HomeMy WebLinkAboutApp-Permit-ComplianceS14OMMONWEALTH OF MASSACHUSETTS
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APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) UpgradeVfAbandon() - 0 Complete System Individual Components
Location 7 e_ t a
Owner's Name QE L�
Map/Parcel# 3 P 77 C j
Address 7r ,
Lot#
Telephone#
Installer's Nameoh"A
Designer's Name
Address 3e `
Address -5,v f Q-2„ Vf
Telephone# —
Telephone# .09 --
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) 0 gpd Calculated design flow Design flow provided gpd
Plan: Date Number of sheets Revision Date
Title
Description of Soils)
Soil Evaluator Form No. (/ Name of Soil Evaluator Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS 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 o ration until a Certificate of Compliance has been issued by the Board of Health.
Signed Date %
Inspections
COMMONWEALTH Of MASSACHUSETTS
t
Board of Health, YPt, MA.
CERTIFICATE OF COMPLIANCE
Description of Work: t.IndiVidual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewa e Disposal System; Constructed ( ), Repaired ( ), Upgraded ( ), Abandoned ( )
by: q-- _
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has been installed in accordance with the proVI'sio s of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. dated %"--�`f>Approved Design Flow (gpd)
Installer
Designer: JDate-
The
The issuance of this permit shall not b Inspector: _� Date: -
construed as a guaranthat the system will function as designed.
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S COMMONWEALTH Of MASSACHUSETTS e 9r�3s
Board of Health, YAgh 0 Q1 -A , MA.
DISPOSAL SYSTEM -CONSTRUCTION PERMIT -
Permission is hereby granted to; Construct( ) Repair( ) Upgrade / Abandon ( ) an individual sewage disposal system
at � G O i �,yZ ��p t',�al zit/ //� as described in the application for
Disposal System Construction Permit No. f�-% VJdated .7"
7Prov?5 /.i a,./� A97—
Provided:
ided: Construction shall be completed within three years of the date of this } All local co 't�ioo�nss must be met.
,��'sF,ogrm 1255 Rev. 5/96 A.r�s�n co. cnadestown, A mate � �'7 -/CBoard of Health
No.:BOHDC-15-1418
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 10, SOUTH YARMOUTH, MA 02664 Owner:
LIZZI JOSEPH A
Map/Parcel#• 033.77C10 1010 S OCEAN BLVD#11-OS
Lot#: C10 � POMPANO BEACH,FL 33062
Phone:
Septic System Installer Designer
CHASE&MERCHANT BSC GROUP,INC.
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 Figtures:
Plan Date:09/25/2014 Number of Sheets: 1 Cafeteria•
Tit1e:SEPTIC COMPONENT REPAIR IJNIT 10,781 RTE 28 Revision Date:
Design Flow(min.required):220 gpd Calculated design flow:220 gpd Design flow provided:221 gpd
Description of Soi1s: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-EXISTING 1000 GAL SEPTIC TANK,PROPOSED
DBOX AND LEACH FIELD: 15'X 20'X 6"
The undersigned agrees to install the above described Individual Sewage Disposal System 1n accordance with the provisions of '
TITLE 5 and furfher aarees not to olace in ooeration until a Certlficate 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 herby granted to;
CHASE&MERCHANT INC., P.O. BOX 5, DENNISPORT, MA 02639
To perform: Upgrade an individual sewage disposal system.
Owner: LIZZI JOSEPH A
1010 S OCEAN BLVD#11-OS
POMPANO BEACH,FL 33062
Location: 785 ROUTE 28 i1NIT 10, SOUTH YARMOUTH,MA 02664
Disposal System Construction Permit No.: BOHDC-15-1418 ,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- EXISTING 1000 GAL SEPTIC TANK, PROPOSED DBOX AND LEACH FIELD:
15'X20'X6"
2. BOH TO INSPECT SOIL REMOVAL
�.�'� ;
Bruce G. Mur y, PH, R.S., CHO/Amy L. von Hone, R.S., CHO
ealth Director/Assistant Health Director
he 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 555.00
Description of Work:Individual Component(s)
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:CHASE&MERCHANT INC.
at:785 ROUTE 28 LTNIT 10,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-15-1418,dated 10/09/2015.
Installer:CHASE&MERCHANT INC.
Address:P.O.BOX 5 DENNISPORT,MA 02639 Inspector:AMY VON HONE,R.S.
Designer:BSC GROUP,INC.
I / �
(.J��
Bruce G. Murphy, P , R.S., CHO/Amy L.von Hone, R.S.,CHO
r Health Director/Assistant Health Director
The issuance of this permit shall not be construed as a guarantee tfiat the system will function as designed.
BO H_Disposal_Construction_CofC.rpt