HomeMy WebLinkAboutApp-Permit-ComplianceNo. t/ut7c 4S'`3" /%�
C®MIMI® ITH ®1F MACCACIIUSFTTStftA
FEE 55,00
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Board of Health, l� , MA. �A�/ , ��'�
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>W APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTI®N PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) - ❑ Complete System Zdiidual Components
Location 3309 a r,,, e-
Owner's Name 01141
ks
Map/Parcel# 6.2 1
Address 339
Lot# ,3
Telephone# d
(, `) �• 11'73
Installer's Name i ��` Le. -A (Cn ske
Designer's Name s
Address o o X % SCA y4�A.
Address o3G
— A-14 Ven,r
Telephone# 777.636 -6'01
Telephone# Ute_ 30_S-
Type of Building ReS,�G>9tti 4,0 Lot Size IS
4601' U sq. ft.
Dwelling - No. of Bedrooms Garbage grinder ( )
Other - Type of Building No. of persons Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow (min. required) gpd Calculated design flows Design flow provided gpd
Plan: Date 1V0%A S, Number of sheets 1-1 Revision Date
Title
Description of Soil(s) d` See-
Soil
ee jGq
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation
DESCRIPTION OF REPAIRSJORALTERATIONS 5 I t+.✓ d' a iC L�' D�` o � t
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 ofo�mvliaance has been issued by the Board of Health.
Signed Date a—
No. e oN ��7JW FEE DO
COMMONWFALT14 Of MASSACIIa�SETTS2 /W"/-� �3s
Board of Health, YA0-M N U t i , MA.
CERTIFICATE OF COMPLIANCE x
Description of Work: vidual Component(s) El Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded(
Abandoned ( )
by: r , t- C ,
at -55S a
has been inst led in accorda ce witthe roN sions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. P� Z ^/� Approved Design Flow 76(gpdd)`
Installer fi ' I?" t — '� I - .�a�l'LO - - .
Designer: :!JeefInspector: Date:
The issuance of this permit shall not be construed as a guar ee that the system will function as designed.
No. pj0WVC.'I 410? LO �,( jc-e� CAtj
/�;- ---2.9"1 COMMON LTH Of MASSACHUSETTS
Board of Health, YAR A00-04 , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
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FEE
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Permission is hereby granted to; Construct( ) Repaip) Upgrade( ) Abandon( ) an individual sewage disposal system
at 3 j ''^� �r� as described in the application for
Disposal System Construction Permit No. % ��� , dated /Z _Z
l7�-C'S— 60 3
Provided: Construction shall be completed within thT_m-yyears of the date of this permit. All local conAittons must be met.
Form 1255 Re, 5196 A.M. Sulkin Co. Chadeslown, MA DateBoardo Health
No.:BOHDC-15-6036
Commonwealth of Massachusetts Fee
' $55.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Individual Component(s)
Location: 338 CAMP ST,WEST YARMOUTH, MA 02673 Owner:
BOWLES ALAN T TR
Map/Parcel#:062.45 BLUEWATERS REALTY TRUST
32 JO ANNA DRIVE
SOUTH YARMOUTH,MA 02664
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
7748366401
i
Type of Building:Dwelling Lot Size: 14,810.00 Sq.Ft. I
Dwelling-No.of Bedrooms:2 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Ot6er Fiatures:
Plan Date: 11/OS/2015 Number of Sheets: 1
Cafeteria: �,
_ Title:PROPOSED SEPTIC DESIGN 338 CAMP STREET Revision Date: i
' Design Flow(min.required):220 gpd Calculated design flow:220 gpd Design flow provided:351 gpd
� Description of Soi1s:SEE PLAN
- Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation: 11/04/2015
ROBIN WILCOX,PLS
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL=REPAIR-EXISTING 1000 GAL SEPTIC TANK,PROPOSED
DBOX,4 HIGH CAPACITY INFILTRATORS W/STONE:36'X 11'X 10"
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of
TITLE 5 and further aarees not to olace in ooeration until a Certificate of Comnliance has been issued bv the Board of Health.
Signed Date
Inspections �
Commonwealth of Massachusetts
� Board of Health, Yarmouth, MA F�
DISPOSAL SYSTEM CONSTRUCTION PERMIT $55.00
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: BOWLES ALAN T TR
BLUEWATERS REALTY TRUST
32 JO ANNA DRIVE
SOUTH YARMOUTH,MA 02664
Location:338 CAMP ST,WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.: BOHDGIS-6036,Dated:December 02,2015
Provided:Construction shall be completed within six months of the date of this permit. All local conditions must be met. '
CONDITIONS:
1.SEPTIC DISPOSAL=REPAIR-EXISTING 1000 GAL SEPTIC TANK, PROPOSED DBOX,4 HIGH CAPACITY
INFILTRATORS W/STONE:36'X 11'X 10"
2. BOH TO INSPECT SOIL REMOVAL '
1
3. MFC VARIANCE APPROVAL: a. GROUNDWATER ADJUSTMENT i
�
4.ZONE II MAXIMUM 2 BEDROOMS
���
Bruce G. Murp ,MPH, R.S., CHO/Amy L.von Hone, R.S.,CHO
�aith Director/Assistant Health Director !
�
The issuance of this permit shall not be construed as a guarantee that the system will function as designed. �
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t
Commonwealth of Massachusetts
Board of�Iealth, Yarmouth, MA Fee
CERTIFICATE OF COMPLIANCE $55.00
�
Description of Work:Individual Component(s)
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:RIKER LAND CONSTRUCTION '
at:338 CAMP ST,WEST YARMOUTH,MA 02673 '
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-15-6036,dated 12/09/2015.
Installer.RIKER LAND CONSTRUCTION
Address:P.O.BOX 726 SOUTH YARMOUTH,MA Inspector:AMY VON HONE,R.S. �
02664 �
Designer: SWEETSER ENGINEERING
Conditions
l.SEPTIC DISPOSAL=REPAIR-EXISTING 1000 GAL SEPTIC TANK,PROPOSED DBOX,4
HIGH CAPACITY INFILTRATORS W/STONE:36'X 11'X 10"
�
2.BOH TO INSPECT SOIL REMOVAL
3.MFC VARIANCE APPROVAL: a.GROUNDWATER ADNSTMENT
4.ZONE II MAXIMUM 2 BEDROOMS
�' /„,
��
Bruce G. NJurph ,MPH, 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. I
BOH_Disposal_Construction_CofC.rpt ;
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