HomeMy WebLinkAboutApp-Permit-ComplianceNo. d G-� J-blJ�� 6(,b gLA(o— ()0 c�271Z FEE ` cCJc5,C)'Ci
COMMONWEALTH Of MASSACHUSETTS
Board of Health, AcgkID lTIA , MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon( ) - omplete System ❑ Individual Components
Location d,�
Owner's Name AL Vj,C4 5 jDi)V1
Map/Parcel# S G S
Address '13
�^1h 9Q r V4 lg
Lot# 6
Telephone#
� — YO %
Installer's Name �, j„ C
Designer's Name
QSC
Address PO XiDE, S.
Address ti7es
eT 9 v^
Telephone# L6N2L
Telephone#p
- %) J
Type of Building _ %e S
Dwelling - No. of Bedrooms
Other - Type of Building _
No. of persons
Lot Size 14/L sq. ft.
Garbage grinder( )
Showers ( ), Cafeteria ( )
Other Fixtures ��
Design Flow (min. r uire) 33 V gpd Calculated design flow ' Design flow provided SSS gpd
Plan: Date Jr% d 1 Number of sheets 0 Revision Date t A -1- IS
Title
Description of Soil(s)
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS 17,, 5 A, 1
vcfes 'N 0•J. o- _ /.J 0
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 iance has been issued by the Board of Health.
Signed /,�� Date /4 G
Inspections
r r,lt;
No. B O iI D t �( S-iaU �j-7 FEE1 5S_ O0
C®MMONWEAI.T14 OF MASSACHUSETTS
Board of Health, % y 1'i -1 , MA.
CERTIFICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) omplete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded (.a Abandoned ( )
by: L -C
at r, CATIA 0C e r/1 ,
has been installed In' Vc4dance,;ith t&Vdri7ns of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. 0� Z, dated / z / Approved Design Flow 7 317 (gpd)
Installer
1 _
Designer:S� Inspector:( Date: 1°-- �� 5
9 i
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
No. Cil -1"N)( -1 04 WX--a uwlso Cops . FEE 55, 00
/ 1 z
COMMONWEALTH OF MASSAC14USETTS 014 3zo-!�>
Board of Health, )�A`r j MA.
DISPOSAL SYSTE[ CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repo� ) Upgrade ( ) Abandon ( ) an individual sewage disposal system
at aid r t k as described in the application for
Disposal System Construction Permit No. dated r
'G.A' G^o3
Provided: Construction shall be completSwithm t} e� the da of this permit. All local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date Z " / Board of Health(J
C/
No.: BOHDGIS-6037
Commonwealth of Massachusetts Fee '
$55.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERNIIT
Application for a Permit to:Upgrade-Complete System
Location: 9 CORDICK RD,SOUTH YARMOUTH, MA 02664 Owner:
JARDIN MAUREEN L
Map/Parcel#: 025.105.1 JARDIN DAVID M
53 WILLOW ST
STOUGHTON,MA 02072
Phone:
Septic System Installer Designer
RIKER LAND BSC GROUP,INC.
P.O. BOX 726 SOUTH YARMOUTH, MA 349 ROUTE 28,LTNIT D
02664 WEST YARMOUTH,MA 02673
Phone: 508-778-8919
7748366401
Type of Building:Dwelling Lot Size: 14,375.00 Sq.Ft.
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Fixtures:
Plan Date:09/17/2015 Number of Sheets: 1 Cafeteria•
Tit1e:SEWAGE DISPOSAL SYSTEM REPAIR 9 CORDICK ROAD Revision Date: 10/07/2015 '
Design Flow(min.required):330 gpd Calculated design flow:330 gpd Design flow provided:355 gpd
Description of Soi1s:SEE PLAN �
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:09/09/2015 '
KIERAN HEALY,PLS
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX H-20,
20 ARC 36 iJNITS W/OUT STONE:25'X 11.3'X 0.58'
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 Comoliance has been issued bv the Board of Health.
Signed Date
Inspections
i �
� Commonwealth of Massachusetts
.
Board of Health, Yarmouth, MA Fee
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: JARDIN MAUREEN L
JARDIN DAVID M
53 WILLOW ST
STOUGHTON,MA 02072
Location:9 CORDICK RD,SOUTH YARMOUTH,MA 02664
Disposal System Construction Permit No.: BOHDGIS-6037,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-PROPOSED 1500 GAL SEPTIC TANK, DBOX H-20,20 ARC 36 UNITS W/OUT
STONE:25'X 11.3'X 0.58'
2. MFC VARIANCE APPROVALS:a. GROUNDWATER SEPARATION b.GROUNDWATER ADJUSTMENT
Clcl
Bruce G. Murphy, H, .S., CHO/Amy L.von Hone, R.S., CHO
He Director/Assistant Health Director
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
;