HomeMy WebLinkAboutApp-Permit-ComplianceNo. T2-- /& -- 00X-55
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Board of Health, ��P=MLY % ff , MA.
PLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair UpgradeAbandon( - O Complete System .OrIndividual Components
Location "41da nd
Owner's Name
Map/Parcel# D
Address �� ��
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Lot#
Telephone#
Installer's Nameeft
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Designer's Name
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Address 3 13 HOKUM -t=. Den" ,s
Address O � =E _
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Telephone#V3 -3'� n(
Telephone#
Type of Building MZ �2n�'!� Lot Size sq. ft.
Dwelling - No. of Bedrooms _ Garbage grinder ( }
Other - Type of Building No. of persons Showers O Cafeteria ( )
Other Fixtures -�42' Z
Design Flow (min. required) 3.30 gpd Calculated design flow Design flow provided:'gpd
Plan: Date _ /D!�'%r) !� Number of sheets Li Revision Date
Title
Description of Soil(s)
Soil Evaluator Form No. Name of Soil Evaluat . Date 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 place the systeminop don until a Certificate of Compliance has been issued by the Board of Health.
Signed _�UJ�Y 1 �• . �% Date '
Inspections
No. i O �7C ,— ( ' iG7�Z� j � a 6/d. ' FEE 00
C®�[MON LT14 OF MASSACHUSETTS 011 q'l�
Board of Health, YAgMiQ(04 MA.
CERTIFICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired (,(� Upgraded( ),Abandoned( )
by: - r-
at 1'4 1 t 2Qi r� rr Q .20Irk
las been install d in- ac&rda�ce v flh tl?e visions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. ,'''°7 dated Approved Design Flow ..Y gpd)
Installer 40//
Designer: MQ,Ue P 4- r► Inspector: Date:
The issuance of this permit shall not be construed as a gu tee that the system will function as designed.
No. T "0- J -- -- - - - FEE 0.0
Ir, -2 97 COMMONWEALTH OF MASS C14USETTS
Board of Health, ��t�tli MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( k Upgrade( ) Abandon( ) an individual sewage disposal system
at Q1 9 Cuki CXrd RA2Q a as described in the application for
Disposal System Construction Permit No. /5--->- r7 �, dated'1�
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Provided: Construction shall be completed within th - *0f the date, of this per it^ All local con ' 'ons must be met.
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Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadesfown, MA � Date[ a�.)Board of�alth
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' No.:BOHDGIS-6233 "
Commonwealth of Massachusetts Fee ';
$55.00 �
Board of Health, Yarmouth, MA '
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERNIIT
Application for a Permit to:Upgrade-Individual Component(s)
Location: 29 OUTWARD REACH,YARMOUTH, MA 02675 Owner: :
PALAIMA EDWARD A
Map/Parcel#: 125.86 29 OUTWARD REACH
YARMOUTH PORT,MA 02675
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
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Type of Building:Dwelling Lot Size: 12,632.00 Sq.Ft. �
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Dwelling-No.of Bedrooms:3 Garbage Grinder: ;
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Other Type of Building: No.of persons: S6owers: �
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Other Fixtures: i
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Plan Date: 10/28/2015 Number of Sheets:2 Cafeteria•
Tit1e:SEPTIC SYSTEM REPAIR PLAN 29 OUTWARD REACH Revision Date: i
' Design Flow(min.required):330 gpd Calculated design flow:330 gpd Design flow provided:342.25 gpd j
Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation: 10/08/2015 '
DARREN MEYER,R.S.
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DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK,H-20 DBOX,2 ;
-500 GAL PRECAST H-20 LEACHING CHAMBERS W/4'STONE:25'X 12.5'X 2' �
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 Certificate of Comuliance 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 ass.00
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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: PALAIMA EDWARD A
29 OUTWARD REACH
YARMOUTH PORT,MA 02675
Location:29 OUTWARD REACH,YARMOUTH,MA 02675
Disposal System Construction Permit No.: BOHDGIS-6233,Dated:December 22,2015
Provided:Construction shall be completed within six months of the date of this permit. All local wnditions must be met.
CONDITIONS:
1. SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK, H-20 DBOX,2-500 GAL PRECAST H-20
LEACHING CHAMBERS W/4'STONE:25'X 12.5'X 2'
2. MFC VARIANCE APPROVAL:a. DEPTH OF LEACH FACILITY
3. BOH TO INSPECT SOIL REMOVAL
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Bruce G. rphy,MPH, 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. �
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