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HomeMy WebLinkAboutApp-Permit-ComplianceNo. 6044 bC-I ✓-0+eF,-7 13 U2> { K--t(:z '." WO 1-7 lO FEEJ ®e 00 /j577:-/ � / � OMMO TIS OF MASSACHUSETTS �lS�� 7 ;�� Bad of Health, MA. APPLICATI®N FOR DISPOSAL SYSTEM ��N UCTI�N PERMIT Application for a Permit to Construct�j Repair( ) Upgrade( ) Abandon() - Complete System ❑ Individual Components Location lo j5mkas's a n e, Owner's Name ,' Map/Parcel# ' Address -J?," R -k 6,4- rith AO -y' Lot# Telephone# ?qV - g? - g 6, Installer's Name Pea) co-�� =n Cs Designer's Name �, eQts2-(r ej; f'7 een n Address31,3 ` S Address, -)03 Je,+uC Lt12J -- 4--4n"S Telephone#1g s - Telephone# 1 502' -�S °- 6906 Type of Building Qe ceo, -f�` OL Lot Size /11;1, / V �i/ sq. ft. Dwelling - No. of Bedrooms Garbage grinder ( ) Other - Type of Building No. of persons Showers ( ) , Cafeteria ( ) Other Fixtures �7� Design Flow (min. required) gpd Calculated design flow Design flow provided' gpd Plan: Date 5 16 I o -b as- Number of sheets 3 Revision Date Title A Description of Soil(s) c - Soil Evaluator Form No. Name of Soil Evaluator ee f-sQ-(,Date of Evaluation OF RE ,AIRS OR ALTERATIONS `�e�pC �nseta I i a n - 1600 r/\ f to f111 .e r� f 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 t place tem in operation until a Certificate of Compliance has been issued by the Board of Health. Signed4WD Date 1 ,No.I�! �� ��'...FEE., COMMONWEALTH; O F MASSACHUSETTS ,,..,, QQ,, �-�-^7 _ till J 5L® Board of Health, , MA. CERTIEI� TL ©L ®NI�LI NSE Description of Work: ❑ Individual Component(s) Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed Repaired ( ), Upgraded ( ), bandoned () 4 by: (Yl Ctrs q+?n -T-n. C- !+ J �'►U �S �, � at t7 Yl �JGk S t -t (t 2. has been installed in accorda7ce wfth'tlie provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. J / dated Approved Design Flow (gpd) Installer Dl In it nn-�rla f 4,nrc T_A G Designer': �� r�f% [ j= d'1,,,1 Inspector: � _ VA, Date: The issuance of this permit shall not be construed as a guarantee that the system will function as designed. ODU 00V OOG O 000 O 0 O 00000000000 G O 000000000'0.00000000000 OO 0 o 000000 G 00000 000 o 00 O 0000000000000000,000000000b 0.0000 O 0.O f 000000000.00000..7< No.��,," 'C`i !"�") FEE / COMMONWEALT14 Of MASSACHUSETTS C, ls5-(,o7 Board of Health, y /Vt 01.T1V , MA. DISPOSAL SYSTE4 CONSTRUCTION PERMIT Permission is hereby granted to; Constructk Repair( ) Upgrade( ) Abandon( ) an individual sewage,disposal system at i n-�V3 0, 4 n t\ -P-- as described in the application for Disposal System Construction Permit No. dated %` Provided: Construction shall be completed withinthe date of this-pprmit. All local conditions must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown, MA Date. Board of Health No.: BOHDC-15-0455 Commonwealth of Massachusetts FBe ' S770.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to:New Construction-Complete System Location: 10 EMBASSY LN,YARMOUTH, MA 02675 Owner: MCCARTHY MICHAELJ � Map/Parcel#: 151.48 PO BOx 52 WEST DENNIS,MA 02670-0052 Phone: Septic System Installer Designer PKM CONTRACTORS, SWEETSER ENGINEERING P.O. BOX 175 EAST DENNIS, MA P.O. BOX 713 �2�� SOUTH DENNIS,MA 02660 Phone: 508-385-6900 Type of Building:Dwelling Lot Siu: 15,246.00 Acres Dwelling-No.of Bedrooms:3 Garbage Grinder: Other Type of Building: No.of persons: Showers: Other Futures: Plan Date:OS/06/2015 Number of Sheets: 1 Cafeteria: Tit1e:PROPOSED SEPTTC DESIGN t0 EMBASSY LANE Revision Dah: Desigo Flow(min.required):330 gpd - Calwlated design ilow:330 gpd Desigo itow provided:351 gpd Description of Soi1s:SEE PLAN Soil Evaluator Form No.: Name of Soil Evaluator. Date of Evaluation:07/23/2014 ROBIN WILCOX,PLS DESCRIPTION OF REPAIRS OR ALTERATIONS:NEW-PROPOSED 1500 GAL SEPTIC TANK,DBOX,4 HIGH CAPACITY INFTLTRATORS W/STONE:36'X 11'X]0" � . 7he untlersigned 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 Ce�cate of Comoliance has heen issued hv the Boartl of HeaRh. Signed Date Inspections Commonwealth of Massachusetts ` Board of Health, Yarmouth, MA F� DISPOSAL SYSTEM CONSTRUCTION PERMIT s»o.00 Permission is herby granted to; PKM CONTRACTORS, INC., P.O. BOX 175, EAST DENNIS, MA 02641 To perform:New Construction an individual sewage disposal system. Owner: MCCAR'I'IIY MICHAEL J PO BOX 52 WEST DENNIS,MA 02670-0052 Location: 10 EMBASSY LN,YARMOUTH,MA 02675 Disposal System Construction Permit No.: BOHDC-1SO455,Dated:July 09,2015 Provided: Cons[ruc[ion shall be completed within six months of[he da[e of[his permi[. All local conditions mus[be met. Couditions I.NEW-PROPOSED I500 GAL SEPTIC TANK, DBOX, 4 HIGHCAPACITYINFILTRATORS W/ STONE: 36'X 11'X 10" 2. FOUNDATION VARIANCE APPROVED (� Bruce G. M hy, PH, R.S., CHO/Amy L.von Hone, R.S.,CHO � ealth Diredor/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 F� CERTIFICATE OF COMPLIANCE s++a.00 Description of Work:Complete System The undersigned hereby certify that the Sewage Disposal System; New Construction by:PKM CONTRACTORS,INC. at: 10 EMBASSY LN,YARMOUTH,MA 02675 Has been installed in accordance with the provisions of 310 CMIt 15.00(Title 5)and the approved design plans or as-built plans relating to application No.: BOHDC-1SO455,dated 09/03/2015. Installer.PKM CONTRACTORS,INC. Address:P.O.BOX 175 EAST DENNIS,MA 02641 Inspector:BRUCE MURPHY,R.S. Designer:SWEETSER ENGINEERING Conditions 1NEW-PROPOSED 1500 GAL SEPTIC TANK,DBOX,4 HIGH CAPACITY INFILTRATORS W/ STONE:36'X 11'X 10" 2.FOUNDATION VARIANCE APPROVED �`! /„ , � L/V� Bruce G. Mu y, PH, R.S.,CHO/Amy L.von Hone, R.S.,CHO Health Director/Assistant Health Diredor The issuance of t6is permit shali not be construed as a guarantee that the system will function as designed. BO H_Disposal_ConsVuction_CofC.rpt