HomeMy WebLinkAboutApp-Permit-Compliance No.:BOHDGIS-4426
Commonwealth of Massachusetts F� •
555.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERNIIT
Application for a Permit to: Upgrade-Individual Component(s)
� LocaHon: 355 BUCK ISLAND RD,WEST YARMOUTH, MA 02673 . Owner:
SILVEIRA JOHN F
Map/Parcel#: 04674 355 BUCK ISLAND RD
WEST YARMOUTH,MA 02673
Phone:
Septic System Installer Designer
RIKER LAND BSC GROUP.INC.
P.O. BOX 726 SOUTH YARMOUTH, MA 349 ROUTE 28 LJNIT D
02664 WEST YARMOUTH,MA 02673
Phone: 508-778-8919
. Type of Buildiug:Dwelling Lot Siu:22,651.00 Acres
� Dwelliog-No.ofBedrooms:4 GarbageGrinder:
Other Type of Building: No.of persons: Showers:
Other Fiatures:
Plan Date:08/19/2015 Number of S6eets: 1
, Cafeteria:
� TitIe:SEPTTC SYSTEM REPAIR 355 BUCK ISLAND ROAD Revision Date:
. Design Flow(min.required):440 gpd Calculated design Flow:440 gpd Design flow provided:444 gpd �
Description of SoiIs:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:07/29/2015
BRIAN YERGATIAN,P.E.BSC GROUP �
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-EXISTING 1500 GAL SEPTIC TANK,A-20 DBOX,4
-500 GAL H-20 PRECAST CIIAMBERS W/3'STONE:40'X]0'X 2' ��
The undermigned agrees W Install the above describetl Intlivitlual Sewage Disposal System in aeeordanee with fhe provisions of � �
TITLE 6 and further aarees not to olace in ooeration until a Cerfifieafe of Comolianee has been issued bv the Board of Health.
Signed Date
Inspections
il '
;
Commonwealth of Massachusetts
� Board of Health, Yarmouth, MA F�
DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00
Permission is herby granted to;
RIKER LAND CONSTRUCTION, P.O. BOX 726,SOUTH YARMOUTH, MA 02664
To perform:Upgrade an individual sewage disposal system.
Owner: SILVEIRA JOHN F
' 355 BUCK ISLAND RD
WEST YARMOUTH,MA 02673
LocaHon: 355 BUCK ISLAND RD, WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.: BOHDGIS-4426,Dated: September 04,2015
Provided:Construction shall be completed within six months of the da[e of this permit. All local conditions must be met.
CONDITIONS:
1. SEPTIC DISPOSAL-REPAIR-EXISTING 1500 GAL SEPTIC TANK, H-20 DBOX,4-500 GAL H-20 PRECAST �
CHAMBERS W/3'STONE:40'X 10'X 2'
2. BOH TO INSPECT SOIL REMOVAL
3. MFC VARIANCE APPROVALS:a. SETBACKS b.WETLANDS
4.ZONE II MAXIMUM 4 BEDROOMS
� i
,��v CJy �1/1/OD
Bruce G. Mu hy, PH, R.S.,CHO/Amy L.vo� Hone, R.S.,CHO
ealth Diredor/Assistant Health Diredor
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.