HomeMy WebLinkAboutApp-Permit-ComplianceNo. 60WDC-"1S-18-7✓ FEE `PI too' ®D
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® LTH Of MASSAC14 JSETTS 3Ld 1
Board of Health A0460VT74 MA. J ' , r00� /
APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTION PERMIT
Ipplication for a Permit to Construct Repair( ) Upgrade( ) Abandon() - Zltomplete System O Individual Components
Location
,,
Owner's Name ACS C'
Map/Parcel#Address
^ be�a•
Lot#
Telephone# � 776 .6yb
Installer's Name
e r O ACI ,,
Designer's Name ,'Re Jkt
Address
O o v V(0 r
Address IS7_3
Telephone#
7L _ (,J
'779-03(,-
Telephone# d
Type of Building f
Dwelling - No. of Bedrooms
Other - Type of Building _
Other Fixtures
No. of persons
Lot Size 7 sq. ft.
Garbage grinder ( )
Showers ( ), Cafeteria ( )
Design Flown'
•equired) ��V6 gpd Calculated design flow _ Design flow
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 �: �J+F�i'/ ) Sa 0 4 C, ), S, %. . Q - 60X fi.9d
JI
'V bed
If
gpd
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to not to place the system in operation until a Certificate of Yompliance has been issued by the Board of Health.
` Signed Date 70(J -7f
C, L ., v 6 1 :. c. C. L C.:, C, [, (. C. ,. .... L..., ..A_ il,,i,..0
COMMONWEALTH Of MASSACHUSETTS 1��0044 310 !!
Board of Health, YAiemovn4 MA.
CERTIFICATE Of COMPLIANCE
Description of Work:f LJ Individual Component(s)amplete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( )> Upgraded ( ), Abandoned (; )
by:.�_� .
at
has been inst the Gordan the
application No. J �/ �� dated
t•. --Installer
Designer:
:)f-310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
Approved Design Flow W6 (gpd)
Inspector:
Date:
The issuance of this permit shall not be/onstrued as a guararftee. that the system will function as designed.
iOVOG �C?.O'O �O"�7iCO C, CbC.D -GD O.i^;OOO a00 090Qo 0_O OS:O Up:9000.000 COOC).UDO.U(,OOU 0 0 iJOOCOUGOU 060 0000000000OG 0�y0y�000000000
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No.� C`i�S'�a,jif FEE
COMMONWEALTH Of MASSACHUSETTS A iL � 1 °l
Board ofHealth, (121190 ym , MA.
D60SAI. SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Co/nstruct(NSL,.Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system
at 1 64 -1 f gee L A _ as described in the application for
Disposal System Construction Permit No. �_/<.,, dated
t/TC-/S=/e7>-
Provided: Construction shall be completed within of the date of this permj.ti'�ll local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown, MA D,/ajte � l ! Board of alth
• No.: BOHDC-15-1873
Commonwealth of Massachusetts Fee
. 5165.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:New Construction-Complete System
Location: 213 CRANBERRY LN, SOUTH YARMOUTH, MA 02664 Owner:
HENNESSY FRANCIS L
Map/Parcel#: 026.39 MAFFEI MARIE
21 NIMBLE HILL DR
� YARMOUTH PORT,MA 02675
Phone:
Septic System Installer Designer
RIKER LAND JM O'REILLY&ASSOCIATES INC.
P.O. BOX 726 SOUTH YARMOUTH, MA P.O.BOX 1773
02664
Phone: BREWSTER,MA 02631
508-896-6601
Type of Building:Dwelling Lot Size: 17,860.00 Acres
Dwelling-No.of Bedrooms:4 Garbage Grinder:
Other Type of Building: No.otpersons: Showers:
Other Fixtures:
PlanDate:04/18/20t4 NumberofSheets: l Cafeteria:
Tit1e:STIE&SEWAGE D[SPOSAL SYSTEM DESIGN Revision Date:OS/07/2014
Design Flow(min.required):440 gpd Calculated design tiow:440 gpd Design Ilow provided:444 gpd
Description of SoiIs:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:03/19/2014
MATTHEW FARRELL,EIT
DESCR[PTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-NEW-PROPOSED 1500 GAL SEPTIC TANK,DOBX,40'X I S'
X P LEACH FIELD
� 7he undersigned agrees to insfall the above deseribed Intlivitlual Sewage Disposal System in accoManee with the provisions of
717LE 6 and further aarees not W olate in ooerafion until a Certificate of Comoliance has heen lssuetl bv the 8oartl of Heakh.
Signed Date
Inspections
Commonwealth of Massachusetts
• Board of Health, Yarmouth, MA F�
DISPOSAL SYSTEM CONSTRUCTION PERMIT a++a.00
Permission is he�by granted to;
RIKER LAND CONSTRUCTION, P.O. BOX 726, SOUTH YARMOUTH, MA 02664
To perform:New Construction an individual sewage disposal system.
Owner: HENNESSY FRANCIS L
MAFFEI MARIE
21 NIMBLE HILL DR
YARMOUTH PORT,MA 02675
Location:213 CRANBERRY LN,SOUTH YARMOUTH,MA 02664
Disposal System Construction Permit No.: BOHDGIS-1873,Dated:July 27,2015
Provided: Construc[ion shall be completed within six months of the date of[his permit. All local condi[ions must be met.
c� `�" �� /
Bruce G. Mu� , M H, R.S., CHO Amy L.vo Hone, R.S.,CHO
=� Health Direc[or/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 $110.00
Description of Work:Complete System
The undersigned hereby certify that the Sewage Disposal System; New Construction
by:RIKER LAND CONSTRUCTION
at:213 CRANBERRY LN, 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-15-1873,dated 08/04/2015.
Installer:RIKER LAND CONSTRUCTION
Address:P.O.BOX 726 SOUTH YARMOUTH,MA Inspector:AMY VON HONE,R.S.
02664
Designer:JM O'REILLY&ASSOCIATES INC.
�V�L
Bruce G. Murphy, H, .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