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Home My WebLink AboutApp-Permit-ComplianceNo. K-- 15 I�� e)Lz —, yz.r((D-002-31 / FEE ,00 his a�7 COMMONWEALTH OF MASSACHUSETTS Board of Health, 'I Af2' 101 i� , MA. APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTION PERMIIT Application for a Permit to Construct( ) Repair q.Upgrade( ) Abandon( ) - Vomplete System ❑ Individual Components Location 33 Owner's Name Map/Parcel#ay hi so Address pe y� - yCb�� A Lot# - Telephone# Installer's Name 91 Kc Z .1 j �� , �` Designer's Name /3 SC � Address go TOX %nb, J- h At Address 7- Telephone# Sob -77G -V -y,6 Telephone# 501f 7& Type of Building Lot Size sq. ft. Dwelling - No. of Bedrooms 7 'I, rev 16645' Garbage grinder( ) Other - Type of Building No. of persons Showers ( ) , Cafeteria ( ) Other Fixtures /� Design Flow (min. required))) �� `i gpd Calculated design flow 3) Design flow provided 316 gpd Plan: Date �% 50!?01J Number of sheets 1 Revision Date Title Description of Soil(s) Ql I&A S Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS c% /l�rl� E�ce��+�� his- IJ ,4(.2'y /Sha,—q 1 S. i . 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 omp 'ance has been issued by the Board of Health. '8 Signed oe� Date ® juts Inspections No. (J ��•i�J'° fia�a• %� `!' FEE S'„�,00 0/57- a37 COMMONWEALTH OF M ASSACHUSETT �,. � i,� � � 30 ! Board of Health, LIA-RMoQT�k , MA. CERTIFICATE Of COMPLIANCE Description of Work: ❑ Individual Components) "omplete System The undersi ned hereby certify that the + Sewage Disposal System; Constructed ( ), Repaired ( ), Upgrade, Abandoned ( ) by: ��✓ 4LL11►t► d tw si,wcat 3.� ��a�'sTc✓ Lam► - has been�rh�l�eivance with the prs of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No.f 5 - 7 dated fa ,� c}al S Approved Design Flow(gpd) Installer Designer: 4V Lz Inspector: (7 L L AW- L ate: '�P— o The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. 6�nt4�C"`15' E �Ip4M t-/ PV CGFQ'S TV- t FEE ' -�37COMM ON�ET14 Of MASSACHUSETTS - �3� �i Board of Health, �f i{if} V t ►� , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( ) Upgrad Abandon( ) an individual sewage disposal system at - -#- 33 j q,�+�'s�r,/ ` Z IgAc. as described in the application for Disposal System Construction Permit No. I /,Y- 437 , dated Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date f Board of Health v No.:BOHDC-15-4892 • Commonwealth of Massachusetts Fee sss.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERNIIT Application for a Permit to:Upgrade-Complete System Location: 33 BANISTER LN, SOUTH YARMOUTH, MA 02664 Owner: ' KUCZER NORMA MAE LIFE EST �� Map/Parcedt: 033.133 COSTA ANTONIO P 43 Ml WAY � UXBRIDGE,MA 01569 Phone: Septic System Installer Designer RIKER LAND BSC GROUP,INC. P.O. BOX 726 SOU7H YARMOUTH, MA 349 ROUTE 28 LJNIT D 02664 WEST YARMOUTH,MA 02673 Phone: 508-778-8919 Type of BuOding:Dwelling Lot Size:8,712.00 Acres Dwelling-No.of Bedrooms:3 Garbage Grinder: Other Type of Buildiog: � No.ot persons: Showers: Other Futures: Plan Date:09/28/2015 Number oi Sheets: 1 Cafeteria: TitIe:SEPTIC SYSTEM DESIGN 33 BANSTER LANE Revision Date: Desigo Flow(min.required):330 gpd Calculated design tlow:330 gpd Desigo flow provided:336 gpd Descripfion of Soi1s:SEE PLAN Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:09/24@O15 ' ffiERAN HEALY,P.L.S. DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC D[SPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,3- • 500 GAL PRECAST CHAMBERS W/STONE 225'ON ENDS,2.5'ON SIDES:30'X 9.83'X 2' The undersigned agrees W insfall the above describetl Individual Sewa9e Dispoaal System In aeeordance with the provisions of TITLE 5 and furtlier aarees not to olace in ooeration until a Gert'rfieste of Comolianee has been issued hv the Boartl of NeaRh. Signed Date [nspections Commonwealth of Massachusetts ' Board of Health, Yarmouth, MA F� DISPOSAL SYSTEM CONSTRUCTION PERMIT �•0° I ; IPermissian is herby granted to; � RIKER LAND CONSTRUCTION, P.O. BOX 726, SOUTH YARMOUTH, MA 02664 � To perform:Upgrade an individual sewage disposal system. Owner. KUCZER NORMA MAE LIFE EST � COSTA ANTONIO P I 43 MP WAY � UXBRIDGE,MA 01569 ' Location:33 BANISTER LN,SOUTH YARMOUTH,MA 02664 I Disposal System Construction Permit No.: BOHDGIS-4892 ,Dated:October 27,2015 Provided: Construc[ion shall be completed wi[hin six mon[hs of the date of this permit. All local conditions must be met. CONDITIONS: 1. SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK, DBOX,3-500 GAL PRECAST CHAMBERS W/STONE 2.25'ON ENDS,2.5'ON SIDES:30'X 9.83'X 2' i � 2. MFC VARIANCE APPROVAL a. SETBACKS � ' � �U� IBruce G. Murphy, M , R.S.,CHO/Amy L.von Hone, R.S.,CHO �� Heal iredor/Assistant Health Diredor The issuance of t6is permit shall not be construed as a guarantee that the system wi0 function as designed. Commonwealth of Massachusetts Board of Health, Yarmouth, MA FeB CERTIFICATE OF COMPLIANCE sss.00 Description of Work:Complete System The undersigned hereby ceRify that the Sewage Disposal System; Upgrsded by:RIKER LAND CONSTRUCTION at:33 BANISTER 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.: BOHDGIS-4892,dated 10/23/2015. Installer:RIKER LAND CONSTRUCTION Address:P.O.BOX 726 SOUTH YARMOUTH,MA Inspector:BSC GROUP ENGINEER CERTIFICATION � 02664 Designer:BSC GROUP,INC. CondiNons 1.SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,3-500 GAL i PRECAST CAAMBERS W/STONE 2.25'ON ENDS,2.5' ON SIDES:30' X 9.83' X 2' 2.MFC VARIANCE APPROVAL a.SETBACKS �j� l . Bruce G. Mu y, MPH, R.S.,CHO/ my L. on Hone, R.S.,CHO Health Director/Assistard Health Oirector The issuance of this permit shall not be coustrued as a guarantee that the system will funMion as designed. i BOH_Disposal_Construction_CofC.rpt