HomeMy WebLinkAboutApp-Permit-ComplianceNo. &O DC. 15-541 (D 1. L-rD ` , `-1 G --00 Zq ! g FEE 46-15-i OD
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COMMONWEALTH Of MASSACHUSETTS 1 � � 7(a
Board of Health, a`Ti+ , MA.
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APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTI®N PERMIT
jApp ication for a Permit to Construct( ) Repair( ) UpgradeO< Abandon( ) -Complete System ❑ Individual Components
Location
Owner's Name 1400L
p/Parcel# p I
Address of? rleE; 9 _ _ (l rno
Lot#
N
Telephone# I
Installer's Name Alm •fin c,
Designer's Name S)S G
Address -36 Hokum
Address g E S d o) ia -6-
Telephone# SVT 03,S 99
Telephone# x j
Type of Building 1t. -
Dwelling - No. of Bedrooms
Other - Type of Building _
Lot ize /( / V "Ut)a sq -ft -
)Garbage grinder( )
No. of persons Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow (min. /required) ,�Z1 gpd Calculated design flow Design flow provided gpd
Plan: Date /D / f 4 / 1<1 Number of sheets _ :3 Revision Date
Title
Description of Soil(s) _
Soil Evaluator Form No,
Name of Soil Evaluator
DESCRIPTION OF REPAIRS OR ALTERATIONS
of Evaluation
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 atem ' eration until a Certificate of Co fiance has b en issued by the Board of Health.
Signed x. Date /0
Inspections
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No.R cG( t // F FEEJ�t
COMMONWEALTH LTH ®E MASSACHUSETTS
Board of Health, ffi& o t -ml , MA.
CERTIFICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) 011--lomplete System y
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded (' ,Abandoned
;by:
at
.:rte
i, has been install�d in rr a ice wt t provisions of 310 CMR 15.00 Title 5 and thea roved desi n lans/as built fans relatingto
application No. fz� % �'� dated %�'�''� " Approved Design Flow ,(gpd)
Installer r P a a
Designer: , f .t 4-SnrIS �-^ Inspector:t l✓i rt��`-� - r�A Date:
The issuance o this permit shall not be construed as a guarayt that the system will function as designed
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/ " 6 b COMMONWEALTH Of MASSACHUSETTS Ct4I5 77� .
Board of Health, y (143 14- , MA.
DISE®SAI. SYSTEM CONSTRUCTION PERMIT
Permission is herebygranted to; Construct( ) Repair( ) UpgradelV( Abandon( ) an individual sewage disposal system
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at ,r� 5 Z � Iv -Y-) '� as described in the application for
Disposal System Construction Permit No., dated
Provided: Construction shall be complete'd�h nst e f the date of this permit. All local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslovn, MAf Date 1- -d Boa g O Oaf 116
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� No.:BOHDC-15-5416
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� Commonwealth of Massachusetts Fee
555.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Complete System
Location: 28 CHARLES ST, SOUTH YARMOUTH, MA 02664 Owner:
JENNEY AVA L LIFE EST
I Map/Parcel#: 070.114 28 CHARLES ST
SOUTH YARMOUTH,MA 02664-3104
Phone:
Septic System Installer Designer
PKM CONTRACTORS, MEYER&SONS,INC.
P.O. BOX 175 EAST DENNIS, MA P.O.BOX 981
02641 EAST SANDWICH,MA 02537
Phone: 508-360-3311
5083855993
Type of Building:Dwelling Lot Size:47,916.00 Sq.Ft.
Dwelling-No.of Bedrooms:5 Garbage Grinder• �
Other Type of Building: No.of persons: Showers: '
Other Fixtures: �
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Plan Date: 10/16/2015 Number of S6eets:2 Cafeteria: �
Tit1e:SETPIC SYSTEM REPAIR PLAN 28 CHARLES STREET Revision Date: 11/10/2015
� Design Ftow(min.required):550 gpd Calculated design flow:550 gpd Design flow provided:566 gpd
Description of Soiis:SEE PLAN '
� Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:09/23/2015
DARREN MEYER,R.S. i
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED 2500 GAL 2 COMPARTMENT SEPTIC '
TANK,H-20 DBOX,4-500 GAL PRECAST CHAMBERS W/4'STONE:42'X 13'X 2' i
The undersigned 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 Cerfificate of Comoliance has been issued bv the Board of Health.
Signed Date '
Inspections
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' ; 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
1 To perform:Upgrade an individual sewage disposal system.
Owner: JENNEY AVA L LIFE EST
28 CHARLES ST
SOUTH YARMOUTH,MA 02664-3104
Location:28 CHARLES ST,SOUTH YARMOUTH,MA 02664
Disposal System Construction Permit No.: BOHDC-15-5416,Dated:November 13,2015
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-PROPOSED 2500 GAL 2 COMPARTMENT SEPTIC TANK, H-20 DBOX,4-
500 GAL PRECAST CHAMBERS W/4'STONE:42'X 13'X 2'
2. PLUMBING AND ELECTRICAL PERMIT REQUIRED
3. EJECTOR PUMP FOR BASEMENT FLOW(40%OF TOTAL HOUSEHOLD FLOW-O
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Bruce G. Mu hy, PH, R.S., CHO/Amy L.von Hone, R.S., CHO
ealth Director/Assistant Health Director
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The issuance of this permit shall not be construed as a guarantee that the system will function as designed. j
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