HomeMy WebLinkAboutApp-Permit-ComplianceNo. ON�S�ZtPCO !�' LDTZ-iS-Oo(1?a FEE_ "t UW
X- X/7 COMMONWEALTH OF MASSACHUSETTS
Board of Health, A/1m f j l-rw , MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construc�,�') Repair( ) Upgrade( ) Abandon( ) - Complete System ElIndividual Components
Location (00 LOA) lS U`A-p
Owner's Name d
Map/Parcel# 2-2 du r^ Ole/ �
Address
Lot#
Telephone# M71 P Wtv
Installer's Name
Designer's Name VTP,
Address��
Address
Telephone#
Telephone# 6/a—
Type of Building _ I
Dwelling - No. of Bedrooms
Other - Type of Building _
Lot Size sq. ft.
Garbage grinder ( )
No. of persons Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow (mi/n. required) � gpd Calculated design flow Design flow provided -7 gpd
Plan: Date 14Number of sheets Revision Date -
Title Tr16 C) S
Description of Soil(s) lonmq4b 01
Soil Evaluator Form No.
Name of Soil Evaluator JO)AA rL-( i ) JOAN Date of Evaluation -Vc l& / 1 . )
DESCRIPTION OF REPAIRS OR ALTERATIONS
The undersigned agrees to install the above dfscribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to not to Vp,���in#ration until a Certificate of//Co pli cie bas been issued by the Board of Health.
Signed Date
Inspections
Z.
No. & FVic "15'". ZA G 9 COMMONWEALTH �I+TH ®fit' MASSACHUSETTS FEE �,,2 ��
//� di -415 8
Board of Health ,tOtIT�� , MA.
CERTIFICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed
by:—
at
y:—at i o tr) LQ .. � � c i� � n nO
, Repaired ( ), Upgraded ( ), Abandoned ( )
n ,r a '
has been installed in aEc rda ce t ovisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. dated Approved Design Flow �(gpd)
Installer _ O il_ 0 e) n -1,,n: arc "J:7;t C AAZk GlC- at tl�r t.l..
Designer: .-FPC LC Inspector: s/rte✓f/%.7/ _ Date: t——`,`'
The issuance of this permit shall not be construed as a guar ee th t the system will function as designed.
UGGOuuu Guo oJv->J000 Uocouo0c U00000 VOJCOG 00'00000U oOooQao oO uocaA0o0.'OIIU.oaCiri-n0000-oe0o o^Coa%?O ec 000C nkro C-a`ncoorocb cc. ciC %Jo'�coocro icooOc
No. G � 'T (cs�� P 1:LH FEE 4 S� , O
COMMON LTII-OF.. SSACI-IUSETTS ck-- s548
Permission is hereby granted
at dao kewfS
Board of Health, Y �/ -Wnkk , MA. DISPOSAL
DISPOSAL STST CONSTRUCTION PERMIT
Construct
()
0 Or N I)
Repair( ) Upgrade(, ) Abandon( ) an individual sewage disposal system
as described in the application for
Disposal System Construction Permit mp e�thiNo.
l/_/� , dated �� Z `
Provided: Construction shall be con l� flthe date of this perm . A�l local conditions must be met.
.� _� .5
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chatlestown, MA Date oard of Health
i .
� No.:BOHDC-15-2469
Commonwealth of Massachusetts Fee �
555.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
i
iApplication for a Permit to:Upgrade-Complete System
j Location: 100 LEWIS RD,WEST YARMOUTH, MA 02673 Owner:
� DEMAIO A THOMAS
Mep/ParC¢I#: 022.305 4 PIERREPONT RD
NEWTON,MA 02162-t118
i
Phone:
Septic System Installer Designer
PKM CONTRACTORS, VTP ASSOCIATES.INC.
� P.O. BOX 175 EAST DENNIS, MA 132 ADAMS STREET
02�� SECOND FLOOR, SUITE 3
', Phone: ���,��
�
. Type of Building:Dwelling Lot Siu: 13,068.00 Acres
� Dwelling-No.of Bedrooms:4 Garbage Grioder.
iOther Type of Building: No.of persons: Showers:
i
� Other Fiatures:
I' Plan Date: 1 U06/2014 Number of Sheets:2
i Cafehria:
��i Tit1e:SEWAAGE DISPOSAL SYSTEM]00 LEWIS ROAD Revision Date:OS/14/2015
Design Flow(min.required):440 gpd Calculated design Flow:440 gpd Design flow provided:577 gpd
�
iDescription of SoiIs:SEE PLAN .
� Soil Evaluator Form No.: Naroe of Soii Evaluator: Date of Evaluatioo:03/26/2015
JOSEPH PORTER,SE '
� DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-PROPOSED 1500 GAL 2 COMPARTMENT SEPTIC TANK W/ZABEL
FILTER,DBOX,26'X 30'LEACH FIELD �
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance wkh the provisions of
TITLE 5 and further aarees not to olate in ooeration until a Cerlificate of Comollance has heen Issued hv the Board of Meakh.
Signed Date
Inspections
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00
Permission is herby granted to;
; PKM CONTRACTORS, INC., P.O. BOX 175, EAST DENNIS, MA 02641
I
To perform: Upgrade an individua] sewage disposal system.
( Owner: DEMAIO A THOMAS
i 4 PIERREPONT RD
� NEWTON,MA 02162-1118
Location: 100 LEWIS RD,WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.: BOHDC-15-2469,Dated:June 22,2015
IProvided: Construction shall be comple[ed within six months of the date of this permit. All local wnditions must be met.
' Conditions
i
� 1. REPAIR-PROPOSED I500 GAL 2 COMPARTMENT SEPTIC T.9NK W/ZABEL F1LTE$ DBOX, 26'
' X 30'LEACH FIELD
�Vuu
Bruce G. urphy, MPH, R.S.,CHO/Amy L.von Hone, R.S., CHO
� Health Director/Assistant Health Diredor
The issuance of this permit shall not be construed as a guarantee that the system will fuuction as designed.
�,i
Commonwealth of Massachusetts
; Board of Health, Yarmouth, MA F88
CERTIFICATE OF COMPLIANCE ass.00
Description of Work:Complete System
� The undersigned hereby certify that the Sewage Disposal System; Upgraded
� by:PKM CONTRACTORS,INC.
�
at: ]00 LEWIS RD,WEST YARMOUTH,MA 02673
Has been installed in accordance with the provisions of 310 CMR 15.00(TiUe 5)and the approved
design plans or as-built plans relating to application No.: BOHDGIS-2469,dated 08/OS/2015.
� Installer:PKM CONTRACTORS,INC.
I
j Address:P.O.BOX ]75 EAST DENNIS,MA 02641 Inspector:AMY VON HONE,R.S.
�
Designer:VTP ASSOCIATES,INC.
Conditions
L REPAIR-PROPOSED I500 GAL 2 COMPARTMENT SEPTIC TANK W/ZABEL FILTER,
DBOX,26' X 30'LEACH FIELD
� v(�
Bru G. urphy, MPH, R.S., CHO/Amy L.von Hone, R.S.,CHO
j Health Director/AssistaM Health Diredor
I The issuance of this permit shall not be construed as a guarantee that the system will funMion as designed.
BOH_Disposal_Construdion_CofC.rpt