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No. 4- C.-6-00.72.
14- COMMONWEALTH OF MASSAC14USETTS
t Board of Health, )4W= t C Q714 111"M.
FEE 4110000
00
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APPLICATION FOR DISPOSAL SYSTEM C®NS RUCTI®N PERMIT
Ap lica�
tion for a Permit to Construc�Repair( ) Upgrade( ) Abandon() - Complete System ❑ Individual Components
ocation %
M Chi) 9dr
Owner's Name 13 a gra /
Map/Parcel#
Address /1 KtAQC 06\1
Lot#
Telephone# '7-
SZ _S -7-7-
Instal
Installer'sName c/
",, /L)e Aad
Designer's Name t e-1er2S1401cell►�)
Address Po i7ex ZJ
6 . S .G IMV1 k
I Address fol Y7 r 3 A, ? em -'5 4
Telephone# 015 - 77 & .
6/ Yk t)
1 Telephone# Spo- 99.5-- L-0
Type of Building�S�'d�6+�+��1 Lot Size �, .���r I sq. ft.
Dwelling - No. of Bedrooms �j1/� C Garbage grinder ( )
Other - Type of Building
Other Fixtures
No. of persons Showers( ), Cafeteria ( )
Design Flow (min. required) gpd Calculated design flow31i Design flow provided gpd
Plan: Date —S cl A Number of sheets Revision Date A
Title
Description of Soil(s) _
Soil Evaluator Form No.
Name of Soil Evaluator
Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS r �S��i s S° / - �%�� /t'I/i//7rn �Ci / ,.e --P
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 Compliance has been issued by the Board of Health.
Signed Date 0 7 G %
Inspections
No. tJt4 isp ( 72- ' '+ t P ,' �111-kE 4110,66
COMMONWEALTH Of MASSACHUSETTS
Board of Health, )��JM(I Lnaj , MA.
CERTIFICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) 1:4 Complete System
The undersigned
hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded ( ), Abandoned ( )
by: o� Il er Z 4111 6►^Vd < A6 --r
at 1
has been installe in a c witm, visions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. °ff_, dated Approved Design Flow :yam-—(gPd)
Installer
!' t.....-
Designer: C..ie��rl' C./rFi;�/r/1 N,0 Inspector: � Date:
The issuance of this permit shall not be construed as a grantee that the system will function $s designed.
`o VCU' J4> 900 y oC o,,. � 00 Co o o 00 a c"o 0 0UC2 Dcln0.rOt' oor, �e oo c Ob 6o OVcF,��o�ogC+`-�J:. (Y6o �: `n'G (;Uo�_ coo o�ci�Uo ootJ u.,-�uou�J �.0 o�c_�Jo:: c J.�. .. �7/o�o u(,,a�''O)�O[Voo oc
No. �r'V�_ � r --15.:'.007-Z- R1 K-Giz FEE f , 06
/ C:�- /.,�l COMMONWEALTH OF MASSACHUSETTS cD -:?o9,5-
Board of Health, i%t�f1 MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct) Repair( ) Upgrade ( ) Abandon ( ) an individual sewage disposal system
at /9 X i h ,tr l`p� . as described in the application for
Disposal System Construction Permit No. dated 7" 2. "/�
Provided: Construction shall be completed within tlza va o/f t/hee�dateeof this permit. All local conditions must be met.
$ 7 4*0 —S
Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date
% �oard
`: Bof Health '
No.: BOHDC-15-0072
Commonwealth of Massachusetts Fee
s++o.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:New Construction-Complete System
Location: 17 KATHARYN MICHAEL RD,YARMOUTH, MA 02675 Owner:
BAYRIDGE REALTY LLC
Map/ParceHi: 124.95 16 KINGS WAY
HYANNIS,MA 02601
Phone:
Septic System Installer Designer
RIKER LAND SWEETSER ENGINEERING
P.O. BOX 726 SOUTH YARMOUTH, MA P.O.BOX 713
02664 SOUTH DENNIS,MA 02660
Phone: 508-385-6900
Type of Building:Dwelling Lot Siu: 12,197.00 Acres
Dwelliog-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Futures:
PlanDate:05/02/2015 NumberotSheets: l Cafeteria:
Tit1e:PROPOSED SEPTIC DESIGN l7 KATHRYN MICHAEL ROAD Revision Date:06/23/2015
Design Flow(mio.required):330 gpd Calculated design f1ow:330 gpd Design 11ow provided:351 gpd
Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator. Date of Evsluation:OS/Ol/2014
• 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 untlersigned agrees to install the above described Individual Sewage Disposal System in aeeortlanee with the provisions of
TITLE 5 and turther aarees not to olace in oaeration until a Certificafe of Comoliance has 6een issued bv the 8oard of Flealth.
Signed Date
Inspections
• Commonwealth of Massachusetts
Board of Health, Yarmouth, l�lli Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT s++o.00
Permission is herby granted to;
. RIKER LAND CONSTRUCTION, P.O. BOX 726, SOUTH YARMOUTH, MA 02664
To perform:New Construction an individual sewage disposal system.
Owner. BAYRIDGE REAL1'P LLC
16 KINGS WAY
HYANNIS,MA 02601
Location: 1�KATHARYN MICHAEL RD,YARMOUTH,MA 02675
Disposa7 System Construction Permit No.: BOHDC-15-0072,Dated:Juty 02,2015
Provided: Cons[ruction shall be completed within six months of the date of this pertni[. All bcal conditions must be met.
Conditions
1. NEW-PROPOSED I500 GAL SEPTIC TANK, DBOX, 4 HIGH CAPACITYINFILTRATORS W/
STONE: 36'X 1 PX 10"
2. MAXIMUM 3 BEDROOM PER TITLE 5 DESIGN
/
Bruce G. Mu hy, PH, R.S., CHO/Amy L.von Hane, R.S., CHO
ealth Director/Assistant Health Direc[or
T6e 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 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: 17 KATHARYN MICHAEL RD,YARMOUTH,MA 02675
i 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-15-0072,dated 07/02/2015.
Installer:RIKER LAND CONSTRUCTION
Address:P.O.BOX 726 SOUTH YARMOUTH MA Ins e r•AMY
cto . VON HONE R.S.
� P ,
02664
Designer: SWEETSER ENGINEERING
Conditions
1.NEW-PROPOSED 1500 GAL SEPTIC TANK,DBOX,4 HIGH CAPACITY INFILTRATORS W/
STONE:36'X 11'X 10"
2.MAXIMUM 3 BEDROOM PER TITLE 5 DESIGN
�
Bruce G. Mur ,M H, 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 that the system will function as designed.
BOH_Disposal_Construction_CofC.rpt