HomeMy WebLinkAboutApp-Permit-ComplianceNo. —/t— 14* * 1 < FEE %%�
B o WDC c �4 d
COMMONWEALTH OF MASSACITiJSETTS
Board of Health, ��QQIV , MA.
APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTION PERMIT
Application for a Permit to Construe, ( Repair( ) Upgrade( ) Abandon() �mplete System ❑Individual Components
Location La A e L C, 6 c
Owner's Name
G rVN
Map/Parcel#
Address 30a kc4d w"
IF
&VVI el A
Lot#Telephone#
7 7 C _ C
Installer's Name_ X.*cics�
Designer's Name G^v-,% Cs C
Address 7 �" �J4� w
Address U
4jr5 7
Telephone# -7 7& L YG U
Telephone#
Type of Building Ee el it J1 l Lot Size T I%_ sq. ft.
Dwelling - No. of Bedrooms <t Garbage grinder( )
Other - Type of Building No. of persons Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow (min. required) 33 Ogpd Calculated design flow 350 Design flow provided gPd
Plan: Date �) 1 Dumber of sheets Revision Date e '7 r,)
Title <n�
Description ofSoil (s) log
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS �I+C � ' gA (LI `�°� � � ��Csx c eL � JUG tiT 41
Dr � tI LS'
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 to place the system in operation until a Certificate of Co p ' nce has been issued by the Board of Health.
Signed Date
Inspections
No. -i6�' �`�'" FEE
COMMONWEALTH OF MASSACHUSETTS �/d
Board of Health, rid F—MO 0714
CERTIFICATE Of COMPLIANCE ,j � .� r & j /
Description of Work: ❑ Individual Component(s) Si6omplete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( Repaired ( ), Upgraded ( ), Abandoned ( )
by:
at a G
has been installed in accordance with theprovisions of 310 CMR 15.00 (Title 5) and th proved design plans/as-built plans relating to
�
application No. –/ , dated f �T Approved Design Flow _(gpd)
Installer
Designer:{?Gv✓� �du9t ti� .ie_ i Inspector: Date: U dot
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
C..-% ..r, .^ -•;: �' �C` -.. .`:.`:'_ ., :.. ...-yti-7 f. is f-. C�UC Cr C^N� ., J.,. ' )v9; ;. G;,,C '��`J Gc] _�)Jn uU�._ r'�v..-•�< ,. .
No... FEE
X014 C N -oaf COMMON LT14 Of MASSACHUSETTS �� '0 - tel a
Board of Health, h"O un+
DISPOSAL SYSTEM[ CONSTRUCTION PERMIT
Permission is hereby granted to; Construct Repair( ) Upgrade,( ) Abandon( ) an individual sewage disposal system
at
as described in the application for
Disposal System Construction Permit No. ' �� , dated
Provided: Construction shall be completed within -ter the date of this permit. All local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown, MA Date V ~I IW— Board of Health `� v
,
No.: BOHDGI4-0075
Commonwealth of Massachusetts Fee
s++o.00
Board of Health, Yarmouth, MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERNIIT
Application for a Permit to:New Construction-Complete System
Location: 12 FEATHERBED LN,WEST YARMOUTH, MA 02673 Owner
Map/Parcel#: 038.69 Name:
RODERICK THERESA A(LIFE EST)
Address:
50 NORTH RD WEST YARMOUTH, MA 02673
Phone:
Septic System Installer
Name:
RIKER LAND CONSTRUCTION
Address:
P.O. BOX 726 SOUTH YARMOUTH,
MA 02664
Phone:
5087766460
Type of Building:Dwelling Lot Size:038 sq.R.
Dwelling-No.of Bedrooros:3 Garbage Grioder:
Other Type of Building: No.of pereons: S6owers: Cafeteria:
Other Fixtures:
Plan Date: 11/11/2013 Number of Sheets: l
TiHe:1'[1'I,E 5 SITE PLAN Revision Date:07/30/20t4
Design Flow(min.required):330 gpd Calculated design ilow:330 Design 11ow provided:330 gpd
8Pd
Description of Soi1s:SEE PLAN �
Soil Evaluator Form No.: Name of Soil Evaluator. Dah of Evaluation: 10/16/2013
DAIVIEL GONSALVES �
DESCRIPTION OF REPAIRS OR ALTERATIONS: 1500 GAL SEPTIC TANK
DBOX
2-500 GAL CHAMBERS WITH 4'STOIVE
25'X 12.83'X 2'
The undersigned agrees to insfall the above described Individual SewaQe Disposal System in accordance wkh the provisions
of TI7LE 5 and further anrees not to place in olwration unlil a Certifieate of Compliance has been issued bv the Board of Health.
Signed Date
Inspections
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA. Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT s++o.00
Permission is herby granted to;ADAM RIKER Address:P.O.BOX 726
SOUTH YARMOUTH,MA 02664
To perform:New Construction an individual sewage disposa7 system.
Owner. RODERICK TI-IERESA A(LIFE ES'I)
50 NORTH RD
WEST YARMOUTH,MA 02673
Location: 12 FEATHERBED LN, WEST YARMOUTH,MA 02673
Disposa7 System Construction Permit No.: BOHDG140075,Dated: August Ol,2014
Provided: Cons[ruction shall be completed within six months of the date of this permit. All local conditions must be met.
�
Bruce G. Murphy P , R.S., CHO/Amy L.von Hone, R.S., CHO
He h Director/Assistant Health DireIXor
The issuance of t6is permit shall not be construed as a guarantee that the system will function as designed.