Loading...
HomeMy WebLinkAboutApp-Permit-ComplianceNo. d %iC 7 � 8L-VTfL— ko —V© 1 Z 5-I FEE 653.0© COMMONWEALTH LTH ®F MASSACHUSETTS ch4ciioz., Board of Health, y6ia0uM4 , M. // /Gy- ,F bw,t APPLICATI®N FOR DISPOSAL SYSTEM[ CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade f,�`Abandon( ) - ❑ Complete Syste ndividual Components Location d 9U f Owner's Name U 117 k, At Lys Map/Parcel# a 3 p Address Lot# Telephone# S-0 Installer's Name Designer's Names' �C) ,�e��(J� Address 3 0 NPojh b %6 ! 1 Address ox' �6�,- _nil Telephone# b - - d Telephone# r . - 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) 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 C7zo 0l1 -✓t_ 13. l/4AS E� Ines Glc -TnC 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 operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date ZJ-/ 1 Inspections No. � "" a -� 3- FEE COMMONWEALTH LTH ®E MASSACHUSETTS ! I c) Z - Board of Health, Yk'ilt o LrN , MA. t CERTIFICATE ©i�mCOMPLIANCE Description of Work:-, a Tn'dividual Component(s) ❑ Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( )> Upgraded( 'Abandoned ( ) by;at has been installed /in accor ance ith te roes o s of 310 CMR 15.00 (Title 5) and the proved design plans/as-built plans relating to application No. l �i 1��� , dated Approved Design Flow (gpd) Installer (r �i i;�J C ! `�L, C Z %' '7 T 11 C -7a1 -ti MA=i2Lt AfJT Designer: r,. , ,'f'r r I'i lYJ ! i ) /y Inspector: #1/ �- (pG l . ,�a :�J '/ Date: 2 "� + The issuance of this permit shall not be construed as a guarantee that the system will function as designed. 6 b-^s��e�oa!ur2Fae-e No. L% i '� � +. C +-A G - f MQA�T FEE COMMONWEALTH LTH ®E MASSACHUSETTS 9102,.. Board of Health,� R=W.0UV MA. p� DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( ) Upgrade (%'S Abandon( ) an individual sewage disposal system { , �.'� at i Jl 1 J ? J T i? / ' /�/ /fi/ ` GI % '} -`,J % as described in the application for Disposal System Construction Permit No. r'% 5 , dated 1 Provided: Construction shall be comple e within �s9 Ste of this pe .nit All local condi ' s must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown, MA Date 9 - �—/Z Board of Health No.:BOHDC-15-4432 ' Commonwealth of Massachusetts Fee 555.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to:Upgrade-Individual Component(s) Location: 40 SQUIRREL RUN,YARMOUTH PORT, MA 02675 Owner: CAMPBELL DOUGLAS T Map/Parcel#: 123.88 CAMPBELL JEANNE M 40 SQUIRREL RUN YARMOUTH PORT,MA 02675-1836 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 508-362-8132 Type of Building:Dwelling Lot Size: 13,068.00 Acres Dwelling-No.of Bedrooms:3 Garbage Grinder: Other Type of Building: No.of persons: Showers: Ot6er Fixtures: Plan Date:07/30/2015 Number of 56eets: 1 Cafeteria• ' Tit1e:SEPTIC SYSTEM DESIGN 40 SQUIRREL RiJN Revision Date: � r Design Flow(min.required):330 gpd Calculated design flow:330 gpd Design flow provided:334 gpd Description of Soils:SEE PLAN Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:07/22/2015 STEPHEN HAAS,PE DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK,H-20 DBOX,2 -500 GAL PRECAST CHAMBERS W/2.5'STONE:32'X 9'X 2' • 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 Health. Signed Date Inspections 1 1 - • Commonwealth of Massachusetts j Board of�Iealth, Yarmouth, MA Fee i DISPOSAL SYSTEM CONSTRUCTION PERMIT $55.00 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: CAMPBELL DOUGLAS T CAMPBELL JEANNE M 40 SQUIRREL RUN ' YARMOUTH PORT,MA 02675-1836 , Location:40 SQUIRREL RiJN,YARMOUTH PORT,MA 02675 Disposal System Construction Permit No.:BOHDC-15-4432,Dated: September 04,2015 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, H-20 DBOX,2-500 GAL PRECAST ' CHAMBERS W/2.5'STONE:32'X 9'X 2' i ��S C..F%J Bruce G. Murphy, P , R.S., CHO/Amy L.von Hone, R.S.,CHO He Director I Assistant Health Director The 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 ass.00 Description of Work:Individual Component(s) The undersigned hereby certify that the Sewage Disposal System; Upgraded by:CHASE&MERCHANT INC. at:40 SQUIRREL RUN,YARMOUTH PORT,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-15-4432,dated 10/21/2015. Installer:CHASE&MERCHANT INC. Address:P.O.BOX 5 DENNISPORT,MA 02639 Inspector:STEPHEN HAAS,P.E. Designer: STEPHEN HAAS,PE Conditions 1.SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK,H-20 DBOX,2-500 GAL PRECAST CHAMBERS W/2.5' STONE:32'X 9'X 2' �j, , ��C�l Bruce G. Murph , PH, R.S.,CHO/Amy L.von Ho e, 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. ' i BOH_Disposal_Construction_CofC.rpt