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HomeMy WebLinkAboutApp-Permit-ComplianceNo. �C—I �7" i$�� �--DO Vrj!� FEEr J� D�MMON EA TH OFASSAC14USETTS 3 / Bard of Health, APPLICATION OR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgradev Abandon( ) - Complete System ❑ Individual Components Location ce Owner's Name 8ar&G( a' -d oe-r— Map/Parcel# - r Address Lot# Telephone# soE� - 9,39-194 Installer's Name S ir, G Designer's Name C6 4 Address I� _ Address Telephone# SO9— 9 5r Telephone# q _ 9O0 Type of Building ! V__G i d U n 4 Gt / Lot Size 2-9 sq. ft. Dwelling - No. of Bedrooms Garbage grinder ( ) Other - Type of Building No. of persons Showers ( ) , Cafeteria ( ) Other Fixtures z Design Flow (min. required)© gpd Calculated design flow Z% Design flow provided / gpd Plan: Date M q I I q Number of sheets 4 Revision Date Title iAer Description of Soils) _ Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS '-) P_G i77 r,, l.i�It 4-1 D 4 The undersigned,agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees toinot to xe�eration until a Certificate of Compliance has�n issued by the Board of Health. Signed • Date 1.20 a Inspections No. bo FEE C ._ COMMONWEALTH OF MASSAC14USETTS Board of Health, , MA. �u Tf''bl/ltjJL d� CERTIFICATE Of COMPLIANCE %3LAP.� ttia�i3Z �� Description of Work: ❑ Individual Component(s) ❑ Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired ( ),Upgraded, Abandoned ( ) by: l'on4rA cft /S atlue— 12ocIC "Q& Fav ��-,. -/ � x� has been installed in accorsdance with fhe rovisions of 310 CMR 15.00 (Title 5) and the a proved design plans/as-built plans relating to application N(o�.�/O�i' � / , dated � , �� . Approved Desigrt'Flow i�%���(gpd) > Installer P� tai 00/r ra cfDrs J-4 C.- zj: y _2: 1 __ '7iTGirr%s% /�s�'✓✓ 0 Designer: �t. 15 %j Inspector: C Y Date: The issuance of this permit shall not be construed as a guar a that the system will function as designed. .• r _ ('OU GO_OC 00'-.. - --... .•,� �n G_COn OOOCOC� �_OOOGOOO Gnt)00')YJ O.O:)C.^C O: COOO DOO-OOCO^090-0.000_Q OO,:?.1105]9000gC_ No. 1900" D C. .. 65 —19,53 Pico FEE 557, 00 _ C®MMON LTH OF MASSACHUSETTS ��� 1534�B Board of Health, YMAI D VTO , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; CoIn//s��truct( Repair( ) Upgrade k Abandon( ) an individual sewage disposal system l at 1u e. � 04a Q J) as described in the application for Disposal System Construction Permit No. A;- , dated 4 / C �-/S�3 Provided: Construction shall be completed within tl�e�+e __ s o Sate of this pe71' iAll local conditions must be met. /Form 1255 /Rev. 5/96 A.M. Sullkkkiiinn�Go. Chadestm, MA Date �� / Board of ealth )Ll 1 �/.iii l' �f • ' No.: BOHDC-15-1853 Commonwealth of Massachusetts F� sss.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to:Upgrade-Complete System Location: 56 BLUE ROCK RD, SOUTH YARMOUTH, MA 02664 Owner: GARDINER BARBARA A TR Map/Parcel#: 110.48 SILVA FAMILY TRUST 56 BLUE ROCK RD SOUTH YARMOUTH,MA 02664 Phone: Septic System Installer Designer PKM CONTRACTORS, CIVIL ENGINEERING ASSOCIATES P.O. BOX 175 EAST DENNIS, MA P.O.BOX 916 02641 DENNIS,MA Phone: (4131246-9804 Type of Building:Dwelling Lot Size:24,82920 Acres Dwelling-No.of Bedrooms:3 Garbage Grinder. Other Type of Building: No.of persons: Showers: Other Fixtores: - Plan Date: 12/04/2014 Number otSheets:4 Cafeteria: TitIe:PROPOSED SEWAGE DISPOSAL SYSTEM 56 BLUE ROCK ROAD Revision Date: Design Flow(min.required):330 gpd . Calculated design f1ow:330 gpd Design Oow provided:333 gpd Description of Soi1s:SEE PLAN . Soil Evaluator Form No.: Name of Soil Evaluaror. Date of Evaluation: 12/03/2014 JILL CAFARELLI,R.S. DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR- I500 GAL SEPTIC TANK,DBOX, I S'X 30'LEACH FIELD . The untlersigned agrees to insWll the above described Intlividual Sewage Disposal System in accortlance with the provisions of TITLE 5 and further aarees not to olace in oueration until a CertificaM of Comollance has been issued hv the Board of Health. Signed Date Inspections Commonwealth of Massachusetts Board of Health, Yarmouth, l�lli Fee DISPOSAL SYSTEM CONSTRUCTION PERMIT $55.00 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. GARDINER BARBARA A TR SILVA FAMILY TRUST 56 BLUE ROCK RD SOUTH YARMOUTH,MA 02664 Location: 56 BLUE ROCK RD, SOUTH YARMOUTH,MA 02664 Disposal System Construction Permit No.: BOHDC-1S1853 ,Dated: May 08,2015 Provided: Construction shall be completed within six months of the date of this permit. All loca]condi[ions must be met. Conditions 1. REPAIR- 1 S00 GAL SEPTIC TANK, DBOX, 1 S'X 30'LEACH FIELD 2. SOILS TO BE VERIFIED PRIOR TO CONSTRUCTION 3. ZONE II MAXIMIJM 3 BEDROOM 4. PLUMBING PERMIT REQU7RED � Bruce G. M hy, MPH, R.S., CHO/Amy L.von Hone, R.S.,CHO �Health 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 F� CERTIFICATE OF COMPLIANCE ass.00 Description of Work:Complete System The undersigned hereby certify that the Sewage Disposal System; Upgraded by: PKM CONTRACTORS,INC. at:56 BLUE ROCK RD, 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-1�1853,dated 06/02/2015. Installer:PKM CONTRACTORS,INC. Address:P.O.BOX 175 EAST DENNIS,MA 0264] Inspector:AMY VON HONE,R.S. Designer.CIVIL ENGINEERING ASSOCIATES Conditions 1.REPAIR- 1500 GAL SEPTIC TANK,DBOX,15'X 30' LEACH FIELD 2.SOILS TO BE VERIFIED PRIOR TO CONSTRUCTION 3.ZONE II MAXIMUM 3 BEDROOM 4.PLUMBING PERMIT REQUIRED V�-�f Bruce G. Murphy PH, .S., CHO/Amy L.von Hone, R.S., CHO Health Director/Assistant Health Diredor The issuance of this permit shall not be construed as a guarant hat the system will funMion as designed. BO H_Disposal_Construction_CofC.rpt