HomeMy WebLinkAboutApp-Permit-ComplianceNo. 1$17 4 -Dc- 69 "'f -1 (o"Q FEE 1"5-5--00
COMMONWEALTH OF MASSACHUSETTS "w o
Board of Health, YA'121i" 0 , MA.
APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade //Abandon( - J'Complete System ❑ Individual Components
Location
Owner's Name
Map/Parcel# ,
Address
Lot#
Telephone#
Installer's Name
esigner's Name
Address ,4% J!" l -
Address /��
Telephone#
Telephone#
r/3�
Type of Building
Dwelling - No. of Bedrooms
Other - Type of Building
No. of persons
Lot Size sq. ft.
Garbage grinder ( )
Showers ( ), Cafeteria ( )
Other Fixtures 77��
Design Flow (min. required) J gpd Calculated design flow ...-4�� Design flow provided V 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
furthers to not to lace the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date
Inspections
No.Q�-i. C-IS_�f�Fbt�
''�'. � "� FEE
COM[M ON LT14 Of MASSACHUSETTS
" -
Board of HealthYAV= Q 1J7� t MA.
CERTIFICATE OF COMPLIANCE
Description of Work: ❑ Individual Component(s)mplete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded, Abandoned ( )
at/ ti? FiAr3 ��f 6f .s s� -: a r9
has been installedii fiEeofddr0e witlf the rdCsions of 310 CMR 15.00 (Title 5) and
application No. X dated. Approved Design Flow
Installer jr
(gpd)
design plans/as-built plans relating to
Designer: Zf 4g4,4I./ Inspector: r� l" / Date:
The issuance of permit shall not be construed as a guaran 1111 that the system will function as designed.
iUQ.i:L rhiCu�.0i�a3�^.-4G)-0iJ J o O. C o C> e-.^, L -.')C . 9//L O.O o J i).S> c 110 o n p -p p <1¢ od.26o 0 0: U-0 O o"O �Tn-O ..�o-�:y,9:.4i'O+'!'O Ct stn trL C3-�AS�-P{}gAr>C) t1C1(J Cho O-<i:o0.O
No. �C�,�" � is9� CORS& I McK-cff*�JT FEE
COMMONWEALTH Of MASSACHUSETTS 3 9111
Board of Health, YaA t2.1ti1 n UM , MA.
DISPOSAL SYSTLM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgrade�Abandon( ) an individual sewage disposal system
at _ "� as described in the application for
/�qDisposal System Construction Permit No. `� % ,dated �
Provided: Construction shall be comp etec>-witliiof the date of this �rmht. All local cgnditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadesfawn, MA Date Board of Health �� 5
<.� Y
No.:BOHDC-15-4460
` Commonwealth of Massachusetts Fee
555.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERNIIT
Application for a Permit to:Upgrade-Complete System
Location: 38 NORTH MAIN ST, SOUTH YARMOUTH, MA 02664 Owner:
DWYER AMELIA A TR
Map/Parcel#•061.67 AMELIA A DWYER FAMILY TRUST
• 38 NORTH MAIN 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
Type of Building:Dwelling Lot Size: 11,326.00 Acres
Dwelling-No.of Bedrooms:5 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Fixtures:
Plan Date:08/25/2015 Number of Sheets: 1 Cafeteria:
Tit1e:SEPTIC SYSTEM DESIGN 38 NORTH MAIN STREET Revision Date:
Design Flow(min.required):550 gpd Calculated design flow:550 gpd Design flow provided:560 gpd
Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:08/25/2015
STEPHEN HAAS,PE
' DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTTC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TA1VK,DBOX,4-
500 GAL PRECAST CHAMBERS W/4'STONE:42'X 12.8'X 2'
The unde�signed 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 Comuliance has been issued bv the Board of Health.
Signed Date
Inspections
� Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT 355.00
Permission is herby granted to;
CHASE&MERCHANT INC., P.O. BOX 5, DENNISPORT, MA 02639
To perform:Upgrade an individual sewage disposal system.
Owner: DWYER AMELIA A TR
AMELIA A DWYER FAMILY TRUST
38 NORTH MAIN ST
SOUTH YARMOUTH,MA 02664
Location:38 NORTH MAIN ST,SOUTH YARMOUTH,MA 02664
Disposal System Construction Permit No.: BOHDC-1�4460,Dated: September 21,2015
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 SEPTIC TANK, DBOX,4-500 GAL PRECAST
CHAMBERS W/4'STONE:42'X 12.8'X 2' :
�
Bruce G. u y,MPH, R.S.,CHO/Amy L.von Hone, R.S.,CHO
Heaith 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, � 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:38 NORTH MAIN 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-15-4460,dated 11/18/2015.
Installer:CHASE&MERCHANT INC.
Address:P.O.BOX 5 DENNISPORT,MA 02639 Inspector:AMY VON HONE,R.S.
Designer: STEPHEN HAAS,PE
Conditions
1.SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,4-500 GAL
PRECAST CHAMBERS W/4' STONE: 42'X 12.8'X 2' ��C , ������
��0/
Bruce G. Mur y, PH, 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_Construction_CofC.rpt
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