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HomeMy WebLinkAboutApp-Permit-ComplianceNo. S'2_0273 W/COM'MONWEALTH OF MASSACHUSETTS FEE `V���� -� `BOARD OF HEALTHOF F� APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTIO Application for a Permit to Construct( ) Repair ( ) Upgrade (< Abandon( ) - [-]Complete System ❑ Individual Components Location Map/Parcel # P i) l+r'l t nfi^ cc.t Ute 5L nstaller's Nam 3 f,� �o Kum Telephone # A 45 DA.y-.np©rf laea[AIA t tIC �" 94SSQ -D"-j Telephone # 1901-3 �'C,t.r_u f— es ms's NaV OeAn I s Telephone # Type of Building: ` l e41 11'1 Lot Size Z 0 -7Q,,Sq. feet Dwelling — No. of Bedrooms Garbage Grinder ( ) Other — Type of Building No. of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow (mi . req ired) -/ ' '� gpd Calculated de n flow gpd Design flow providedpd Plan: Date Numbed of shegts Revision Date Description of Soil(s) I Mfl1 — ►sh t Soil Evaluator Form No. Name of Soil Evaluator �' Date of Evaluation DE IPTION OF REPAIRS OR ALTERATIONS v / X"qQ b The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees not to place the syslem in operation until a Certificate of Compliance has ee issued 4y the Boarof Health. Signed 091X. DateA-4,�&J - .n -7i7 -Z C _NA, / //d �1L JAJI✓A s FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 `-----` �i' M� 0RIX.--{S'-2-0 THE OF MASSACHUSETTS FEE i'S �"" 00 No. /�; -" R 7 BOARD OF HEALTH C,,kit' 15-3.7 -7 CERTIFICATE OF COMPLIANCE Description of Work: ❑ 'Individual Component(s) Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired (. ), Upgra&d'Abandoned ( ) Cfn6�6 ri r Arolat C7� has been installed in accordance with the provisions of 310 CMR 00 (Title 5) and the approved design plans/ uilt plans relating to application No. da d 57/� l Approved Design Flow 'ice d) Installer �%t�l\'C> C "C Q/r Designer:LA)QeVS?(_ E()Cilre' Qti Inspector Date rff rf 4 The issuance of this certificate shall not be construed as a gu onfee that the system willyunction as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP A4ROVED FORM 5/96 No. 00 X f —2-020 THE COMMONWEALTH OF MASSACHUSETTS FEE isy. GQ � � c�z -� 153? ? 7 f�l(,("(-Ij BOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to Con t ( Repair ( ) Upgrade (K() Abandon ( ) an individual sewage disposal system at 6°7 `� 9 nC� i2� /``�� as described in the application for Disposal System Construction Permit No. Provided: Construction shall be completed within thre__ e�€ the Date �J�`7 �� (bWA a d ; dated ate of this per Allopafl conditions mu be met. of Health FORM 2 - DSCP DEP APPROVED FORM 5/96 FORM 1255 (REV 5/96) H&W HOBBS& WARREN TM PUBLISHERS - BOSTON No.: BOHDC-15-2023 ' Commonwealth of Massachusetts Fee Ess.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERNII'P Application for a Permit to:Upgrade-Individual Component(s) Location: 59 JOEL RD,YARMOUTH, MA 02675 Owner: DAVENPORTDEWITTIR Map/Parcel#: 10821 DAVENPORT REALTY TRUST 20 NORTH MAIN ST SOUTH YARMOUTH,MA 02664 Phone: Septic System Installer Designer PKM CONTRACTORS, SWEETSER ENGINEERING P.O. BOX 175 EAST DENNIS, MA P.O.BOX 713 02641 SOUTH DENNIS,MA 02660 Phone: (5081385-6900 Type of Building:Dwelling . Lot Size:25,700.40 Acres Dwelling-No.of Bedrooms:4 Garbage Grinder: Other Type of Building:DUPLEX No.of persons: Showers: Other Futures: Plan Date:0423/2015 Nurober of Sheets: I Cafehrie: TitIe:PROPOSED SEPTTC DESIGN 57/59 JOEL ROAD Revisioo Date: Design Flow(min.required):440 gpd Calculated desigo flow:440 gpd Design Flow provided:463.48 gpd Description of Soi1s:SEE PLAN Soil Evaluator Form No.: Name ot Soil Evaluator. Date of Evaluatioo:04/23/2015 ROBIN WtLCOX,PLS DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-EXISTING 1000 GAL SEPTTC TANK,PROPOSED 1000 GAL SEPTTC TANK,DBOX,6 HIGH CAPACITY INFILTRATORS W/STONE:48'X I1'X 10" The unde�signetl agrees to install the above described Indivitlual Sewage Disposal System in aceordance wRh the provisions of TITLE 5 antl further aarees not to olace in ooeration untll a Certiticate of Comoliance has heen issued 6v the Board of Neakh. Signed Date Inspections � , Commonwealth of Massachusetts Board of Health, Yarmouth, MA Fee DISPOSAL SYSTEM CONSTRUCTION PERMIT E55.00 i Permission is herby grattted to; i PKM CONTRACTORS, INC., P.O. BOX 175, EAST DENNIS, MA 02641 To perform:Upgrade an individual sewage disposal system. Owner. DAVENPORTDEWITTTR DAVENPORT REALTY TRUST 20 NORTH MAIN ST SOUTH YARMOUTH,MA 02664 Location: 59&61 JOEL RD, YARMOUTH,MA 02675 Disposal System Construction Permit No.: BOHDC-1�2023 ,Dated: May 19,2015 Provided: Construction shall be completed within six months of the date of this permit. All local conditions must be met. Conditions l. BOH TO INSPECT SOIL REMOVAL 2. REPAIR-EXISTING 1000 GAL SEPTIC TANK, PROPOSED 1000 GAL SEPTIC TANK, DBOX, 6 HIGH CAPACTlY INFILTRATORS W/STONE: 48'X 11'X 10" 3. ZONE II A�XIMUM 4 BEDROOMS �v Bruce G. Mu y, PH, R.S., CHO/Amy L. von Hone, R.S.,CHO ealth Director/Assistant Health Diredor The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Commonwealth of Massachusetts Board of Health, Yarmouth, MA Fee CERTIFICATE OF COMPLIANCE sss.00 Description of Work:Individual Component(s) The undersigned hereby ceRify that the Sewage Disposal System; Upgraded by:PKM CONTRACTORS,INC. at:59&61 JOEL RD,YARMOUTH,MA 02675 Has been installed in accordance with the provisions of 310 CMR 15.00(TiUe 5)and the approved design plans or as-bailt plans relating to application No.: BOHDC-15-2023,dated 06/11/2015. Installer.PKM CONTRACTORS,INC. Address:P.O. BOX 175 EAST DENNIS,MA 02641 Inspector:AMY VON HONE,R.S. Designer: SWEETSER ENGINEERING � Conditions 1.BOH TO INSPECT SOIL REMOVAL 2.REPAIR-EXISTING 1000 GAL SEPTIC TANK,PROPOSED 1000 GAL SEPTIC T AN DBOX � , 6 HIGH CAPACITY INFILTRATORS W/STONE: 48'X 11' X 10" 3.ZONE II MAXIMUM 4 BEDROOMS � � Bruce G. M ,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. BO H_Disposal_Construction_CofC.rpt