HomeMy WebLinkAboutApp-Permit-ComplianceNo. b ok*Dc - l S'i `t 't'°0 2 -
GL -DT 7--IL-00151
COMMONWEALT14 OF MASSAC14USETTS
FEE -4 S5�
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14C f�l Board of Health, Q LM4�_, MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION /PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade(y Abandon() - U Complete System,.l�lIndividual Components
Location v
�Q n
` el Owner's Name l�r4l
Map/Parcel# /Q/
Address� 'y G
Lot#
Telephone# - 394 - 1
Installer's Name N�
�-' Designer's Name �der �
Address /• 3 14oXwnti
.
^ LL^ ` y� Address _ -
Telephone#s
Telephone# - '
Type of Building
Dwelling - No. of Bedrooms _
Other - Type of Building
Other Fixtures
Design Flow (min. required)
Plan: Date rl
� 0 w,I r
Title �
Description of Soil(s) Ao
Soil Evaluator Form No.
DESCRIPTION OF REPAIRS
a
No. of persons
Lot Size 3 sq. ft.
Garbage grinder ( )
Showers ( ), Cafeteria ( )
gpd Calculated design flow Design flow provided gpd
Number of sheets Revision Date
7 f 42
Name of Soil Evaluator / nO Date of Evaluation
171C,AC_1c401 PE
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TrfLE 5 and
further agrees to notxtheo operation until a Certificate of Compliance has been issued by the Board of Health.
Signed ' Date '
Inspections
l S -C r—� — oc-e-e OA --d
No. Bo vG-f s'q 4,OZ FEEoQ
COMMONWEALTHCOMMONWEALTHCOMMONWEALTH®f MASSACHUSETTS
R t S-ler� OV1 c.d 11
Board of Health, YAAMOOMA , MA.`
CERTIFICATE Of COMPLIANCE Zaf,.-Z7--
Description of Work: AIndividual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded Abandoned( )
by:
at
has been install divnfaccor�1ance Atfit a provisions of 310 CMR 15.00 (Title 5) and the approved design plans/a wilt plans relating to
application No. dated //- .:) -/Approved Design Flow (gpd)
Installer d V y Y it C' n4rr.rC--f-A...S_ _ -71""n G . PA Tiz &- V, Kr. be)t k)f;u, ,
Designer: 4X-�- KiInspector: Date: t 1 1 d t-31
The issuance of this permit shall not'b onstrued as a guarantee that the system will function as designed.
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No. ,�"�!'rU�"'"i '7 �i P Kh FEE.
COMMONWEALTH LTH ®F MASSACHUSETTS
i Board of Health, Y A:4motiT14 , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct(
at lei t dra d?'1 f�� ✓
Al
Repair( ) Upgrade (o Abandon( ) an individual sewage disposal system
as described in the application for
2-1
Disposal'System Construction Permit No. ��, dated 1-
Provided: Construction shall be compie`ted within f the date of this pgrn t. , l local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date// Board of Health
No.:BOHDC-15-4462
� Commonwealth of Massachusetts Fee
$55.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Individual Compouent(s)
Location: 55 MIDSTREAM DR, SOUTH YARMOUTH,MA 02664 Owner:
PASHOIAN RICHARD S TRS
Map/Parcel#• 101.69 PASHOIAN ERNESTINE I TRS
� 55 MIDSTREAM DR
SOUTH YARMOUTH,MA 02664
Phone:
Septic System Installer Designer
PKM CONTRACTORS, BASS RIVER ENGINEERING
P.O. BOX 175 EAST DENNIS, MA P.O.BOX 1163
02641 EAST DENNIS,MA 02641
Phone: 508-385-3426
5083855993
Type of Building:Dwelling Lot Size: 17,860.00 Sq.Ft.
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building: No.of persons: Showers: '
Ot6er Fia�tures:
Plan Date:07/03/2015 Number of 56eets: 1 Cafeteria•
Tit1e:SITE PLAN 55 MIDSTREAM DRIVE Revision Date:
� Design Flow(min.required):330 gpd Calculated design flow:330 gpd Design flow provided:330 gpd
Description of Soi1s:SEE PLAN
� Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:OS/21/2015
THOMAS MCLELLAN,P.E.
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK,DBOX,3-500
GAL PRECAST CHAMBERS W/STONE 2.5'SIDES,2'ENDS:29.5'X 9.8'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 Certi£cate of Comoliance has been issued bv the Board of Heakh.
Signed Date
Inspections
i
Commonwealth of Massachusetts
� Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT ass.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: PASHOIAN RICHARD S TRS
PASHOIAN ERNESTINE I TRS
55 MIDSTREAM DR
SOUTH YARMOUTH,MA 02664
Location: 55 MIDSTREAM DR,SOUTH YARMOUTH,MA 02664
Disposal System Construction Permit No.: BOHDGIS-4462,Dated:November 02,2015
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,3-500 GAL PRECAST
CHAMBERS W/STONE 2.5'SIDES,2' ENDS:29.5'X 9.8'X 2'
2. MFC VARIANCE APPROVAL a. SETBACK DISTANCE TO PROPERTY LINE
3.ZONE II MAXIMUM 3 BEDROOMS
�
Bruce G. Murp y, PH, R.S.,CHO/Amy L.von Hone, R.S.,CHO
r alth Director/Assistant Health Director
The issuance of this permit shall not be construed as a guarantee t6at the system will function as designed.
� �_;
�
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.
at: 55 MIDSTREAM DR,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-15-4462,dated 11/20/2015. '
Installer:PKM CONTRACTORS,INC.
Address:P.O.BOX 175 EAST DENNIS,MA 02641 Inspector:BRUCE MURPHY,R.S.
Designer:BASS RIVER ENGINEERING
Conditions
1.SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK,DBOX,3-500 GAL
PRECAST CHAMBERS W/STONE 2.5' SIDES,2'ENDS:29.5'X 9.8'X 2'
2.MFC VARIANCE APPROVAL a.SETBACK DISTANCE TO PROPERTY LINE
3.ZONE II MAXIMUM 3 BEDROOMS
U�
Bruce G. Murphy,MP , .S., CHO/Amy L.von Hone, R.S.,CHO
ealth Director/Assistant Health Director
The issuance of this permit shall not be construed as a guarantee that the system wiil function as designed.
BOH_Disposai_Construction_CofC.rpt