HomeMy WebLinkAboutApp-Permit-ComplianceNo. !!L ✓'' q42-7 FEE
COMMONWEALTH LTH ®F MASSACHUSETTS�-
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APPLICATION.FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repah<Upgrade( ) Abandon( ) - 4Qeomplete, System ❑ Individual Components
Location - /fie
Owner's Name
Map/Parcel# Z/0 �j
Address f� ��eJ oesx s>tl� �pS 114
Lot# /Pe
Telephone# } gt S COO
Installer's Name )��� S�i� T�
Designer's Name BSC &W
Address C1 17OX 7Yev Adv+
Address -nm &J- d t vA,4 D V*AA
Telephone# 779-t A,- 4e;W,)
Telephone# - 770 -- gql
Type of Building rZ 1�' cam. A Lot Size s410 _ sq. ft.
Dwelling - No. of Bedrooms f Wc. Garbage grinder ( )
Other - Type of Building
No. of persons Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow (min. iequi ed) a !r% gpd Calculated design flow l �0 Design flow provided � gpd
Plan: Date r Number of sheets Revision Date ,..,
Title �+
Description of Soil(s) y}' J-ee b9's 3� " J Z? C' M r� 4),- 4 fy
Soil Evaluator Form No. Name of Soil, /Evaluator
NDate of Evaluation J t
DESCRIPTION OF REPAIRS OR ALTERATIONS J` i� "v 9�� S 4vc 14Nk crd 9sA),A1A%
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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 Comp iance has been issued by the Board of Health.
Signed Date
Inspections
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�f C®MMONWFAI,T14 Of MASSAC14USETTS 0�yZ-
Board of Health, .114 0 OTH , MA. 6 V l
CERTIFICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) odfComplete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded �-)-Aftndoned ( )
by:
at
has been install
application No.
Installer A -
ordan?e with tie rovsions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
dated Approved Design Flow (gpd)
Designer: 15,5c (�ovj� Inspector: Date:
7 _.
The issuance of this permit shall not be construed as a guar . ee that the system will function as designed.
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COMMONWEALTH OF MASSACHUSETTS !.3Z
Board of Health, ,Y MOtlT}�J- , Nrn.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repaid. Upgrade( ) Abandon( ) an individual sewage disposal system
at S' B .. ^^ 14- SiJ'Ce�- as described in the application for
Disposal System Construction Permit No. L' / 9.7 , dated
' /=✓Provided: Construction shall be completed within thrre the date of this permit.. -till to al conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown, MA Date "^ Board of Health A&:e
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i No.:BOHDGIS-4427
Commonwealth of Massachusetts Fee "
$55.00
Board of Health, Yarmouth, MA
j APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Complete System
Location: 38 SOUTH ST, SOUTH YARMOUTH, MA 02664 Owner:
� PUNCH WILLIAM A
! Map/Parcel#: 042.107 PLTNCH CAMILLE M
358 MARLBOROUGH STREET
BOSTON,MA 02115
Phone:
Septic System Instalier Designer
RIKER LAND BSC GROUP,INC.
P.O. BOX 726 SOUTH YARMOUTH, MA 349 ROUTE 28 UNIT D
02664 WEST YARMOUTH,MA 02673
Phone:
508-778-8919
Type of Building:Dwelling Lot Size: 10,890.00 Acres
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Fixtures:
Plan Date:07/08/2015 Number of Sheets: 1 Cafeteria•
Tit1e:SEPTTC SYSTEM REPAIR 38 SOUTH STREET Revision Date:
Design Flow(min.required):330 gpd Calculated design flow:330 gpd Design flow provided:355 gpd
Description of Soi1s:SEE PLAN
Soil Evatuator Form No.: Name of Soil Evaluator: Date of Evaluation:07/02/2015
KIERAN HEALY,P.L.S. '
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,30'X
16'X 6"LEACH FIELD '
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance wRh the provisions of
TITLE 5 and further aarees not to olace in ooeration until a Certificate of Comoliance has been issued bv the Board of Heakh.
Signed Date
Inspections
�
�
Commonwealth of Massachusetts .
Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT $55.00
Permission is herby granted to;
� RIKER LAND CONSTRUCTION, P.O. BOX 726, SOUTH YARMOUTH, MA 02664
i
,' To perform:Upgrade an individual sewage disposal system.
Owner: PiJNCH WILLIAM A
PUNCH CAMILLE M
358 MARLBOROUGH STREET
� BOSTON,MA 02115
Location:38 SOUTH ST,SOUTH YARMOUTH,MA 02664
; Disposal System Construction Permit No.: BOHDC-15-4427,Dated: September 04,2015
� 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-PROPOSED 1500 GAL SEPTIC TANK, DBOX,30'X 16'X 6"LEACH FIELD
2. BOH TO INSPECT SOIL REMOVAL
� �
� ���
Bruce G. Mu y, PH, R.S., CHO/Amy L.von Hone, R.S., CHO
ealth Director/Assistant Health Director
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
CERTIFICATE OF COMPLIANCE 555.00
Description of Work:Complete System
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:RIKER LAND CONSTRUCTION
at:38 SOUTH ST,SOUTH YARMOUTH,MA 02664
( Has been installed in accordance with the provisions of 310 CMR 15.00(Title 5)and the approved
i
] design plans or as-built plans relating to application No.: BOHDGIS-4427,dated 09/14/2015.
'; Installer:RIKER LAND CONSTRUCTION
� Address:P.O.BOX 726 SOUTH YARMOUTH,MA Inspector:AMY VON HONE,R.S.
� 02664
Designer:BSC GROUP,INC.
�V
Bruce G. Murp , MPH, R.S., CHO/Amy L.v n 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.
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BOH_Disposal_Construction_CofC.rpt
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