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HomeMy WebLinkAboutApp-Permit-Compliance9 COMMONWEALTH OF MASSACHUSETTS Board of Health, /fit e -JA JOV ,�-k FEE 66 • 00 Gam -77173 APPLICATI®N FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade$< Abandon( ) - Q Complete System jAIndividual Components Location q 6 , 2 ✓'rc, LA -Y" Owner's Name Mq rc �,krlSA-j Map/Parcel# (o -7 - 9�0 Address 9 6 S, c,-^ tVc% W, Y el m4 Lot# plea,, /.3(-t 2Z-1 /A S Telephone# eZ-6 73 Installer's NameDesigner's Name Address 3 0 R Address / 2 Telephone#'V � _ �?4/b Telephone# S� �- 4 °7 7 - -!TS ) 5 l72 Co f( Type of Building &S " n "t Lot Size 1A Q PO sq. ft. Dwelling - No. of Bedrooms 3 Garbage grinder ( ) Other - Type of Building eilA No. of persons Showers( ), Cafeteria ( ) Other Fixtures N/ A Design Flow (min. required) 3307 gpd 'Calculated design flow '33 Q Design flow provided 3 gpd Plan: Date 0I 31) t �_ Number of sheets /Revision Date / Title -er/3v1skd s4loil111- S y S�f✓''1 (105 n► o /;,/c, -A i �o i` e ((A G� r �cew, Description of Soil (s) �� f- 1�i L -t- `v� C� - 7 G L-5 Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation w I Z Zat s' S'L<-,z- DESCRIPTION OF REPAIRS OR ALTERATIONS �, - tlr The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agreVs to not to place the system in operation until Certificate of Compliance has been issued by the Board of Health. Signed Date % © `� ✓E' Inspections EEC®NJ[[MONWEAI,TOf.MASSACHUSETT Board of Health, % ! , AIA. CERTIFICATE O ®MPLIANCE Description of Work: Individual Component(s) ❑ Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( )> Upgraded Abandoned ( ) P by: at Si E !r Y' Ct��t1 pu'f'f. has been install, application No. Installer Designer: The issuance of Ptlfithe pro-7sions of 310 CMR 15.00 (Title 5) and design plans/as-built plans relating to Date: the system will function as designed. No. ^6 0 1� C 15- r7" -j (. J °� �7`i s %C � i� l /.� C FEE" z .. COMMONWEALTH Of MASSACHUSETTS Board of Health, "rgrAlOv J-- 1- , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( ) Upgrade() Abandon( ) an individual sewage disposal system at --/6 S, e'rq Way Vj VA rm o v as described in the application for Disposal System Construction Permit No. dated /l 1 - Provided: Construction shall be comped within tth�. .ar-- of the date of this permit: All local condi ' ns must be met. Form 1255 Rev. 5196 A.M. Sulkin Co. Charlestown, MA Date //-.) -/ Board of Health E _ k91 kl,�I%,P( A/ , %n SlJ / 1 07 4,4 1 .,0Gf � No.:BOHDGIS-4964 I - Commonwealth of Massachusetts Fee ' ' E55.00 : Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to:Upgrade-Individual Component(s) Location:46 SIERRA WAY,WEST YARMOUTH, MA 02673 Owner: BRUYERE MARC D Map/Parcel#: 067.80 BRLJYERE KRIST'EN R 46 SIERRA WAY WEST YARMOUTH,MA 02673 Phone: Septic System Installer Designer CHASE&MERCHANT ENGINEERING WORKS,INC. P.O. BOX 5 DENNISPORT, MA 02639 12 WEST CROSSFIELD ROAD Phone: FORESTDALE,MA 02644 � 5083982116 508-477-5313 � I i j Type of Building:Dwelling Lot Size: 10,890.00 Sq.Ft. � i Dwelling-No.of Bedrooms:3 Garbage Grinder: � 4 Other Type of Building: No.of persons: Showers: � Other Fiatures: Plan Date:08/31/2015 Number of Sheets:3 Cafeteria: Tit1e:PROPOSED SEPT'IC SYSTEM UPGRADE PLAN 46 SIERRA WAY Revision Date: . Design Flow(min.required):330 gpd Calculated design flow:330 gpd Design flow provided:331.5 gpd Description of Soi1s:SEE PLAN � Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:07/02/2015 PETER MCENTEE,PE DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK,PROPOSED 500 GAL WATERPROOFED H-20 PUMP CHAMBER,DBOX,32'X 14' PRESBY ENVIRO-SEPTIC LEACH FIELD 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 bv the Board of Heakh. Signed Date Inspections Commonwealth of Massachusetts � � Board of Health, Yarmouth, MA Fee ' � DISPOSAL SYSTEM CONSTRUCTION PERMIT 555.00 i � i i Permission is herby granted to; CHASE&MERCHANT INC., P.O. BOX 5, DENNISPORT,MA 02639 To perform:Upgrade an individual sewage disposal system. Owner: BRIJYERE MARC D BRUYERE KRISTEN R I ; 46 SIERRA WAY WEST YARMOUTH,MA 02673 Location:46 SIERRA WAY,WEST YARMOUTH,MA 02673 , Disposal System Construction Permit No.: BOHDGIS-4964,Dated:November 02,2015 f 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 500 GAL WATERPROOFED H-20 PUMP CHAMBER, DBOX,32'X 14' PRESBY ENVIRO-SEPTIC LEACH FIELD j 2. ENGINEER TO INSPECT SOIL REMOVA� i 3. ELECTRICAL PERMIT REQUIRED FOR PUMP SYSTEM ' � 4. MFC VARIANCE APPROVAL a. GROUNDWATER SEPARATION WITH PRESBY ENVIRO-SEPTIC SYSTEM � � � � I Bruce G. Murp , PH, R.S., CHO/Amy L.von Hone, R.S.,CHO � H alth Director/Assistant Health Director i The issuance of this permit shall not be construed as a guarantee that the system will function as designed. ! I i f � i i 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:46 SIERRA WAY,WEST YARMOUTH,MA 02673 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-15-4964,dated 11/13/2015. Installer:CHASE&MERCHANT INC. Address:P.O.BOX 5 DENNISPORT,MA 02639 Inspector:AMY VON HONE,R.S. Designer:ENGINEERING WORKS,INC. Conditions 1.SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK,PROPOSED 500 GAL WATERPROOFED H-20 PUMP CHAMBER,DBOX,32'X 14' PRESBY ENVIRO-SEPTIC LEACH FIELD 2.ENGINEER TO INSPECT SOIL REMOVAL 3.ELECTRICAL PERMIT REQUIRED FOR PUMP SYSTEM 4.MFC VARIANCE APPROVAL a.GROUNDWATER SEPARATION WITH PRESBY ENVIIiO-SEPTIC SYSTEM Bruce G. Murphy,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 guarantee that the system will function as designed. BO H_Disposal_Construction_CofC.rpt i