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App-Permit-Compliance
No. �S�Z'77 �`L,DTj2�'I '�O / N���6y FEE `P v W7//// COMMONWEALM OF MASSACHUSETTS Board of Health , MA. APPLICATI®N FOP, DISPOSAL SYSTEM CO711�0p, TRUCTION PERMIT Application for a Permit to Construct Rep ir() Upgrade( ) Abandon( -te � stem ❑ Individual Components CC .76,/� �//''.��� /�Yi/���/ate „��ls�l��"� Location �� Owner's Name ---/-,-,n Map/Parcel# ! AddressIbR)C Lot# Telephone# Installer's Name P 11 Designer's Name",' ' G Address3 �� o & rh a� Address /�~ _ 46 Telephone# ci Telephone# 5-0g�© Type of Building k ez Lot Size sq. ft. Dwelling - No. of Bedrooms Garbage grinder ( ) Other - Type of Building No. of persons Showers( ), Cafeteria ( ) Other Fixtures Design Flow (min.. req%fired) gpd Calculated design flow Design flow provided -d7- gpd Plan: Date , c2ho 1—)o ts/ Number of sheets --3 Revision Date Title — / (W i Description of Soil (s) Soil Evaluator Form No. DESCRIPTION OF REPAIRS OR Name of Soil Evaluator Date of Evaluation The undersigned pgrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees tcrnot t the=operation until a Certificate of Compliance has been issued by the Board of health. Signed• Date 061 6 ' .r -�/ COMMONWEALTH OF MASSACHUSETTS FEE Board of Health,, MA. I l CERTIFI��E OF COMPLIANCE Description of Work: L3 Individual Components) ®Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed, Repaired ( )> Upgraded k, Abandoned( ) by: at has been installed i cc rd zce with the provisions of 310 CMR 15.00 (Title 5) and thea proved design plans/as-built plans relating to application No, J 2 ted . Approved Design Flow (gpd) Installer -40 t PAro IrLe P �[ Designerc777/1'1 n 1 0,p -t 1 1 0 be construed as a guaran that Inspector: Date: The issuance of this permit.shall not the system will function as designed. t'.,.:0-1`C.1•CIIGC'1ur.r,P0130U."; (.:_C: '?, C^.VD<.'C i. �__Y_f Com! l_i?.;JCC Oy�C.v UO(^'JCSC` f_C+;GOGJO'..0.(?UUGG<�>CUOOC7GOO.c`nOLO�'tYr Yy"C+'tiQOC. No. b p � F � / 1 �"I FEE COMMONWEALTH Of MASSACHUSETTS Board of Health, V n 1 ] Tl;- MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Con at Repair( ) Upgrad4(/) Abandon( pl— an individual sewage; disposal system t;; _ as described in the application for Disposal System Construction Permit No//-��'/""` i /, z3ated r� Provided: Construction shall be complefeeYwi& f the date of this permit. ) local conditions must be met. Form 1255 Rev. 5/96 A.M. Sulkin Coy. Charlestown. MA Date •4 ' / l7�' \J Board of Health • No.:BOHDC-15-2399 Commonwealth of Massachusetts Fee $710.00 ' Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to:New Construction-Complete System Location: 236 CENTER ST,YARMOUTH, MA 02675 Owner: JAMESON LARRY J Map/Parcel#: 140.45 JAMESON CATHY A 39 HICKORY DR MAPLEWOOD,NJ 07040 Phone: Septic System Installer Designer PKM CONTRACTORS, JM O'REILLY&ASSOCIATES INC. P.O. BOX 175 EAST DENNIS, MA P.O.BOX 1773 02641 BREWSTER,MA 02631 Phone: (5081896-6601 Type of Building:Dwelling Lot Size: 124,582.00 Acres Dwelling-No.of Bedrooms: 1 Garbage Grinder: Other Type of Building: No.of persons: Showers: Other Fixtures: Plan Date:02/10/2015 Number of Sheets: 1 Cafeteria: Title:PROPOSED SITE&SEPTIC SKETCH PLAN 236 CENTER STREET Revision Date: Design Flow(min.required): 110 gpd Calculated design flow: 110 gpd Design flow provided:550 gpd Description of Soi1s:SEE PLAN Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation: 12/02/2014 , KEITH FERNANDES,P.E. DESCRIPTION OF REPAIRS OR ALTERATIONS:NEW-2000 GALLON MONO WATERPROOFED TIGHT TANK FOR DEMO/RECONSTRUCTION OF 1 BEDROOM ACCESSORY COTTAGE 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 oneration until a Certificate of Comoliance has been issued 6v the Board of Health. Signed Date Inspections �. Commonwealth of Massachusetts Board of Health, Yarmouth, MA Fee DISPOSAL SYSTEM CONSTRUCTION PERMIT 5710.00 Permission is herby granted to; PKM CONTRACTORS, INC., P.O. BOX 175, EAST DENNIS, MA 02641 To perform:New Construction an individual sewage disposal system. Owner: JAMESON LARRY J JAMESON CATHY A 39 HICKORY DR MAPLEWOOD,NJ 07040 Location:236 CENTER ST,YARMOUTH,MA 02675 Disposal System Construction Permit No.: BOHDC-15-2399,Dated:July 27,2015 Provided: Construction shall be completed within six months of the date of this permit. All local conditions must be met. Conditions 1. NEW-2000 GALLON MONO WATERPROOFED TIGHT TANK FOR DEMO/RECONSTRUCTION OF 1 BEDROOMACCESSORYCOTTAGE 2. TIGHT TANK PER BOHAPPROVAL 02/09/201 S-MAXIMUM 1 BEDROOM 3. ENGINEER TO INSPECT AND CERTIFY ,/'" r / '� ,l Bruce G. MurpJ�y, H, R.S., CHO/Amy L. von Hone, R.S., CHO Health Director/Assistant Health Director ✓x The issuance of this permit shall not be construed as a guarantee that the system will function as designed.