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HomeMy WebLinkAboutApp-Permit-ComplianceNo. ew9c-I'1 —672-1 FEE 4W,0,0, COMMONWEALTH Of MASSACHUSETTS �03 Board of Health, A C -N10 Qn4 , MA. APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTI®N PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade(1-AbandonO - tTComplete System ❑ Individual Components Location 11a6l Owner's Name Map/Parcel# "57 / Address lG Lot# Telephone# Installer's Name 4- Designer's Name Address3 Q Address ®� 3 S, Telephone# �a l Telephone# Type of Building Dwelling - No. of Bedrooms Other - Type of Building _ No. of persons sq. ft. _ Garbage grinder ( ) Showers ( ), Cafeteria ( ) Other Fixtures Design Flow (min. required) '3 6 gpd Calculated design flow 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 further es to not to place the system in operati n until a Certificate of C m li ce has been issued by the Board of Health. Signed /OZ /� Date Iy Inspections No. c -1 �4. -0-711 COMMONWEALTH OF MASSACHUSETTS 64 71-12--t9 Board of Health, I AA•WIWil-1 , MA. CERTIFICATE Of COMPLIANCE Description of Work: ❑ Individual Component(s) 0 Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded (-); Abandoned j ( ) by: (� ,/ at P // has been insta led r c�o�dan wrt the pro -visions of 310 -CMR 15.00 (Title 5) aYtd thea proved design plans/as-built plans relating to application No. 7 0 dated Approved Design Flow (gpd) Installer Designer: Zll _, � �� ,rtGrs�e Inspector: a'� C. � f Date: The issuance of this permit shall not be construed as a guarant, a that the system will function as designed. No. w G- 4 _0-72-1 FEE S6 4 0 COMMONWEALTH OF MASSAC14USETTS &V 0 Board of Health. Yf:AM burl+ , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( ) Upgrade (ti)' Abandon( ) an individual sewage disposal system at as described in the application for Disposal System Con truction Permit No. 1-4--,64 , dated Provided: Construction shall be completed /within t111T� PeaefV of the ate of this perm' .All local condi 'ons must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown, MA', Date Board of Health No.: BOHDC-14-0721 Commonwealth of Massachusetts F� ' ass.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to:Upgrade-Complete System Location: 160 LONG POND DR, SOUTH YARMOUTH, MA 02664 Owner: SHAUGIINESSY,MARTIN Map/Parcel#: 059.8 SHAUGHNESSY,SANDRA L 160 LONG POND DR SOUTH YARMOUTH,MA 02664-4144 Phone: Septic System Installer Designer CHASE&MERCHANT PiINKHORN SERVICES P.O. BOX 5 DENNISPORT, MA 02639 P.O.BOX 483 Phone: SOUTH DENNIS,MA 02660 (5081564-8379 Type of Building:Dwelling Lot Size:018 Acres Dwelling-No.of Bedrooms:3 Garbage Grinder: � Other Type of Building: No.of persons: Showers: Other Fiatures: Plan Date: 10/30/2014 Number otSheets: 1 Cafeteria: Tit1e:PROPOSED SEP7'IC DESIGN 160 LONG POND DRIVE Revision Date:Ol/06/2015 Design Flow(min.required):330 gpd Calculated design flow:330 gpd Design Flow provided:351 gpd Description of Soi1s:SEE PLAN Soil Evaluator Form No.: Name ot Soil Evaluator: Date of Evaluation: 10/29/2014 ROBIN WILCOX,PLS � DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-1500 GAL SEPTIC TANK,DBOX,4 HIGH CAPACITY INFILTRATORS W/STONE:36 X 11'X 10" The undersigned agrees to install the above described Intlivitlual Sewage Dispoaal Syatem in accordance wkh the provlsions of � • 717LE 6 and further aarees no[te olace in oceratlon unUl a Certifleate of Comoliance has been issued bv the Boa�d ot Neakh. Signed Date Inspections Commonwealth of Massachusetts ` Board of Health, Yarmouth, MA F� DISPOSAL SYSTEM CONSTRUCTION PERMIT 555.00 Permission is herby granted to; CHASE&MERCHANT INC., P.O. BOX 5, DENNISPORT, MA 02639 To perform:Upgrade an individual sewage disposal system. Owner: SHAUGIINESSY,MART[N SHAUGHNESSY,SANDRA L 160 LONG POND DR SOUTH YARMOUTH,MA 02664-4144 Location: 160 LONG POND DR, SOUTH YARMOUTH,MA 02664 Disposal System Construction Peanit No.: BOHDC-140721 ,Dated:January 08,2015 Provided:Construction shall be completed within six months of the date of this permit. All local conditions must be me[. Conditions 1.REPAIR- 1 S00 GAL SEPTIC TANK, DBOX, 4 HIGH CAPACITY INFILTRATORS W/STONE. 36'X 11'X]0" U� Bruce G u hy, � PH, 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 t6at the system will function as designed. Commonwealth of Massachusetts Board of Health, Yarmouth, MA F� 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: 160 LONG POND DR,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.: BOHDC-140721,dated 02/12/2015. Installer:CHASE&MERCHANT INC. Address:P.O. BOX 5 DENNISPORT,MA 02639 Inspector:AMY VON HONE,R.S. Designer:PUNKHORN SERVICES Conditions 1.REPAIR- 1500 GAL SEPTIC TANK,DBOX,4 HIGH CAPACITY INFILTRATORS W/STONE: 36' X11' X10" s� ( vCQv Bruce G. M , MPH, R.S., CHO/Amy L. van Hone, R.S.,CHO Health Director/Assistant Health Diredor The issuance of this permit shall not be construed as a guarantee that the system will funMion as designed. BOH_Disposal_Construction_CofC.rpt