Installer: CHASE& MERCHANT INC.
Address:P.O. BOX 5 DENNISPORT, MA 02639 Inspector: AMY VON HONE, R.S.
Designer: MORAN ENGINEERING ASSOC., LLC
Conditions
1. SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX, 10 CULTEC 180
UNITS W/OUT STONE IN TRENCH CONFIGURATION: 2 ROWS 32.65' X 3' X 1.17'
2. ZONE II MAXIMUM 3 BEDROOMS
c�'f
Bruce G. Murph , R.S., CHO/Amy L. v n 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_Construction_CofC.rpt