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HomeMy WebLinkAboutApp-Permit-ComplianceNo.604DC- 16-5(041 3L0 -0 1 VJ OMMON LTH ®L MASSACHUSETTS � CkA� � Board of Health, Y4gW10U—J-4 , MA. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) - ❑ Complete System ❑ Individual Components Location 5.I Owner's Name 9; Map/Parcel# �� Address P© Lot# Telephone# Installer's Name r Designer's Name -d Address Address e Telephone#�,� �2f f Telephone# Type of Building Lot Size Id t/ sq. ft. Dwelling - No. of Bedrooms 13 Garbage grinder( ) Other - Type of Building No. of persons Showers ( ) , Cafeteria ( ) Other Fixtures Design Flow (min. required) gpd Calculated design flow i U Design flow provided -7:50 gpd Plan: Date Number of sheets Revision Date Title Description of Soil(s) —42-e-0— 49Z l� Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation 4 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 system in operati a Certificate of Co pliance has been issued by the Board of Health. Signed Date /� Inspections J kv � ...�, C®MM®NLTII Of MASSACHUSETTSo2 s Board of Health, 0 MA. C f' CERTIFICATE OF, COMPLIANCE Description of Work: ❑ Individual Component(s) ❑ Complete System The unders' ned hereby certify that the Sewage Disposal System; emfConstructed ( ), Repaired ( ), Upgrade, Abandoned( by at has been installed in � cor � e Wl l the ovisions of 3110 CMR 15.00 (Title )and the p r ed design plans/as-built plans relating to application No. /�� �7� ,dated ��/ :/L Approved Design Flow s (gpd) aft Installer ,,7` Designee: 7� . 'ate . _Inspector: (�! Date: The issuance of ",Permit shall not a construed as a guarantee that the system will function as designed. >0000_occcoc0000/000_ coooc.c FEE 1�5, 6�3 /5--276 COMMONWEALTH Of MASSACHUSETTS CA--* 921 Board of Health, )&MQUIN- , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( ) Upgrade Abandon( ) an individual sewage disposal system at . J as described in the application for Disposal System Construction Permit No. / -Z� G dated 4 41 Provided: Construction shall be completed/within v of the date of this permit. All local conditions must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown, MA Date l J /( Boa d of Health( �! i I . ( No.:BOHDGIS-5641 � . Commonwealth of Massachusetts F� $55.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to:Upgrade-Complete System ` Location: 33 BERNARD ST, SOUTH YARMOUTH, MA 02664 Owner: DEWART BENJAMIN B Map/Parcel#: 088.84 DEWART THYRA J 33 BERNARD ST SOUTH YARMOUTH,MA 02664-1 6 1 1 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 5083982116 508-432-2878 Type of Building:Dwelling Lot Size: 10,890.00 Sq.Ft. ', Dwelling-No.of Bedrooms:3 Garbage Grinder: Other Type of Building: No.of persons: Showers: Other Fixtures: Plan Date: 10/13/2015 Number of Sheets:2 Cafeteria: Tit1e:SITE AND SEWAGE PLAN 33 BERNARD STREET Revision Date: � Design Flow(min.required):330 gpd Calculated design flow:330 gpd Design flow provided:338.5 gpd Description of Soi1s:SEE PLAN Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:09/30/2015 RICK JUDD,R.S. DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL POLY SEPTIC TANK, DBOX, 12 CULTEC RECHARGER IOOHD UNITS W/OUT STONE:4505'X 605'X 0.5' ! The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further aarees not to olace in ooeration until a Certificate of Comoliance has been issued 6v the Board of Heaith. Signed Date Inspections � i � � � { Commonwealth of Massachusetts ' Board of Health, Yarmouth, MA F� DISPOSAL SYSTEM CONSTRUCTION PERMIT $55.00 Permission is herby granted to; ' CHASE&MERCHANT INC., P.O. BOX 5, DENNISPORT, MA 02639 To perform: Upgrade an individual sewage disposal system. Owner: DEWART BENJAMIN B DEWART THYRA J 33 BERNARD ST SOUTH YARMOUTH,MA 02664-1611 Location: 33 BERNARD ST, SOUTH YARMOUTH,MA 02664 Disposal System Construction Permit No.: BOHDC-15-5641 ,Dated: November 20,2015 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-PROPOSED 1500 GAL POLY SEPTIC TANK, DBOX, 12 CULTEC RECHARGER 100HD UNITS W/OUT STONE:45.5'X 6.5'X 0.5' 2. PLUMBING PERMIT REQUIRED 3.ZONE II MAXIMUM 3 BEDROOMS � Bruce G. Murp , M , R.S.,CHO/Amy L.von Hone, R.S., CHO alth 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 � I � a