HomeMy WebLinkAboutApp-Permit-ComplianceNo. &ooc (T— b 375—
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COMMONWEALTH Of MASSACHUSETTS joe
Board of Health, Y MD LT , MA. 6o 1 3 0 5
APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair() UpgradekAbandon( ) - ,AComplete System ❑ Individual Components
Location UerS
Owner's Name
Map/Parcel# (Q
Address
Lot#
Telephone#
Installer's Name P 0 Ad&a
Designer's Name um
Address ;313140LUM_ t .S
Address R 39 /Y)at in F
Telephone# SQ$ —
Telephone# ,508 —& ,,,;l -- S
Type of Building Lot Size R— sq. ft.
Dwelling - No. of Bedrooms Garbage grinder ( )
Other - Type of Building No. of persons Showers ( ) , Cafeteria ( )
Other Fixtures 7
Design Flow (ming. required) gpd Calculated d sign flow. 3�_ Design flow provided 7 gpd
Plan: Date (I3 aO Number of sheets Revision Date
Title
Description of Soil(s)
Soil Evaluator Form No.
Name of Soil Evaluator
DESCRIPTION OF REPAIRS OR ALTERATIONS r I Ct I )
Date of Evaluation
The unde i Red agrees to install the abo a described Individual Sewage Disposal S , tem m accordance with the provisions of TITLE 5 and
further o t t m operation until a Certificate e as been issued by the Board of health.
Signed Date
Inspections
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No. 1 u ();l S FEE 00
COMMONWEALTH Of MASSACHUSETTS
Board of Health, VA MO JYM , MA. t
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: P
at
has been installed in c or44e'tith the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. atedq Approved Design Flow (gpd)
Installer 6
Designer: Chu)4 Cn.�n, -e !: A .-- Inspector: � Date: %�Z � �✓'�
The issuance of this permit shall nof a construed as a guarantee that the system will function as designed.
�1�. .,C, 1, i C'U
No. t_ C 14-637-5- T FEE $3 $77
COMMONWEALTH OF MASSACHUSETTS 4 C *
Board of Health, VAOM Ulu
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is herebygranted to; Construct( .) Repair( ) Upgrade( Abandon( ) an individual sewage disposal system
at ,(1� _W , % 1 as described in the application for
Disposal System Construction Per it Nq -% 7 dated ��
Provided: Construction shall be completed �'fhin > ffi'e 1e%f this permit. All local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown, MA Date ! T .� Board of Health
� No.: BOHllC-14-0375
Commonwealt6 of Massachusetts F�
. ass.00
Board of Health, Yarmouth, MA.
APPLICATION FOR DISPOSAL SYSTEM CCINSTRUCTION PERMIT
Applicafion for a Permit to:Upgrade-Complete System
LocaHon: 39 WEBBERS PATH,WEST YARMOUTH, MA 02673 Owner
Map/Parcel#: p86.150 Name:
VIR,LfNDA
Address:
� 39 V4EBBER5 PATH WEST YARM4UTH, N1A
026�3
Phex�e:
Septic System Installer
Name:
PKM C4NTRACTORS,INC.
Address:
313 HOKUM ROCK ROAO EA5T
DENNIS, MA 02641
Phone'
. Type o[Building:I}welling Lot Size:0.20 sq.ft.
llwelfiag-Na of Bedruoms:3 Gsrbage Grindsr.
Othu'Lype af BuiWing: No.of persoas: 5howers: Csftteris:
pt6er Fiatuces:
Plart Date:04l03f2Q14 Number of Sheets: t
� TitIe:TI7'LE 5 SITE PLAN OF 39 WEBBERS PATH Revisioa Date:
.. Design Flow(min.required):330 gpd Calaulated desigo flow:330 llesign flow provided:349 gpd
BPd
', Descripiion otSoils:SEE PLAN
5ni1 Evsluatnr Form No.: Name of Soil Evaluator: Date of Evaluation:09/03/2014
DAIVIEL GONSALVF,S,SE
DF,3CRIPT76N OF REPAIRS 4R ALTERATION5: I500 GAL SEPTIC TANK
6BOX
- 2-56p GAL PRECAST CHAMBERS W/4'STONE:
2S'X]2.83'X 2'
lrie undersigned agrees to install the abova deseribetl IndNltlual Sewage Disposal System in accordanee wMh the provisions
M TIttE 5 antl further aprees not ta plaee In overetion vnqf a Certificate�Compiiance has Oeen issuetl by tift Boatd of t#eaith
Signed Date
Inspecrions
Commonweaith of Massachusetts
' Board of Health, Yarmouth, MA. Fee
DISPQSAL SYSTEM CONSTRUCTION PERMIT =�•04
Parmission is herby granted to;PA1'RICK K.MCDOWELL Address:3 t3 HOKUM ROCK ROAD
EAST DENNIS,MA 02641
To perform:Upgrade an individual sewage disposal system.
4wner: VIA,LlNDA
39 WEBBERS PA1H
WEST YARMOUTH,MA 02673
Location:39 WEBBERS PATH,WEST YARMOUTH,MA p2673
Dispasal System ConshucYion Permit No.:Bt}HDC-lA-037S,Dated:September 30,20t4
Providsd:Constru.etion shali be completed wiThin six months of the date of th'ts permit. Atl local conditions must be met.
Conditions
' L Znne!1 Mciximum 3 Bedraoms
' 2. I300 gal Septic Tank, DBax, 2-S00 gal Precast Chambers w/4'Stone:25'x 12.83'x 2'
�-'(
Bruce G. M ,MPH, R.S.,GHO/Amy L.van Hone,R.S.,CHQ
��, Health Director/Assistant Health Directpr
The issuance of this permit shall uot be construed as a guarantee tNat t6e system will funcHan as designed.
Commonwealth of Massachusetts
Board af Health, Yarmouth, MA. F�
CERTIFICATE QF COMPLIAIYCE ��-4°
Description of Work:Complete System
The undersigned hereby ceRffy that the Sewage I}ispasal System; Upgraded
by:PKM CONTRACI'QRS,INC.
at:39 WEBBERS PA1'H, WEST YAKMOUTH,MA 026?3
Has been installed in accardance with the provisions of 310 CMR I5.00(TiUe 5)and the approved
design pians or as-b¢ilt plans relating to applicatian No.: BOHDC-14-0375,dated 10/p4/2p14.
Installer:PKM CONTRACTORS,INC.
Address3 t 3 HOKUM ROCK ROAD EAST DENNIS, Inspector.AMY VON HONE, R.S.
MA 02641
Designer:DOWN CAPE�NGINEERING,INC.
Conditions
1.Zone II M�ximum 3&edrnoms
2.1566 al Se tic Tank DBox 2-500 al Pr ast Chambers wJ 'S ne:25' x 12.83' x 2'
v
Bruce G. M hy, MPH, R.S., CHO/Amy L. von Hone, R.S., CHO
Health Director!Assistant Hea�th Director
The issuance of this permit s6aii not be construed as a guarantee that t6e system will function as designed.
BOH_pisposal_Construction CofC.rpt