HomeMy WebLinkAboutApp-Permit-ComplianceNo. r� "-16-� 6,000 <V FEE 00
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COMMONWEALTH Of 1r ASSAC14USETTS d1--8 q
Board of Health, Y&/Ll' Q �Tb� , MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct Repair( ) Upgrade( ) Abandon( ) - Complete System O Individual Components
Location
Owner's Name
Map/Parcel#
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Address 152e �-af
Lot#
Telephone# ;-0,��iJ�'f?
Installer's Name
Designer's Name
Address
Addres
Telephone# ,1 ,._ ;2—/`
Telephone#
Type of Building
Dwelling - No. of Bedrooms
Other - Type of Building
No. of persons
Lot Size/to/ d ( sq. ft.
Garbage grinder ( )
Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow (min. required) O3 J gpd Calculated design flow �53"59 Design flow provided tel % gpd
Plan: Date Number of sheets Revision Date
Title
Description of Soil(s) d
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation
c
DESCRIPTION OF REPAIRS OR ALTERATIONS
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of T= 5 and
further agmes to not to place the system in opera5tiqu until a Certificate of Compliance has been issued by the Board of Health.
Signed Date
Inspections
3��7FEE 4 co
No. PDQ"' f �3-7, r
,/ COMMON�I.T14 Of MASSACHUSETTS � � z - �- /b e�j�``�"
Board of Health, &d;?—MQ 1�i ' , MA.
CERTIFICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed.( ,`Repaired ( ), Upgraded ( ), Abandoned ( )
by:
at �
has been installeti"in"ac9dan with fh p visions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. ` , dated %� �/.� % Approved Design Flow (gpd) '
Installer "Il � .
.11
Designer: —7)-; ®!`-�J si-!��12 %" Inspector: Date: / — 2.f'"
The issuance of this permit shall not be "trued as a guar a that the system will function as designed.
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No. �, "' l �' 0137 Gam" i l acl �'•. `� (gl L^'i'�'BT�iI �' d '' FEE r /0
� 6 'l.®1°' MON 9'�' EALT14 Of ASSAC1L7t�1JSETTS q'I I q
Board of Health, � A�,�IbI o uro- , MA.
DISPOSAL SYSTEM ST CONSTRUCTION PERMIT
Permission is herebygranted to; Construct j/�Repair( ) Upgrade (p ) Abandon( ) an individual sewage disposal system
at / %1i�"y� P�'y'i i �. %/�. * C✓� g-ofas described in the application for
Disposal System Constructiop Permit No. /moi '� , dated 7-
Provided: Construction shall be completed within t,hs�s of the date of this per ix ¢ill local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chad'eslown. MA Date `%� r pard of Health (�C�
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i
1
� No.:BOHDC-15-0137
Commonwealth of Massachusetts Fee
$55.00
Board of Health, Yarmouth, MA
i APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Complete System
Location: 11 THORNTON BROOK RD,WEST YARMOUTH, MA Owner:
02673 RONGA TANYA L
Map/Parcel#: 046.4 8 BRALJN RD
WEST YARMOUTH,MA 02673
� Phone:
�
Septic System Installer Designer
CHASE&MERCHANT SWEETSER ENGINEERING
P.O. BOX 5 DENNISPORT, MA 02639 P.O.BOX 713
Phone: SOUTH DENNIS,MA 02660
508-385-6900
Type of Building:Dwelling Lot Size: 16,988.00 Acres
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building: No.of persons: Showers: ,
Other Fixtures:
Plan Date:OS/27/2015 Number of Sheets• 1 Cafeteria•
Tit1e:PROPOSED SEPTIC DESIGN 11 THORNTON BROOK ROAD Revision Date:
Design Flow(min.required):330 gpd Calculated design flow:330 gpd Design tlow provided:351 gpd
Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaivation:OS/27/2015
ROBIN WILCOX,PLS
' DESCRIPTION OF REPAIRS OR ALTERATIONS:NEW-PROPOSED 1500 GAL SEPTIC TANK,DBOX,4 HIGH CAPACITY
INFILTRATORS W/STONE:36'X 11'X 10"
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
,
• Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT 555.00
i
�
a Permission is herby granted to;
�
CHASE&MERCHANT INC., P.O. BOX 5, DENNISPORT, MA 02639
{ To perform:Upgrade an individual sewage disposal system.
� Owner: RONGA TANYA L
�
{ 8 BRAUN RD
� WEST YARMOUTH,MA 02673
Location: 11 THORNTON BROOK RD, WEST YARMOUTH,MA 02673
� Disposal System Construction Permit No.:BOHDGIS-0137,Dated:July 10,2015
� Provided:Construction shall be completed within six months of the date of this permit. All local conditions must be met.
� Conditions
�� 1. NEW-PROPOSED 1 S00 GAL SEPTIC TANK, DBOX, 4 HIGH CAPACITY INFILTRATORS W/
STONE: 36'X 11'X 10"
2. MAXIMUM 3 BEDROOM PER TI7ZE S DESIGN
, (. �C.� ' .
� Bruce G. Murph , R.S., CHO/Amy L.von Hone, R.S., CHO
H th Director/Assistant Health Director
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
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