HomeMy WebLinkAboutApp-Permit-ComplianceNo. �L1% //C_��P - t��331c�2r /:� Lam// FEET O�
tbovfDc COMMONWEALTH OF MASSACHUSETTS
Board of Health, Y,%iioU t , MA.
APPLICATION FOR. DISPOSAL SYSTEM CONSTRUCTION PERM IT
Application for a Permit to Construct( ) Repair( ) Upgrade,��Abandon( ) - ❑ Complete System --e.1 Individual Components
Location
Owner's Name 1 S
Map/Parcel#5
Address `�
41
Lot#
Telephone#
Installer's Na rne & ,�76r
Designer's Name.
Address313 — E
Address q In - rryn
Telephone#
Telephone# e
Type of Building e sap -0 hQ I Lot Size 1Z Z sq. ft.
Dwelling - No. of Bedrooms Garbage grinder ( )
Other - Type of Building No. of persons Showers( ), Cafeteria
Other Fixtures
Design Flow (min. required) 3-;� nr gpd Calculated design flow Design flow provided gpd
Plan: Date j1 /,23 1oh/ Number of sheets Revision Date
Title L2 & O km lS
Description of Soil (s)
Soil Evaluator Form No. 13201 Name of Soil Evaluator CM 174�1�fj Date of Evaluation 1
OF REPAIRS OR i-jALTERATIONS --,05-ii I / 1 O Q �s Iii/� d�(,,Ck' I
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 to p p� e system in Wration until a Certificate of C inliance has been issued by the Board of Health.
Signed Date 1 C;0 /b
1
Inspections
No.G?a,.`.i(p`0ts`�1'L.®��®N Ir�lt�t ®� MASSACHUSETTS FEE- . ®Cl
b014DC4s-�1$ ', Ei b5e`71
Board of Health, , MA.
CERTIFICATE Of COMPLIANCE
Description of Work: •tel Individual Component(,) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed�� ,Re aired
(,Upgraded,(jAbandoned
by: ( )
atp
has been insta e i cod nc 3i the provisions of 310 CMR 15.00 (Title 5) and the pproved design plans/as-built plans relating to
application No. Kim ` �� dated ""'/ . Approved Design Flowgpd)
Installer I
Designer: Cue, an C'n - q Inspector: t �a � � Date: -i / Z
The issuance of this permit shall -n be construed as a guarakewe that the system will function as designed.
No.6 -CO q t' 1 ° 1
FEE 575iO
COMMONWEALTH OF MASSACHUSETTS
Board of Health,—MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construc Repair( ) Upg -�Aek. Abandon( ) an individual sewage disposal system
at. G as described in the application for
Disposal System Construction Permit No. dated -/C-A7
�G
Provided: Construction shall be comp ewithm- ree ear of the date of this permit. All local conditions must be met.
Date/Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown, MA `i l BoAdWealth
. No.:BOHDC-15-6185
Commonwealth of Massachusetts Fee
ass.00
' Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Individual Component(s)
Location: 96 CAPT BESSE RD, SOUTH YARMOUTH, MA 02664 Owner:
LEWIS RONALD S
Map/Parcel#: 077.23 96 CAPTAIN BESSE RD
SOUTH YARMOUTH,MA 02664-2807
Phone:
Septic System Installer Designer
PKM CONTRACTORS, DOWN CAPE ENGINEERING
P.O. BOX 175 EAST DENNIS, MA 939 ROUTE 6A
02641 YARMOUTHPORT,MA 02675
Phone: 508-362-4541
5083855993
Type of Building:Dwelling Lot Size: 11,761.00 Sq.Ft.
Dwelling-No.of Bedrooms:3 Garbage Grinder: f
I
4
Other Type of Building: No.of persons: Showers:
Other Fixtures: '
Plan Date: 1 U23/2015 Number of Sheets: 1 Cafeteria•
�
' Tit1e:TITLE 5 SIT'E PLAN 96 CAPTAIN BESSE ROAD Revision Date: �
Design Flow(min.required):330 gpd Calculated design flow:330 gpd Design flow provided:349 gpd �
Description of SoiIs:SEE PLAN ,
� Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation: 11/12/2015
CRAIG J.FERRARI,S.E.
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-EXISTTNG 1000 GAL SEPTIC TANK,DBOX,2-500
GAL PRECAST CHAMBERS W/4'STONE:25'X 12.83'X 2' '
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance wRh the provisions of
TITLE 5 and further aarees not to olace in ooeration until a Certificate of Comoliance has been issued bv the Board of Health.
Signed Date i
Inspections �
� �
` Commonwealth of Massachusetts
, Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT $55.00
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: LEWIS RONALD S
96 CAPTAIN BESSE RD
SOUTH YARMOUTH,MA 02664-2807
Location:96 CAPT BESSE RD,SOUTH YARMOUTH,MA 02664
Disposal System Construction Permit No.: BOHDC-15-6185,Dated:December 15,2015
Provided:Construction shall be completed within six months of the date of this permit. All local conditions must be met.
CONDITIONS:
1. SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK, DBOX,2-500 GAL PRECAST
CHAMBERS W/4'STONE:25'X 12.83'X 2'
2. BOH TO INSPECT SOIL REMOVAL ;
3.ZONE II MAXIMUM 3 BEDROOM
V C1�
Bruce G. Murp , H, R.S.,CHO/Amy L.von Hone, R.S.,CHO '
ealth Director/Assistant Health Director '
The issuance of this permit shall uot be construed as a guarantee that the system will function as designed. !
. �
f
I
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
CERTIFICATE OF COMPLIANCE ass.00
Description of Work:Individual Component(s) '
The undersigned hereby certify that the Sewage Disposal System; Upgraded ;
by:PKM CONTRACTORS,INC. I
at:96 CAPT BESSE RD, 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 plans relating to application No.: BOHDC-15-6185,dated 12/21/2015.
Installer:PKM CONTRACTORS,INC.
Address:P.O.BOX 175 EAST DENNIS,MA 02641 Inspector:AMY VON HONE,R.S.
Designer:DOWN CAPE ENGINEERING
Conditions
1.SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK,DBOX,2-500 GAL '
PRECAST CHAMBERS W/4' STONE:25'X 12.83'X 2'
2.BOH TO INSPECT SOIL REMOVAL
3.ZONE II MAXIMUM 3 BEDROOM
���
Bruce G. Murp ,M H, R.S., CHO/Amy L.von Hone, R.S.,CHO ,
Health Director/Assistant Health Director
The issuance of this permit shall not be construed as a guarantee that the system will function as designed. '
BOH_Disposal_Construction_CofC.rpt
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