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HomeMy WebLinkAboutApp-Permit-ComplianceNo. bQP��� '1s'i 55-q (5'-Is`� 0�-'� / FEE COMMONWEA1.19 OY MASSAC US�TTS Board of Health, _7 .� P IL D 11'f M , MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) UpgradeX Abandon() - omplete System ❑ Individual Components Location Owner's Name ,% ''G Map/Parcel# ag ij Address Qj /J, Mot It �- Lot# or Telephone#AM 3 q72- Installer's Name PV G Designer's Name S' Address3 _ Address o90:3 Je.'t" t.(.c (?j4 % " 2 !� n t Telephone#9� Telephone# 45702; 3 — Type of Building L:D !Y Dwelling - No. of Bedrooms Other - Type of Building _ Lot Size sq. ft. in/ Garbage grinder ( ) No. of persons Showers ( ), Cafeteria ( ) Other Fixtures Design Flow (min. req ired) Q(, gpd Calculated esign flow Design flow provided a 6 gpd Plan: Date Number of sheets Revision Date Title Description of Soils) _ Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESC(RIPTION OF REPAIRS rR_ ERATIONS ��` C-� t L htTX LIC# A18352 71 NEAR MEADOWS RD WEST YARMOUTH, MA 02673 The undersigned agrees to install the above described Individual Sewage Disposal S) further agrees to not to 1 ce the system i operation until a Certificate of fomplia .JOHN B. RAIMO Signed Date k, MASTER ELECTRICIAN %P IV �() �'--% o� f -7 5C7 Inspections HOME (508) 778-1804 TV/TEL. • RESIDENTIAL • REMODELING No. �t��i �iC.! FEE V COMMONWEALTH, OF MASSACHUSETTS �l f Board of Health, rihi®ell'N' , MA. CERTIFICATE ©FtOMPLIANCE Description of Work: ❑ Individual Component(s) ,J2'Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded, Abandoned ( ) at has been installed accbrddnce with the I visions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application N . /S. �� dated `7 ' 7 ` / . , Approved Desi Flow ,.1 g/pd) , Installer '4 (1kXbnoa Cjb Designer: S w e4x-�R r-' eA Q Inspector Date: _ The issuance of this permit shall not be construed as a guarantee that the system will function' as designed. No. , 1 � � '0 P K M FEE 5 — COMMONWLALT14 Of MASSACHUSETTS Board of Health, yh#i M O Vr]f MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; at :33 Old Mr1.1iz``' ( ) Repair( ) Upgrade V Abandon( ) an individual sewage disposal system as described in the application for Disposal System Construction Permit No. tam , dated . Provided: Construction shall be completed within tkx4o4wayref the date of this permi . All local conditions must be met. Board of Health Form 1255 Rev. 5/96 A.M. Sulkin Co. ChS IOStOWO, MA Date )� / i -�✓ • No.: BOHDC-15-1854 Commonwealth of Massachusetts Fee • ass.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERNIIT Application for a Permit to:Upgrade-Complete System Location: 33 OLD MAIN ST, SOUTH YARMOUTH, MA 02664 Owner: CURLEY]OHN F Map/Parcel#: 042.40 CURLEY ELAINE M 91 RIVER ST SOUTH YARMOUTH,MA 02664 Phone: Septic System Installer Designer PKM CONTRACTORS, SWEETSER ENGINEERING P.O. BOX 175 EAST DENNIS, MA P.O.BOX 713 02641 SOUTH DENNIS,MA 02660 Phone: (5081385-6900 Type of Building:Other Type of Building Lot Size: 12,632.40 Acres Dwelling-No.of Bedrooms: Garbage Grioder: Other Type of Building.COMMERCIAL BUILDING No.of persons: Showers: OFFICE/RE'IAIL USE Other Fixtures: Plan Dah:02/04/2015 Number of Sheets: 1 Cafeteria: Tit1e:PROPOSED SEPTIC DESIGN 33 OLD MAIN STREET Revision Dah:OS/07/2014 Design Flow(miarequired):262.5 gpd Calculated design f1ow:262.5 Design Flow provided:36839 gpd gpd Description of Soi1s:SEE PLAN Soil Evaluator Form No.: Name oS Soil Evaluator. Date otEvaluation:02/04/2015 ROBIN WILCOX,PLS • DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-1500 GAL H-20 2 COMPARTMENT SEPTiC TANK,H-20 DBOX,4 HIGH CAPACITY H-201NFILTRATORS W/STONE AROUND AND 3"BELOW: 11'X 36'X 13" 7he undersigned agrees to insfall the above described Individual Sewage Disposal System in accordance wiN the provisions of • TITLE 5 and furfher aarees not to olace in eoeration unUl a Certificate of Comoliance has heen isaued bv the Board ot Heakh. Signed Date Inspecrions Commonwealth of Massachusetts ' Board of Health, Yarmouth, MA Fee DISPOSAL SYSTEM CONSTRUCTION PERMIT 555.00 Permission is herby granted to; PKM CONTRACTORS, INC., P.O. BOX 175, EAST DENNIS, MA 02641 To perform:Upgrade an individual sewage disposal system. Owner. CURLEY JOHN F CURLEY ELAINE M 91 RIVER ST SOUTH YARMOUTH,MA 02664 Location: 33 OLD MAIN ST,SOUTH YARMOUTH,MA 02664 Disposal System Construction Permit No.: BOHDGIS-1854,Dated: May 07,2015 Provided: Construction shall be completed wi[hin six months of the date of this permit. All local conditions must be met. Conditions 1. REPAIR- I500 GAL H-20 2 COMPARTMENT SEPTIC TANK, H-20 DBOX, 4 HIGH CAPACTfY H-20 INFILTRATORS W/STONE AROUND AND 3"BELOW: 11'X 36'X 13" 2. PROPOSED OFFICE/RETAIL USE: 3.500 S F. � Bruce G. Murph PH, R.S., CHO/Amy L. von Hone, R.S.,CHO H Ith Director/Assistant Health Diredor 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 Fee CERTIFICATE OF COMPLIANCE $55.00 Description of Work: Complete System The undersigned hereby certify that the Sewage Disposal System; Upgraded by:PKM CONTRACTORS,INC. at: 33 OLD MAIN ST,SOUTH YARMOUTH,MA 02664 Has been installed in accordance with the provisions of 310 CMR 15.00(Title 5)and the approved design plans or as-built pla�s relating to application No.: BOHDG1S1854,dated 06/08/ZO15. Installer:PKM CONTRACTORS,INC. Address:P.O. BOX 175 EAST DENNIS,MA 02641 Inspector:AMY VON HONE,R.S. Designer: SWEETSERENGINEERING Conditions 1.REPAIR- 1500 GAL H-20 2 COMPARTMENT SEPTIC TANK,H-20 DBOX,4 HIGH CAPACITY H-20 INFILTRATORS W/STONE AROUND AND 3" BELOW: 11' X 36' X 13" 2.PROPOSED OFFICE/RETAIL USE:3,500 S.F. �//�, V�l Bruce G. rp y, 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 function as designed. BOH_Disposal_Construdion_CofC.rpt