HomeMy WebLinkAboutApp-Permit-ComplianceNo. r/v V1"�C"" S,`I �i1i7/ s ♦ FEE
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COMMONWEALTH OF M ASSACIIUSETTS �71,0, �
Board of Health, yA1P=9Q JT)4 , MA.
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�r APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTIO P RMIT
A pl cation for a Permit to Construct Repair( Upgrade Abandon - ❑Complete System P,(ndividual Components
Location //Q
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Owner's Name r
Map/Parcel#
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Address
Lot#
Telephone# cJ
Installer's Name
Designer's Name
Address 3B
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Address
Telephone#
-L-111Telephone#
Type of Building
Dwelling - No. of Bedrooms
Other - Type of Building _
Other Fixtures
No. of persons
Lot Size '7 sq. ft.
Garbage grinder ( )
Showers ( ), Cafeteria ( )
Design Flow (min. required) 1.S -d gpd Calculated design flow - Design flow provided - ice= gpd
Plan: Date Number of sheets Revision Date
Title
Description of Soil(s)-iQ,Q�.dCZ,4&19
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation
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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 a es to not to place the system in operaliA until a Certificate of Compliapce has een issued by the Board of Health.
Signed Date
Inspections //- 2 f --1;L/c i,L
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EENo. qj COMMONWEALT14 OF 03
Board of Health, Ol)71� {( ;= f k' J Idle q 0
CERTIFICATE Of �OMPLIANCE ��j°�'
tion of Work: ndividual Com onent(s) ❑ Complete System „'
Description
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The undersigned hereby certify that the Sewage Disposal System; Constructed ( &)2epatred (fi) i Upgraded.( Abandoned ( )
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by: / l' 1/I sf4 d / ii f ! n ! 4
at At 4
has been installed'wlr - 70 ; n e`w?th the',Tfo'dsibFJ of 3V CMR 15.00 (Title 5) and the apVroved design plans/as-built plans relating to
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application No. //; i/ dated ".� C'✓ S. Approved Design Flow ';'12(gPd)
Installer l� �r s 0 i 7i� + + �' a ' ?i" r *�' 1-AA M ELWALT
ALT 1 f
Designer: / Inspe tor:`�"'� Date:
The issuance of Z permit shall not be construed as a guarantee that the system will function as designed. �—
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No. �. .7 �-.' � t, `fir.. c"se + M�f�-tf'YtA-t + FEE
,!� /e--b4t C®MMONWEALT14 OF MASSACHUSETTS
Board of Health, -.AAI) l _) V , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is herebygranted to; Construct( ) Repair( ) Upgrade(sr'"Abandon( ) an individual sewage disposal system
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at /// /%l/r ( �1,41e 2-1.,- ° 1� ` <' ' r1moas described in the application for
Disposal System Construction Permit No. 1 y / U , dated k =k' ` -Z/>
Provided: Construction shall be completedvithin- ars of the date of this permit. All local conditions must be met.
Form 1255 Rev./5/96 A.M. Sulkin Co. ChMesttoownn,, MA p Date g-,) '� /'<Boaarr'd of Health
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No.:BOHDC-15-4170
- Commonwealth of Massachusetts Fee
$55.00 �
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT �
Application for a Permit to:Upgrade-Complete System
Location: 110 SILVER LEAF LN,WEST YARMOUTH, MA 02673 Owner:
MONROE PATRICIA E
Map/Parcel#: 023.31 110 SILVERLEAF LN
WEST YARMOUTH,MA 02673
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 I
508-362-8I32
Type of Building:Dwelling Lot Size:37,897.00 Acres
Dwelling-No.of Bedrooms:5 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Fixtures:
Plan Date:06/23/2015 Number of Sheets: 1 Cafeteria•
Title:SEPTIC SYSTEM DESIGN 110&116 SILVER LEAF LANE Revision Date:07/O1/2015
Design Flow(min.required):550 gpd Calculated design flow:550 gpd Design flow provided:612 gpd ,
Description of Soi1s:SEE PLAN
Soii Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:OS/13/2015 '
ST'EPHEN HAAS,PE
� DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK,EXISTING
1000 GAL SEPTIC TANK,H-20 DBOX,28 HIGH CAPACITY INFILTRATORS W/OUT STONE:43.75'X 12.8'X 11"
The undersigned agrees to install the above described Individual Sewage Dlsposal 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 Health.
Signed Date
Inspections
i
i
Commonwealth of Massachusetts
- Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT S55.00
Permission is hereby granted to;
CHASE&MERCHANT INC., P.O. BOX 5, DENNISPORT, MA 02639
To perform: Upgrade an individual sewage disposal system.
Owner: MONROE PATRICIA E
110 SILVERLEAF LN
WEST YARMOUTH,MA 02673 ,
Location: 110 &116 SILVER LEAF LN, WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.: BOHDC-15-4170 ,Dated: August 25,2015
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, EXISTING 1000 GAL SEPTIC
TANK, H-20 DBOX, 28 HIGH CAPACITY INFILTRATORS W/OUT STONE:43.75'X 12.8'X 11"
2. BOH TO INSPECT SOIL REMOVAL
3. PLUMBING PERMIT REQUIRED
4. MFC VARIANCE APPROVAL: a. GROUNDWATER ADJUSTMENT
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Bruce G. rphy, MPH, R.S., CHO Amy L. von Hone, R.S., CHO
Health Director/Assistant Heatth Director
. The issuance of this permit shall not be construed as a guarantee that the system will function as designe ���!
.