The URL can be used to link to this page

Home My WebLink AboutApp-Permit-ComplianceNo.FEE b�✓ . Od COMMONWFALT14 Of ASSN USE'TTS Board of Health, 0 i MA(,/0�C%/'� APPLICATION F®I, DISPOSAL SYSTEM CONSTRUCTI®N PERMIT Application for a Permit to Construct( ) Repair( ) Upgrad4i7-A-bandon() - Complete System ❑ Individual Components LocationOwner's Name s Map/Parcel# fi 7 17 / Address Lot# Telephone# Installer's Name Designer's Name Address :w Address Telephone#Telephone# _ Type of Building Dwelling - No. of Bedrooms Other - Type of Building _ No. of persons Lot Size �� sq. ft. Garbage grinder ( ) Showers ( ), Cafeteria ( ) Other Fixtures //yy Design Flow (min. required) e) gpd Calculated design flow C� Design flow provided gPd 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 furtheres to not to place the system in operad until a Certificate of Compliant has been issued by the Board of Health. Signed Date Inspections No. �'" FEE COMMONWEALTH Of MASSACHUSETTS ®� � .� 3- ,�- 6 34`3 7 Board of Health, V'10l% 11,11M. CERTIFICATE Of COMPLIANCE S f Description of Work: ❑ Individual Component(s) id''Complete System.,4. The unde •sig ed hereby certify that the Sewage Dis osal System; Constructed ( ), Repaired ( ), Upgraded (0 -'-Abandoned ( ) by: at -c— has been installed in •a.ccor,rdanit wit e r sions/o�310 CMR 15.00 (Title and roved design plans/as-built plans relating to application No. !tr `ji" dated - '� Approved Design Flow and Installer r -V i /� r'49 Designer: Inspector: f i Date: The issuance of this permit shall not be construed as a guarantt i* tha the system will function as designed. - nc_occoa0000 0 o. -C 0 0000ipo_os.Qcc000000a_9o_oc oo 0000c00000000o0000 co coon ooc No. FEE . /. COMMONWEALTH Of MASSACHUSETTS cAAFS99 7 Board of Health, 00-m , AIA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( ) Upgrade �Abandon( ) an individual sewage disposal system at d' - '�t as described in the application for Disposal System ConstructfYn Permit No. �� , dated 60A,� Provided: Construction shall be completed within three -pears -of -the date of thispermit All local conditions must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown. MA Date / /r / Board of Health L ell, No.:BOHDC-15-2550 . Commonwealth of Massachusetts Fee ass.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to:Upgrade-Complete System Location: 98 STUDLEY RD, SOUTH YARMOUTH, MA 02664 Owner: FRITCHER ELAINE C ' Map/Parcel#: 079.145 8029 MARATHON DR PLANq TX 75024 Phone: � Septic System Installer Designer I 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: 10,019.00 Acres ' Dwetling-No.of Bedrooms:3 Garbage Grinder: Other Type of Building: No.of persons: S6owers: Other Fixtures: Plan Date:06/14/2015 Number of Sheets: 1 i Cafeteria: � Tit1e:SEPTIC SYSTEM DESIGN 98 STUDLEY ROAD Revision Date: � Design Flow(min.required):330 gpd Calculated design flow:330 gpd Design flow provided:350 gpd 1 I Description of Soi1s:SEE PLAN Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:OS/13/2015 i STEPHEN HAAS,PE i . DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-PROPOSED 1500 GAL SEPTIC TANK,H-20 DBOX,16 HIGH CAPACITY ` INFILTRATOR UNITS W/OUT STONE:25'X 12.8'X 11" 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 Comnliance has been issued bv the Board of Health. Signed Date Inspections f ', i I ( � . 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: FRITCHER ELAINE C 8029 MARATHON DR � PLANO,TX 75024 Location:98 STUDLEY RD, SOUTH YARMOUTH,MA 02664 ' Disposal System Construction Permit No.: BOHDC-15-2550,Dated:July Ol,2015 Provided:Construction shall be completed within six months of the date of this permit. All local conditions must be met. Conditions 1. REPAIR-PROPOSED 1 S00 GAL SEPTIC TANK, H-20 DBOX, 16 HIGH CAPACITYINFILTRATOR UNITS W/OUT STONE:25'X 12.8'X 11" 2. SMALL PORTION OF SO UTHWESTERLY REAR CORNER OF LOT IN ZONE II-NO RESTRICTIONS Bruce G. Mu hy, MPH, R.S., CHO/Amy L.von Hone, R.S., CHO ' ealth Director/Assistant Health Director The issuance of this permit shall not be construed as a guarantee that the system will function as designed. j � , : I � Commonwealth of Massachusetts Board of Health, Yarmouth, MA Fee CERTIFICATE OF COMPLIANCE 555.00 Description of Work:Complete System The undersigned hereby certify that the Sewage Disposal System; Upgraded by:CHASE&MERCHANT INC. at:98 STUDLEY RD, 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.: BOHDGIS-2550,dated 09/23/2015. Installer:CHASE&MERCHANT INC. Address:P.O.BOX 5 DENNISPORT,MA 02639 Inspector:AMY VON HONE,R.S. Designer: STEPHEN HAAS,PE Conditions 1.REPAIR-PROPOSED 1500 GAL SEPTIC TANK,H-20 DBOX,16 ffiGH CAPACITY INFILTRATOR UNITS W/OUT STONE:25'X 12.8'X 11" 2.SMALL PORTION OF SOUTHWESTERLY REAR CORNER OF LOT IN ZONE II-NO RESTRICTIONS � � �� Bruce G. Murphy, , 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 f