HomeMy WebLinkAboutApp-Permit-ComplianceFEE / a
C® ® W& MIASSACHU TTS r� s
Board of Health, /3't? ►Vl d UT -4 , MA.(2-011--
APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTION PERMIT
Application for a Permit to Construct Repair( ) Upgrade( ) Abandon( ) - "J Complete System ❑ Individual Components
Location/
Map/Parcel# '.94)
Owner's Name
Address /yy J Ie-
Lot#
Telephone# b-
Installer's Name . �
, .Designer's Name
-
Address t-
Address
Telephone# AQ6,f
Telephone#
Type of Building
Dwelling - No. of Bedrooms
Other - Type of Building _
No. of persons
Lot Size A sq.. ft.
Garbage grinder( )
Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow (min. required) gpd Calculated design flow !e�' Design flow provided gpd
Plan: Date Number of sheets Revision Date
Title
Description of Soil (s) e . e—
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
further agr,pej to not to place the system in operati hl a Certificate of Compliance has been issued by the Board of Health.
Signed ,�-1���!� Date
COMMONWEALTH I,TH Of MASSACHUSES ��-
Board of Health, AAMQ V 7-h , MA.
CERTIFICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) 9b1-41ete System
The undersigned hereby certify that the Sewage Disposal System; Constructed aired ( ),Upgraded ( ),Abandoned
p ( )
by: ( r
at
has been installed/in cc rcfce wi provisions of 310 CMR.I5.O0, (Ti e 5) and thea proved design plans/as-built plans relating to
application No. /r-0�Z dated F-/ 7-/•�7Approved besign Flow -0'25K, gpd)
Installer �-r -
�e,,.,trudaaa
Designer:�-ceo
�,�t—lmpe�-.--,-itsb�amn,
pc�or: ( Date: /2- �9- y
The issu�uar ateat the system will function as designed.
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/5"— / 7 COMMONWEALTH Of MASSACHUSETTS t*4 lowa
ck* 1135 6V
Board of Health, 0Vr) ' , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct(o.YRepair( ) Upgrade( ) Abandon( ) an individual sewage disposal system
at I as described in the application for
Disposal System Construction Permit No. % % L- , dated F'
Provided: Construction shall be compl'e'ted within thT�of the date of this permit. local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown, MA Date P—/77 / S Board of Health
,
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No.:BOHDC-15-3330
Commonwealth of Massachusetts Fee
,
5170.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERNIIT
Application for a Permit to:New Construction-Complete System
Location: 160 SUMMER ST,YARMOUTH PORT, MA 02675 Owner:
EASTMAN PETER
Map/Parcel#: 104.9.2 EASTMAN CYNTHIA J
144 FISK ST
WEST DENNIS,MA 02670
Phone:
Septic System Installer Designer
CHASE&MERCHANT CAPE COD ENGINEERING,INC.
P.O. BOX 5 DENNISPORT, MA 02639 P.O.BOX 1517
Phone: EAST DENNIS,MA 02641
508-385-1445
Type of Building:Dwelling Lot Size: 176,418.00 Acres
Dwelling-No.of Bedrooms:4 Garbage Grinder:
Other Type of Building: No.of persons: S6owers:
Other Fia�tures:
Plan Date: 10/20/2014 Number of Sheets• 1 Cafeteria•
Tit1e:TOPOGRAPHIC SITE PLAN 160 SUMMER STREET Revision Date: 12/09/2014 .
Design Flow(min.required):440 gpd Calculated design flow:440 gpd Design flow provided:454.1 gpd
Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:09/24/2014
ROBERT PERRY,P.E. .
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-NEW-PROPOSED 1500 GAL SEPTIC TANK,DBOX,4-500
GAL H-20 PRECAST CHAMBERS W/4'STONE:42'X 13'X 2' ;
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance wRh the provisions of
TITLE 5 and further aorees not to olace in ooeration until a Certificate of Comoliance has 6een Issued hv the Board of Health.
Signed Date
Inspections ,
a
Commonwealth of Massachusetts •
' Board of Health, Yarmouth, MA Fee ;
I
� DISPOSAL SYSTEM CONSTRUCTION PERMIT $110.00
�
;
Permission is hereby granted to;
CHASE&MERCHANT INC., P.O. BOX 5, DENNISPORT, MA 02639
To perform:New Construction an individual sewage disposal system.
Owner: EASTMAN PETER
EASTMAN CYNTHIA J
144 FISK ST
� WEST DENNIS,MA 02670
Location: 160 SUMMER ST, YARMOUTH PORT,MA 02675
Disposal System Construction Permit No.: BOHDC-15-3330 ,Dated: August 17,2015
Provided: Construction shall be completed within six months of the date of this permit. All local conditions must be met.
CONDITIONS:
1. SEPTIC DISPOSAL-NEW- PROPOSED 1500 GAL SEPTIC TANK, DBOX, 4-500 GAL H-20
PRECAST CHAMBERS W/4'STONE: 42'X 13'X 2'
2. ZONE II MAXIMUM 4 BEDROOM PER SEPTIC DESIGN CAPACITY(LOT SIZE 176,363 S.F.
MAXIMUM 17 BEDROOM CAPICITY WITH APPROPRIATELY SIZED SEPTIC SYSTEM)
�
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Bruce G. MurptSy, PH, R.S., CHO/Amy L. von Hone, R.S., CHO
ealth Director/Assistant Health Director
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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 $110.00
�
� Description of Work:Complete System
� The undersigned hereby certify that the Sewage Disposal System; New Construction
by:CHASE&MERCHANT INC.
at: 160 SUMMER ST,YARMOUTH PORT,MA 02675
jHas 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-15-3330,dated 12/08/2015.
Installer:CHASE&MERCHANT INC.
Address:P.O.BOX 5 DENNISPORT,MA 02639 Inspector:AMY VON HONE,R.S.
Designer:CAPE COD ENGINEERING,INC.
Conditions
1.SEPTIC DISPOSAL-NEW-PROPOSED 1500 GAL SEPTIC TANK,DBOX,4-500 GAL H-20
PRECAST CHAMBERS W/4' STONE: 42'X 13'X 2'
2.ZONE II MAXIMUM 4 BEDROOM PER SEPTIC DESIGN CAPACITY(LOT SIZE 176,363 S.F.
MAXIMUM 17 BEDROOM CAPICITY WITH APPROPRIA Y SIZED S IC SYSTEM)
�
Bruce G. y, H, 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