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HomeMy WebLinkAboutApp-Permit-ComplianceNo. 1Q70 P>LPz12 — 15--®O Z 48C FEE ' �yCo COMMONWEALTH A LTH ®f MASSACHUSETTS ck4oq3 z Board of Health, )LAg o uj:i 1 , MA. z PPLICTI®NFOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Ay plication for a Permit to Construct( ) Repair Upgrade( ) Abandon() - Aomplete System ❑ Individual Components ocation P ' J?a Owner's Name 14,FD eds ap/Parcel#i Address ot# Telephone# S0 Z_ I'7S_ 3086 nstaller's Name tiCA Coo jcDesigner's Name ddress Address - ,-� 90 elephone# %7 3� Telephone# S Type of Building FP _T �'t n 1'A Lot Size S sq. ft. Dwelling - No. of Bedrooms :Thr C Garbage grinder( ) Other - Type of Building No. of persons Showers( ) , Cafeteria ( ) Other Fixtures CC ? U Design Flow (min. required) 3k gpd Calculated design flow 33 Q Design flow provided gpd f Plan: Date M&N, j!j Number of sheets l Revision Dates 6116 a 61q Title Description of Soil(s) %k .Sleep 1W 5 Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS ORALTERATIONS F 0) ey is/yo' 4 TTAs- +ll 1,50 6, rA6, J T. 12,E 5Lbt; v. hrX ey ge, C-q_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 n t to place the system in operation until a Certificate of Cmpli ce has been issued by the Board of Health. Signed Date I1 1 G ` 3 Inspections 1 a' J 3 1 I _1 C- K'yye,./76 1 (-," -t� J �• I S C 1<_ 7 Rv-/ -1- _r. A- i- G S A- S r%Gl - d"✓ t 6- - 6 ! C. No. _;, i", 1; ( (j� l� FEE 0 /� -- COMMONWEALT14 OF MASSACHUSETTSc h f I Board of Health, AELKO l04 , MA. ok t-iZ-fSi V 3 2- 7 -19 - CERTIFICATE !9CERTIFICATE ©f COMPLIANCE Description of Work: ❑ Individual Component(s)'Complete System The undersigned hereby certify that the %Sewage Disposal System; Constructed ( ), RepairedK), Upgraded ( ), Abandoned'( ) by: J�.k,, L4 -c4 C60)4,1V r_4 _1 at has been install application No. Installer 14. ' ke" Atth provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to dated �/ _�`! � . Approved Design Flow 4 / 7 (gpd) l '(. Designer: 13. 6 06 C °,t i (:?.:, Inspector: : ' Date: +t i The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. O',k �j COMMONWEALTH LTH ®f M ASSAC14USETTS Board of Health, Y e M O l_iT A , MA. DISPOSAL SYSTLM[ CONSTRUCTION PERMIT I FEE ''35_,00 -- Permission is hereby granted to; Construct( ) Repair( Upgrade ( ) Abandon ( ) an individual sewage disposal system at IQ ao A � Gia rd • as described in the application for Disposal System Construction Permit No. j� = = b , dated 11-4— Provided: 1— Provided: Construction shall be completed within tl;�_,)_ of the dgtte of this permit. All local conditions must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date % _/ (Board of Health I i Commonwealth af Massachusetts ! Board of Health, Yarmouth, MA F8e CERTIFICATE QF COMPLIANCE sss-oo � � 1 Descriprion of Work: Tha undarsig�d hereby certify that the Sewage Disposal System;Upgraded � by:RIRER LAND CONSTRUCTIQN � at: ]7 ANDRINA RD,WEST YARMOUTII,MA 02673 I i Has been install�d in accordance with the provisions of 310 CMR 15.00(Title 5)and the approved � design ptans or as-built plans relating to application No.: BOHDC-I4-OS$4,dated 01/12/2015. Ij Insta(ler:RIKER LAND CONSTRUCTIUN � Address:P.O.BOX 72b SOUTII YARMOUTH,MA Inspector:AMY VON HONE,R.S. p2664 Designer:DONALD MONCEVICZ,PE Conditions 1.Board of Health Agent to Inspect Soi!Removal 2.Plumbiog Permit Iteqnired 3. 1500 gal Septic Tank,DBox,$Cuitec C4 Drain Panels w/out Stone: 12'x 8' x 3" 4.MFC Variances: 1.3.$"lo Lxach Facility ReduMioa 2.Settrscks ��� �� Bruce G. Murphy, MP , R�HO/Amy L.von Hone, R.S., CMO 4Yealth Diractar t Assis#ant Heatth Dfrector The issuance aYthis per[nit shall nat be constrned as a guara�tee that the system witl function as designed. BpH_Disposal_Gonstrukion CofC.rpt � {