HomeMy WebLinkAboutApp-Permit-ComplianceNo. e)N4 DC-iS-44i3, ��— FEE S� ®C7
Mmm640I.Tu ®r msVIIUSETTS
Board of Health, XFi%11p)d L)nt , MA. /
ION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
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Application for a Permit to Construct( ) Repair( ) UpgradeoAbandon () - ❑ Complete System A Individual Components
Location S% R ft � 0, yjp M d 0
Owner's Name T
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Map/Parcel# 13Z l n 2 —
Address J -e f1v
Lot#
Telephone#
Installer's Name cA qs.•e, a by1AtiG1179,1,Tj
Designer's Name
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Address 3n /U�Uti�i �� /}IjL�' �� %
Address 3 0) W.
Telephone# S�6 _3 _�� d 9 y -,d 1 v
Telephone# r(6
y/9
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) ,Zle) gpd Calculated design flow Design flow provided d
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 tlAe system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed( Date 7�c� %✓1
Inspections
s
No. kowu c "j C" ° FEE 0
COMMONWEALTH Of, MASSACHUSETTS 0 \,1
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Board of Health, r�11 i1101.17}f' , MA f l 71 /
CERTIFICATE Of C®�'l[PLIANC�
�Ifil Description of Work: dividuaComponent(s) ❑ Complete Syste
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded 4-1—,Abandoned ( )
by:
at `r '7 , j!/ 3 i C'7 I
has been installed to accordance tth p �Zsions of 310 CMR 15.00 (title 5) and thea oved design plans/as-built plans relating to
application No. ✓�. 09 dated -7 Approved Approved Design Flow (gpd)
Installer
(,p /i ' i l' 1 7✓ 1 / 1, ;f t -C Kew, � a1"- 1411
Designer:l. _ e' Y' ;i:s"? Inspector: /Cv frr/� Date:
The issuance of this permit shall not be construed as a guar tee that the system will function as designed.
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No. C V",5E i�01efu+k-p ��NCe FEE 4 W, Q0
t®MMON LTH OF MASSACHUSETTS c.k 90/ 0
Board of Health, ffi 0 Un+ , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgrade(;,<Abandon( ) an individual sewage disposal system
'
at , t �! r ii j i , , T (r t ,'?/ ;-.,yy �', , !; I%. f�J'i = 1 si1 ��') r as described in the application for
Disposal System Construction Permit N.P. /' i , dated
Provided: Construction shall be the
'date of this permit. All local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown, MA Date ��Board ofHealtii / � /
No.:BOHDC-15-1413 �
Commonwealth of Massachusetts Fee �
$55.00 '
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Individual Component(s)
Location: 785 ROUTE 28 9, SOUTH YARMOUTH, MA 02664 Owner:
LN JOE TR
Map/Parcel#: 033.77C9 J&K LN REAL'TY TRUST
Lot#: C9 785 ROUTE 28 UNIT 9
SOUTH YARMOUTH,MA 02664
Phone:
Septic System Installer Designer
CHASE&MERCHANT BSC
P.O. BOX 5 DENNISPORT, MA 02639 349 ROUTE 28 UNIT D
Phone: WEST YARMOUTH,MA 02673
508-778-8919
Type of Building:Dwelling Lot Size:0.00 Acres
Dwelling-No.of Bedrooms:2 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Fistures:
Plan Date:09/25/2015 Number of Sheets: 1 Cafeteria•
Title:SEPTIC COMPONENT REPAIR LJNIT 9,781 RTE 28 Revision Date:
Design Flow(min.required):220 gpd Calculated design flow:220 gpd Design flow provided:224.96 gpd
Description of Soils:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:03/12/2014
KIERAN HEALY,P.L.S.
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL H-20 SEPTIC TANK,H-20 �
DBOX TO EXISTING LEACH FIELD 16'X 19'X 6"
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance wkh the provisions of
TITLE 5 and further aarees not to ulace in ooeration until a Certificate of Comoliance has been issued bv the Board of Health. �
Signed Date
Inspections
Commonwealth of Massachusetts �
Board of Health, Yarmouth, MA Fee •
DISPOSAL SYSTEM CONSTRUCTION PERMIT $55.00
Permission is hereby granted to;
CHASE&MERCHANT INC., P.O. BOX 5, DENNISPORT, MA 02639
To perform: Upgrade an individual sewage disposal system.
Owner: LIU JOE TR
J&K LIU REALTY TRUST
785 ROUTE 28 LJNIT 9
SOUTH YARMOUTH,MA 02664
Location: 785 ROUTE 28 i1NIT 9, SOUTH YARMOUTH,MA 02664
Disposal System Construction Permit No.: BOHDC-15-1413 ,Dated: July 23,2015
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 H-20 SEPTIC TANK, H-20 DBOX TO EXISTING
LEACH FIELD 16'X 19'X 6"
2. MAXIMUM TWO BEDROOMS PER TITLE 5 DESIGN
�V�
Bruce G. Murphy, M , 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 guara�ntee that the system will function as designed.
Commonwealth of Massachusetts
, Board of Health, Yarmouth, MA Fee
CERTIFICATE OF COMPLIANCE ass.00
Description of Work:Individual Component(s)
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:CHASE&MERCHANT INC.
at:785 ROUTE 28 UNIT 9, 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-15-1413,dated 10/09/2015.
Installer:CHASE&MERCHANT INC.
Address:P.O.BOX 5 DENNISPORT,MA 02639 Inspector:AMY VON HONE,R.S.
Designer:BSC
�� ����
Bruce G. M ,MPH, 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 guara tee that the system will function as designed.
BO H_Disposal_Construction_CofC.rpt