HomeMy WebLinkAboutApp-Permit-ComplianceNo. BOt� rJ'I Y� ►i/1�4z r i"� FEE
,��y?-�
COMMONWEALTH Of MASSAC14USETTS
-
Board of Health,MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade(' Abandon( ) - 1XComplete, System ❑ Individual Components
Location `
Owner's Name
Map/Parcel# ���
Address Pe,01?dk p&
Lot#
Telephone# ��� ._� (� ._ /.�'✓�
Installer's Name
Designer's Name
Address 30
Address /100
Telephone#
Telephone# --- f
Type of Building
Dwelling - No. of Bedrooms
Other - Type of Building _
Lot Size >e sq. ft.
Garbage grinder ( )
No. of persons Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow (min. required) 313 6� gpd Calculated design flow 3-3 6 Design flow provided gpd
Plan: Date Number of sheets Revision Date
Title
Description of Soil(s) �.,.o
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation
r'
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 -es to not to place the system in op9xation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date��
a
Inspections
No. t,j(`�t' FEE
COMMONWEALTH OF MASSACHUSETTS `qc +Zcf
Board of Health, YA[?=M00-n* , MA.
CERTIFICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded (v), Abandoned ( )
by: v 1 o
at r.
has been installed in accordance with the (lo -visions of 310 CMR 15�� (Title 5) and h_e approved design plans/as-built plans relating to
application No( /f1 G3��dated ��� -I Approved Design Flow �% (gpd)
Installer
Designer: Inspector: ems% (.. e.���/ (��� Date:
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
No. 64 -t I)< - -(� 3 <f (p . C (iy1SE �M e4C H-A1VT
COMMONWEALTH Of MASSACHUSETTS
Board of Health, y&f?-h0lrl + , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct(
at
FEE 0 U
Repair( ) Upgrade(,-') Abandon( ) an individual sewage disposal system
as described in the application for
Disposal System Construction Permit No., i0) */ A/ n. dated
I Ps rth6
Provided: Construction shall be completed w v�ithin tly�a s obthe date of this permit. All local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown, MA Date � J '� Board of Health
No.: BOHDC-14-0346 .
Commonwealth of Massachusetts FeB
$55.00
Board of Health, Yarmouth, MA. �
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Complete System
Location: 77 TROWBRIDGE PATH,WEST YARMOUTH, MA 02673 Owner
Map/Parcel#: 076.168 Name:
MAZZA, CATHERINE M
Address:
P 0 BOX 2006 KENT, CT 06757-0640
Phone:
Septic System InsWller
Name:
CHASE&MERCHANT INC.
Address:
P.O. BOX 5 DENNISPORT, MA 02639
Phone:
Type of Building:Dwelling Lot Size:025 sq.ft.
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building: No.of persons: Showers: Cafeteria:
Other Fiztures:
Plan Date:08/15/2014 Number of Sheets: 1
Tit1e:SITE PLAN SHOWING PROPOSED SEPTIC UPGRADE 77 Revision Date:
1ROWBRIDGE PATH
Design Flow(min.required):330 gpd Calculated design flow:330 Design Flow provided:350 gpd
gpd
Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name ot Soil Evaluator: Date of Evaluation:OS/14/2014
JILL CAFARELLI,R.S.
DESCRIPTION OF REPAIRS OR ALTERATIONS: 1500 GAL SEPTIC TANK
DBOX
24 HIGH CAPACITY QUICK 4INFILTRATOR UIVITS W/OUT STONE-2 ROWS OF 12[JNITS: '
50'X6'X11"
7he undersigned agrees to install the above described Individual Sewage Disposal System in accordance wkh the provisions
of TITLE b and further agrees not to place in operotion until a Certifieate of Compliance has been issued by the Boartl of Mealth.
Signed Date
Inspec[ions .
Commonwealth of Massachusetts •
Board of Health, Yarmouth, MA. Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT E55.00
Permission is herby granted to;JAY MERCHANT Address:P.O.BOX 5
DENNISPORT,MA 02639
To perform:Upgrade an individual sewage disposal system.
Owner. MAZZA,CATHERINE M
P O BOX 2006
KENT,CT 06757-0640
Location: 77 TROWBRIDGE PATH, WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.: BOHDC-14-0346,Dated: September 29,2014
Provided: Construction shall be comple[ed within six months of the date of this permit. All local condi[ions must be met
Conditions
1. Zone II Maximum 3 Bedrooms
2. I500 gal Septic Tank, DBox, 24 High Capaciry Quick 4 Infiltrators w/out Stone-2 Rows of 12 units:
SO'x6'x11"
�l�
Bruce . M rphy,MPH, R.S., CHO/Amy L. von 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 function as designed.
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:77 TROWBRIDGE PATH, WEST YARMOUTH,MA 02673
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-14-0346,dated 10/29/2014.
Instatler: CHASE&MERCHANT INC.
Address:P.O. BOX 5 DENNISPORT,MA 02639 Inspector:AMY VON HONE,R.S.
Designer: PAUL E. SWEETSER,PLS
Conditions
1.Zone II Maximum 3 Bedrooms
2. 1500 al Se tic Tank DBox 24 Hi h Ca aci uick 4 Infiltrators w/out Stone- Rows of 12 units: 50' x 6' x ll
U
Bruce G. ur y,MPH, R.S., CHO/Amy L. von Hone, R.S.,CHO
Health Director/Assistant Health Diredor
The issuance oFthis permit shall not be construed as a guarantee that the system will function as designed.
BOH_Disposal_Construdion_CofC.rpt