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Home My WebLink AboutApp-Permit-ComplianceNo. /Iwo ff C lei'—1 (ff FEE COMMONWEALTH Of MASSACHUSETTS /.v� Board of Health, AR=M D Ur ,MA. CATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct lepair( ) Upgrade( ) Abandon( )-ArComplete System ❑ Individual Components LocationJCV�� Owner's Name �� +�ie a, Al t Map/Parcel# Address fo udk (J"S4 Lot# Telephone# ,S-08 -J86 L -16 Installer's Name�,.✓�� ✓. Designer's Name Addresso oti��, Address 634 S Telephone# SOY,-7)6-6yLQ Telephone# Type of Building ) Lot Size d Sf I b I o J sq. ft. Dwelling - No. of Bedrooms Garbage grinder ( ) Other - Type of Building No. of persons Showers ( ), Cafeteria ( ) Other Fixtures Design Flow (min. re uire gpd Calculated design flow 3 a Design flow provided �S% Cti gpd Plan: Date d Number of sheets t Revision Date Title Description of Soil (s) `� Lt G� ��C1 C t— ��'(j �S�' psi ad Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS /%)'-W �C�► C' ✓�C ��Fh I'd 511 JTD D 4d, , 5.7- 2 -boy e-,1 Ll- H C-Cla --r:n1a)^.ins 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 C mplia ice has been issued by the Board of Health. Signed �, ��'7 ---Z�s Date D 1 Inspections .�q� COMMONWEALTH ®� MASSACHUSETTS 1 Board of Health, YARM6 OW , MA. CERTIFICATE Of COMPLIANCE FEE Description of Work: ❑ Individual Component(s) JXTomplete System The undersigned hereby certify that the Sewage Disposal System; Constructed�tepaired ( ), Upgraded ( ), Abandoned ( ) by: &AG, L 1 -Nd C'OvtSF✓LX 4, ,% '"" at has been installed,,i acc r a e with theprovisions f 310 CMR 15.00 (Title 5) and the a proved design plans/as-built plans relating to application No.& f d % dated ' — Approved Design Flow (gpd) Installer A • e Designer: Inspector: Date: J The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No.�" /�iY /�C7!L�/ ! FEE !i �7 Vy COMMONWFALT14 OF MASSACHUSETTS Board of Health, memo opt , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construak< Repair( ) Upgrade ( ) Abandon ( ) an individual sewage disposal system at J 4 I': i 4ssv L.%.q c yA/ V4 D!kN - as described in the application for Disposal System Construction Permit Nof �� 1 �� ga ed Provided: Construction shall be completed within . rs of the date of this t. All local coondi 'ons must be met. Form 1255 Rev. 5/96 9. Sulkin Co. Chadest , Ma ate' �1'2 Board of Health No.:BOHDGI4-0199 . 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: 10 EMBASSY LN,YARMOUTH, MA 02675 Owner Map/Parcel#: 151.48 Name: MIKE MCCARTHY Address: Phone: Septic System Installer Name: RIKER LAND CONSTRUCTION Address: P.O. BOX 726 SOUTH,YARMOUTH 02664 Phone: 5087766460 Type of Building:Dwelling Lot Size:0.35 sq.ft. Dwelling-No.of Bedrooms:3 Garbage Grinder: Other Type of Building: No.of persons: Showers: Cafeteria: Other Fiztures: Plau Date:07/23/2014 Number atSheets: 1 TitIe:PROPOSED SEPTTC DESIGN FOR[.OT 25,10 EMBASSY LANE Revision Date: Desigu Flow(min.required):330 gpd Calculated design flow:330 Design flow provided:351 gpd BPa Descriplioo of Soi1s:SEE PLANS Soil Evalustor Form No.: Name of Soil Evaluator: Date of Evalnatioo:07/23/2014 ROBIN WILCOX,PLS DESCRIPTION OF REPAIRS OR ALTERATIONS: 1500 GAL SEPTIC TANK DBOX � 4 HIGH CAPACITY INFILTRATORS W/STONE: 36'X11'X11" The undersigned agrees to insfall the above tleseribed Indivitlual Sewage Disposal System in aeeortlanee with the provisions of TITLE 5 and fuRher aarees not to plaee in operation uMil a Cert'rfieate of Comolianee has been issuetl bvlhe Boartl of Nealth. Signed Date Inspections Commonwealth of Massachusetts � Board of Health, Yarmouth, MA. F� DISPOSAL SYSTEM CONSTRUCTION PERMIT s++o.00 Permission is herby granted to;ADAM RIKER Address:P.O.BOX 726 SOUTH,YARMOUTH 02664 To perform:New Construction an individual sewage disposal system. Owner. MIKE MCCAR7'HY Location: 10 EMBASSY LN,YARMOUTH,MA 02675 Disposal System Construction Permit No.: BOHDG140199,Dated: August 29,2014 Provided: Construction shall be completed within six months of[he date of[his permit. All bcal conditions must be me[. Conditions 1 S00 gal Septic Tank, DBox, 4 Hrgh Capacity Infiltrators w/Stone: 36'x 11'x I l" Board ofHealth Agent to Inspect Soil Removal ��>� � Bruce G. Murphy, PH, R.S., CHO/Amy L.von Hone, R.S., CHO � `� Health Diredor/Assistant Health Diredor The issuance of this permit shall not be construed as a guarantee t6at the system will function as designed.