HomeMy WebLinkAboutApp-Permit-ComplianceNo. �/� I -CS V ( FEE I 0 , OD
COMMONWEALTH Of NIASSAC�ItTSETTS �#►��8- s��
7,el Board o Health MA. '/ l; %
i/ -S APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( Repair( ) Upgrade( ) Abandon( ) :,,�mplete System O Individual Components
Locationc;2fie,
Owner's Name
Map/Parcel# � (��
Address - f MA
Lot# ,
Telephone# 60?— 393— a9
Installer's Name
Designer's Namef. #
g :5Wee
Address - /.314,16,m
Address - n r
Telephone# 668 — .—s Q 3
Telephone# 669 — 12t g— &900
Type of Building I
Dwelling - No. of Bedrooms
Other - Type of Building _
No. of persons
Lot Size Gl sq. ft.
Garbage grinder (410
Showers( ), Cafeteria ( )
Other Fixtures
Design Flow (min. req fired)LIggpd Calculated design flow Design flow provided gpd
Plan: Date_ Number of sheets Revision Date
Title
Description of Soil(s) _
Soil Evaluator Form No.
Name of Soil Evaluator
DESCRIPTION OF REPAIRS OR ALTERATIONS �Oc- :ras1 a r
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 no a to operation until a Certificate of Compliant has beeissued by the Board of Health.
Signed x•'MyW�K Date % r �D r
Inspections
No. �,. VX —.14— O(O� D .FEE
7COMMONWEALTH®F MASSACHUSETTS�� ��I C4 t- � SZ)
Board of Health, - O�)Tl4 , MA.
CERTIFICATE Of COMPLIANCE
Description of Work: El Individual Component(s) Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed k), Repaired ( ), Upgraded ( ), Abandoned ( )
by: #) Y
at
has been installed In a��rddnc provisions of 310 CMR 15.00 (Title 5) and the proved design plans/as buuilt plans relating to
application No. �/ dated�> / / /4 . Approved Design Flow and
Installer ►'1
Designer: , Sr/t' r jy . Inspector: Date:
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
- No.13Dc ` y 1 "G (o FEE 1 (Q- Q
-7 COMMONWEALT14 Of MASSACHUSETTS r� �c ��►�-v3s- �s�. �
Board of Health, y_&�6 un -1 , MA.
DISPOSAL SYSTLM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system
at c,2 & po �a11P kDt I �°- as described in the application for
Disposal System Construction Permit No. / 4 4 / ? , dated
Provided: Construction shall be comr6ted within three -fears of the date of this permit. All local conditions must be met.
:' 0
Form 12^55 Rev. 5/96 A.M. Sulkin Co. Cha/deeslown, MA (/�J Date
C/ �'Board of Health
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_s' �ompose h « �► � Dele[e �] Move . Q Spam v •^ More v - - * + X
�obo�cu "�2 Bowen Lane Septic Permit Fee '-
' Draks(31) �
Sent ���Na�e•AmY - DPC 5 dt 258 PM � . -
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irash
. � . we are in receipt af Ne septic permit packag=for the above address. Fhe pertnit(ee is 4110.00(new constroction)and we have
" Fold¢rs 555.00 on file. � �
251 koute 28 Chades... - �
qrphives � The easiest thing would be to submit an additiuirel check for 555.00(mail or drop off at offre is 9ne).
__ _ Dig Safe Please call or email with queZioPx _ . � . - . ___. -� � — —
"Smart Views Thanks,Amy .
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' $terred
People Amy L von Hone,R.S.,[.H.O.
Sociai Assistant Hea%h Director � - . . . . .
Shopping yarmouth Health Department .
. finance 1146 Route 26 �
� > Recem South Yartnwth,MA W664
� � (0)508-398-2231 X1I41
(F)SOBJ60-3472
avonhone@yarmouth.ma.us �
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UEC �fi"i 2014
- HEALTH DEPT.
�
No.:BOHDC-14-0660
Commonwealth of Massachusetts F�
� a„o.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to: New Construction-Complete System
� Location: 2 BOWEN LN,WEST YARMOUTH, MA 02673 Owner:
DAVENPORT BUILDING CO.
Map/Parcel#: 038.40 . DAVENPORT BUILDING CO.
� 20 NORTH MA[N STREET
SOUTH YARMOUTH 02675
Phone:
Septic System Installer Designer
PKM CONTRACTORS, S WEETSER ENGINEEffiNG
313 HOKUM ROCK ROAD EAST P.O.BOX 713
DENNIS, MA 02641 SOUTH DEAINIS,MA 02660
Phone: (5081385-6900
Type of Building:Dwelling Lot Size:021 Acres
Dwelliog-No.of Bedrooms:4 Garbage Grinder:
Other Type of Buildiog: No.of persons: Showers:
Other Fixtures:
Plan Date: (1/19/2014 Number of Sheets: l Cafehria:
TitIe:PROPOSED SEPTIC DES[GN 2 BOWEN LANE Revisioo Date: 12/]0/2014
Design Flow(min.rcquired):440 gpd Calculated design 11ow:440 gpd Design tlow provided:454.36 gpd
Description of SoiIs:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation: ll/19/2014
ROBIN WILCOX,PLS
DESCRIPTION OF REPAIRS OR ALTERATTONS:NEW-1500 GAL SEPTIC TANK,DBOX,4 HIGH CAPACITY INFILTRATORS W/
STONE AROUND AND BELOW:38'X 11'X 2'
The undenigned agrees to insfall the above tleseribed Individual Sewage Disposal System in accordanee wRh!he provisions of
TITLE b and furfher aareea not to olace In oceraHon un[il a CertiFitate of Comoliance has heen Issued hv the Bosrtl ot Hwkh.
Signed Date
Inspections
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA FBe
DISPOSAL SYSTEM CONSTRUCTION PERMIT s++o.00
Permission is herby granted to;
PKM CONTRACTORS, INC., 313 HOKUM ROCK ROAD, EAST DENNIS, MA 02641
To perform:New Construction an individual sewage disposal system.
Owner: DAVENPORT BUILDING CO.
DAVENPORT BUILDING CO.
20 NORTH MAIN STREET
SOUTH YARMOUTH 02675
Locarion:2 BOWEN LN,WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.: BOHDG140660,Dated: December 19,2014
Provided: Construction shall be completed within six months of the date of this permit. AII bcal conditions must be met.
Conditious
1.NEW- I S00 GAL SEPTIC TANK, DBOX, 4 HIGH CAPACITY INFILTRATORS W/STONE AROUND
AND BELOA'• 38'X 11'X 2'
2. BOH TO INSPECT SOIL REMOVAL
� �
Bruce G. Mu y MPH, R.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 will funMion as designed.