HomeMy WebLinkAboutApp-Permit-ComplianceNo. �. " 1-� '`f `GFEE C7�
COMMONWEALTH OF M ASSAC14USETTS
Board of Health, Or d 1%1 W
APPLICATION F®I, DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade�bandon() - ❑ Complete System 215dividual Components
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) ?3 e 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
t
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 es to not to place the system in opera until a Certificate of Compliana has been issued by the Board of Health.
Signed Datej
Inspections
y ,
No. FEE
COMMONWEALTH Of MASSACHUSETTS
Board. of Health, 'D ®(tT `' , ALA.
CERTIFICATE Of C®NIS NCS 1'e,
Description of Work: p ndivi( al Component(s) ❑ Complete System /
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded.{r`<Abandoned O
at
has been instalfddin dc(
application No. i �s
Installer ( } --0-4
risylif 310 CMR M.W (Title 5) and th proved design plans/as-built plans relating to
Approved Design Flow(gpd)
Designer:bf ! ' _ Inspector f�bw� � Date: %���
The issuance of this permiAs all not be con trued as a guarantee that will function as designed.
,UUOP000 L`�C-UL'c?t'U-00i)DJ OJOJ OOc).O�OJC�0007.0000'.:C O00 UU OOOGOC CU OG`ODOOCOOOOUG C)`OOC OOOOG OO OtJ000000000 COCGOO UU000()OOOG OOG OOUOOD 0000')Oi')GC
FEE S!!;# # 0.0
COMMONWEALTH OF MASSACHUSETTS $57
Board of Health, Y8 -9M0 VT1+ MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is herebxgranted to; Construct( ) Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system
at 4/16 / 9YY7_ A _ sA tr�I ' 4 � >� s� _ r°��,11W as described in the application for
r.
Disposal System Construction Permit No.
Provided: Construction shall be completed within t4 a ea' rs of the date of this per i All local condi 'ons must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date
/0 - 9 ?- Board J ftealth ?
•Telephone#Installer's
Name 14 //
f Designer's Name
Address
Address
Vill
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) ?3 e 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
t
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 es to not to place the system in opera until a Certificate of Compliana has been issued by the Board of Health.
Signed Datej
Inspections
y ,
No. FEE
COMMONWEALTH Of MASSACHUSETTS
Board. of Health, 'D ®(tT `' , ALA.
CERTIFICATE Of C®NIS NCS 1'e,
Description of Work: p ndivi( al Component(s) ❑ Complete System /
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded.{r`<Abandoned O
at
has been instalfddin dc(
application No. i �s
Installer ( } --0-4
risylif 310 CMR M.W (Title 5) and th proved design plans/as-built plans relating to
Approved Design Flow(gpd)
Designer:bf ! ' _ Inspector f�bw� � Date: %���
The issuance of this permiAs all not be con trued as a guarantee that will function as designed.
,UUOP000 L`�C-UL'c?t'U-00i)DJ OJOJ OOc).O�OJC�0007.0000'.:C O00 UU OOOGOC CU OG`ODOOCOOOOUG C)`OOC OOOOG OO OtJ000000000 COCGOO UU000()OOOG OOG OOUOOD 0000')Oi')GC
FEE S!!;# # 0.0
COMMONWEALTH OF MASSACHUSETTS $57
Board of Health, Y8 -9M0 VT1+ MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is herebxgranted to; Construct( ) Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system
at 4/16 / 9YY7_ A _ sA tr�I ' 4 � >� s� _ r°��,11W as described in the application for
r.
Disposal System Construction Permit No.
Provided: Construction shall be completed within t4 a ea' rs of the date of this per i All local condi 'ons must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date
/0 - 9 ?- Board J ftealth ?
i
I -
; No.:BOHDC-15-4498
,
� Commonwealth of Massachusetts Fee
• ass.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Individual Component(s)
Location: 106 POMPANO RD,YARMOUTH, MA 02675 Owner:
EATON STEPHEN E
� Map/Parcel#: 135.23 EATON JOAN G
� 106 POMPANO RD
I
1 . YARMOUTH PORT,MA 02675
i
j � Phone:
Septic System Installer Designer
� CHASE&MERCHANT DOWN CAPE ENGINEERING.INC.
i
j P.O. BOX 5 DENNISPORT, MA 02639 939 ROUTE 6A
� Phone: YARMOUTHPORT,MA 02675
� 508-362-4541
Type of Building:Dwelling Lot Size: 11,761.00 Acres
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other F�tures:
Plan Date:08/28/2015 Number of Sheets: 1 Cafeteria•
Tit1e:T'I'TLE 5 SITE PLAN 106 POMPANO ROAD Revision Date:
Design Flow(min.required):330 gpd Calculated design flow:330 gpd Design flow provided:349 gpd
Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:08/27/2015
DANIEL GONSALVES,SE
• DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTTC TANK,DBOX,2-500
GAL PRECAST CHAMBERS W/4'STONE:25'X 12.83'X 2'
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of
' TITLE S and further aarees not to olace in ooeration until a Certificate of Comoliance has been issued bv the Board of Heakh.
Signed Date
Inspections
1
i
�
� .
�
� Commonwealth of Massachusetts
I :
Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00
� Permission is herby granted to;
; CHASE&MERCHANT INC., P.O. BOX 5, DENNISPORT,MA 02639
i To perform:Upgrade an individual sewage disposal system.
Owner: EATON STEPHEN E
EATON JOAN G
106 POMPANO RD
YARMOUTH PORT,MA 02675
Location: 106 POMPANO RD,YARMOUTH,MA 02675
, Disposal System Construction Permit No.:BOHDGIS-4498,Dated:October 09,2015
� 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-EXISTING 1000 GAL SEPTIC TANK, DBOX,2-500 GAL PRECAST
CHAMBERS W/4'STONE:25'X 12.83'X 2'
;
2. BOH TO INSPECT SOIL REMOVAL
i �� i
� 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.
f
i
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
CERTIFICATE OF COMPLIANCE $ss.00
� Description of Work:Individual Component(s)
�
� The undersigned hereby certify that the Sewage Disposal System; Upgraded
' by:CHASE&MERCHANT INC.
at: 106 POMPANO RD,YARMOUTH,MA 02675
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-15-4498,dated 12/14/2015.
� Installer:CHASE&MERCHANT INC.
� Address:P.O.BOX 5 DENNISPORT,MA 02639 Inspector:AMY VON HONE,R.S.
Designer:DOWN CAPE ENGINEERING,INC.
� Conditions
1.SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK,DBOX,2-500 GAL
PRECAST CHAMBERS W/4'STONE:25'X 12.83'X 2'
! 2.BOH TO INSPECT SOIL REMOVAL
� � �����
� Bruce G. Murph , 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