HomeMy WebLinkAboutApp-Permit-ComplianceNo. �U7J i"Q`i� /�'°`- 78 `�c7� FEE r0�
COMMONWEALTH OF' ASSACHUSETTS
Board of Health, 'I k M 0 VrH- , MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgradel(7 Abandon() - C�Complete System ❑ Individual Components
Location ;Ojt
Owner's Name
Map/Parcel# l9
Address 2
Lot#
Telephone# 629--
Installer's Name
Designer's Name
Address /
Address'PO 6 146 57
Telephone#
Telephone#S'— — 6rZ
Type of Building
Dwelling - No. of Bedrooms
Other - Type of Building
3
No. of persons
Lot Size / a *K sq. ft.
01
Garbage grinder ( )
—Showers( ), Cafeteria ( )
Other Fixtures
Design Flow (min. required) 3 3 d gpd Calculated design flow ?J ;%V Design flow provided gpd
Plan: Date Number of sheets Revision Date
Title
Description of Soil (s) �t7 .11 -
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 a ees to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signe �-.4-A —:244 e-4 Date t7
�_. / n -.
No. (�QDC-1q-0q2o FEE s3oe
COMMONWEAI.T14 Of MASSAC14USETT5
Board of Health, YAC-wi00131 , MA.
CERTIFICATE Of COMPLIANCE
Description of Work: NgIndividual Component(s) Complete System
The undersi ned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded (✓� Abandoned ( )
by: a
at 0-417 `fr3vt�. �v �ri►l- �_ �f1 a� % laJ�s �a�,4-tf ,
has been installed in accordancewith the provisions of 310 CMR 15.00 (Title 5) and th proved design plans/as-built plans relating to
application Ngl�I t - /y-'f�Aated / --�- . Approved Design Flow ( d) /®
Installer /I/t �.4aw
Designer: Inspector: i Date: S
The issuance oftg permit shall not be construed as a guarante that the system will function as designed.
No. _&04 DC _ 1 �" `t Z G%�1=� S t f / " 1 Ek (, 1 A k) -r FEE . 00
COMMONWEALTH O MASSACHUSETTS
Board of Health, YA F -mo lith' , MA.
DISPOSAI. SYSTEM CONSTRUCTION PERMIT
Permission is herebygranted to; Construct( ) Repair( ) Upgrade( -'f Abandon( ) an individual sewage disposal system
at
as described in the application for
v
Disposal System Con uction Permit NoL oF{ - � =dated
Provided: Construction shall be completed within �so4e�date of this per it.01
l local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown, MA Date/ V � / —///Board of Health v
�
No.:BOHDGl4-0420
� Commonwealth of Massachusetts Fee
$55.00
Board of Health, Yarmouth, MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Repair-minor-
Location: 249 LONG POND DR, SOUTH YARMOUTH, MA 02664 Owner
Map/Parcel#: 059.92 Name:
O'LEARY, RHODA T TR
Address:
C/0 PENELOPE BACH P O BOX 765
Phone:
Septic System Installer
Name:
CHASE&MERCHANT INC. .
Address:
P.O. BOX 5 DENNISPORT, MA 02639
Phone:
Type of Building:Dwelling Lot Size:0.43 sq.ft.
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type oYBuilding: No.of persons: Showers: Ca&teria:
Other Fixtures:
Plan Dah:OS/22/2014 Number of Sheets: t
Title:SEPTIC SYSTEM DESIGN 249 LONG POND DRIVE Revision Date:
Design Flow(min.required):330 gpd Calculated design Flow:330 Design flow provided:348 gpd
BPd
Descripfion of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluatioo:07/03/2014
STEPHEN HAAS,P.E.
DESCRIPTION OF REPAIRS OR ALTERATIONS: 1500 GAL SEPTIC TANK
DBOX
' 2-500 GAL PRECAST CHAMBERS W/4'STONE:
25'X 12.8'X 2'
The undersigned agrees to install the above described Indlvidual Sewage Disposal System in accordance with fhe provisions
of TITLE 5 and further as�rees not to place in oceration untll a Certificate of Complianee has been issuetl bv the Board of Health.
Signed Date
Inspections
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA. F�
DISPOSAL SYSTEM CONSTRUCTION PERMIT 555.00
Permission is herby granted to;JAY MERCHANT Address:P.O.BOX 5
DENNISPORT,MA 02639
To perform:Repair-minor an individual sewage disposal system.
Owner: O'LEARY,RHODA T 7R
C/O PENELOPE BACH
P O BOX 765
WEST DENNIS,M.4 02670
Location:249 LONG POND DR, SOUTH YARMOUTH,MA 02664
Disposal System Consuuction Permit No.: BOHDC-140420,Dated:October 03,2014
Provided: Cons[ruc[ion shall be completed within six months of the da[e of this permit. All local conditions must be met.
Conditions
1. Zone II Mcuimum 3 Bedrooms
2. I500 gal Septic Tank, DBox, 2-S00 gal Precast Chambers w/4'Stone:25'x 11.8'x 2'
�V �-c
Bruce G. Mu y, MPH, R.S., CHO/Amy L.von Hone, R.S.,CHO
ealth Director/Assistant Health Diredor
The issuance of this permit shall not be construed as a guarantee that the system will funMion as designed.
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
CERTIFICATE OF COMPLIANCE ses.00
Description of Work:
The undersigned hereby certify that the Sewage Disposal System; Repair-minor
by:CHASE 8c MERCHANT INC.
at:249 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.: BOHDG140420,dated 10/20/2014.
Iastaller: CHASE&MERCHANT INC.
Address:P.O.BOX 5 DENNISPORT,MA 02639 Inspector:AMY VON HONE,R.S.
Designer: STEPHEN HAAS,P.E.
Conditions
1.Zone II Maximum 3 Bedrooms
2.1500 gal Septic Tank,DBox,2-500 gal Precast Chambers w/4' St e 25' x 12.8' x 2'
Bruce G. Murphy , R.S., CHO/Amy L.von Hone, R.S., CHO
Heafth Director/Assistant Health Director
The issuance of t6is permit shall not be construed as a guarantee that the system will function as designed.
BO H_Disposal_Construdion_CofC.rpt