HomeMy WebLinkAboutApp-Permit-ComplianceAke xpl r" l lew-,4 wl� FEE
COMMONWEALTH Of MASSACHUSETTS A, -
Board
Board of Health, YmmtiOuT u
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTI®N PERMIT
'ermit to Construct( ) Repair( ) Upgrad�Abandon() - ❑ Complete System .TdTndividual Components
Location 40 N A Mei4aro", r y
Owner's Name GG
Map/Parcel# '
Address
Lot# 7
Telephone#
Installer's Name �� �. C.
Designer's Name es -C 6 iov
Address v Ok /, S CII j,1 ft4
Address .9419 04-V% lee+ ?$
Telephone# _
Telephone# SN, g • n/
Type of Building A
Dwelling - No. of Bedrooms
Other - Type of Building _
Lot Size I Si off 1) sq. ft.
Garbage grinder ( )
No. of persons Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow (min. required) gpd Calculated design flow =: Design flow provided gpd
Plan: Date Number of sheets Revision Date
Title
Description ofSoil(s) _
Soil Evaluator Form No.
Name of Soil Evaluator
Date of Evaluation
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 d
Inspections _
No. � 60 t+DC - l s- -4T �l S L. - r FEE iLO
COMMONWEALT14 Of I SSAC14USETTS/I S Z
Board of Health,pNR=60 TTT-i , MA.
CERTIFICATE Of COMPLIANCE
Description of Work: Individual Component(s) ❑Complete System !!!
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired>e , Upgraded ( ), Abandoned ( )
by: TC * K,�-- C-4 S �'" L- z=
at /045 Tn,-l.% .. ✓1 em.,&J 0,"%,r
has been install
application No.
Installer A_
iCcord?i cewitK tfiejro-6sions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
.2./ dated 9 V .��� � �Approved Design Flow (gpd)
Designer: LS SC C'�rc�.D Inspector:
The issuance of this permit shall not be construed as a guars
Date:
the system will function as designed.
No. g O N QC l -� `t7 �-t F--�%, ,� FEE
COMMONWEALT14 Of MASSACHUSETTS Clk-# 315-3
Board of Health, YAP HQ UXI+ , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) RepaiP�^) Upgrade( ) Abandon( ) an individual sewage disposal system
at
as described in the application for
Disposal System Construction Permit No. �� -��y , dated"..�
Provided: Construction shall be completed within three ars If the date of this pefmit All local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown, MA Date Board of Health
/ y
No.:BOHDC-15-4475
Commonwealth of Massachusetts Fee '
555.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERNIIT
Applicatioo for a Permit to:Upgrade-Individual Component(s)
Location: 1001NDIAN MEMORIAL DR, SOUTH YARMOUTH, MA Owner:
O2� BROOKS ARTII[JR TRS
Map/ParC¢I#: 069.199 BROOKS MARY E TRS
80 COUN7RY CLUB DR BAYBERRY 5
SOUTH YARMOUTH,MA 02664
Phone:
SepHc System Installer Designer
RIKER LAND SWEETSER ENGINEERING
P.O. BOX 726 SOUTH YARMOUTH, MA P.O.BOX 713
�2� SOUTH DENNIS,MA 02660
Phone: 508-385-6900
Type of Buildiog:Dwelling Lot Size: 15,246.00 Acres
Dwelling-No.otBedrooms:2 Garbage Grinder:
Other Type ot Buildiog: No.of persoos: Showers:
Other Fiatures:
Plao Date: 11/13/2003 Number of Shcets: I Gfeteria:
Tit1e:PROPOSED SEPITC DESIGN 100INDtAN MEMORIAL DRIVE Revision Date:
Design Flow(mio.required):220 gpd Calculated design Flow:220 gpd Desigu ilow provided:351 gpd
DescripNoo of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluaror: Date of Evaluation: 1 V12/2003
ROBIN WILCOX,PLS
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTiC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK TO
EXISTING DBOX AND LEACH FACILITY(4 HIGH CAPACITY INF[LTRATORS W/STONE:36'X 1 P X 10")TO ACCOMODATE NEW
HOUSE AND DECK
The unde�signed agrees to insfali the above described Individual Sewage Disposal System in accordance wkhlhe provisions of
TITLE S and further aarees not W olace In ooentlon until a Cerfifitate of Comoilance has heen isaued bv the Boartl of Heakh.
Signed Date
Inspections
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA FBe
DISPOSAL SYSTEM CONSTRUCTION PERMIT ass.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. BROOKS ARTIiIJR TRS
BROOKS MARY E TRS
80 COUNTRY CLUB DR BAYBERRY 5
SOUTH YARMOUTH,MA 02664
Location: 100 INDIAN MEMORIAL DR,SOUTH YARMOUTH,MA 02664
Disposal System Co�struction Permit No.: BOHDG1S4475,Dated: September 25,2015
Provided:Construction shall be completed within six months of the da[e of[his permi[. All local conditions must be met.
CONDITIONS:
1.SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK TO EXISTING DBOX AND LEACH
FACILITY(4 HIGH CAPACITY INFILTRATORS W/STONE: 36'X 11'X 10")TO ACCOMODATE NEW HOUSE
AND DECK
Bruce G. M ,MPH, R.S., CHO/Amy L.von Hone, R.S., CHO
Health Director/Assistant Health Director
The issuance of this permit s6a11 not be construed as a guarantee that the system wiil functian as designed.
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA F�
CERTIFICATE OF COMPLIANCE E55.00
Description of Work:Individual Component(s)
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:ffiKER LAND CONSTRUCTION
at: ]00 INDIAN MEMORIAL DR,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-1S4475,dated 09/24/2015.
Installer:RIKER LAND CONSTRUCTION
Address:P.O.BOX 726 SOUTH YARMOUTH,MA Inspector:AMY VON HONE,R.S.
02664
Designer: SWEETSER ENGINEERING
�/'��,
���� l�f�
Bruce G. Murphy,MP , R.S., CHO/Amy L. n Hone, R.S., CHO
/ Health Director/Assistant Health Diredor
The issuance of this permit shall not be construed as a guaraotee that the system will functiou as designed.
BO H_Disposal_ConsVudion_CofC.rpt