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HomeMy WebLinkAboutApp-Permit-ComplianceNo. &WPC -154 /7-77 COMMONWEALTH 1LTH O MASSACHUSETTS aL0 1 P—s —0049() Board of Health, YtAtZMOM4 , MA. APPLICATION FOR DISPOSAL SYSTEM CON TRUCTI®N FEE I IL�r W1 91 FlEAL-RA DEPT. Application for a Permit to ConstructyQ Repair( ) Upgrade( ) Abandon( ) - Complete System ❑ Individual Components Location&q ket Owner's Name Map/Parcel# Address Lot# Telephone# 22—'-:W& Installer's Name&and= Designer's Name 1A Address. ^ 04n • Address GJ' n Telephone# 13' 3� Q Telephone# zza— Type of Building I Dwelling - No. of Bedrooms Other - Type of Building _ Other Fixtures Lot Size sq. ft. Garbage grinder ( ) No. of persons Showers ( ), Cafeteria ( ) Design Flow (min requir d) _ gpd Calculated designow Design flow provided gPd i 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 _ The uni further Signed Inspections Date of Evaluation to in the above des Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and pla a system.' ope tion til a Certificate of ompli ce has been issued by the Board of Health. Date t"J . 5, No. bobc--1 5-+52-77 FEE km V. 00 r = COMMONWEALTH ®f MASSACHUSETTS �- Board of Health,Z4dlO1J'J'°4 , MA. CERTIFICATE Of COMPLIANCE Description of Work: ❑ Individual Component(s) ❑ Complete System The undersigned hereby certify that the Sewage Disposal System; ConstructedRepaired ( ), Upgraded ( ), Abandoned ( ) by: Pt" &fit M'0a4 rS irl � at HR has been installe A0 0 12 i at o ancr�with 1 ovisions of 310 CMR 15.00 (Title 5) and thea roved design plans/as-built plans relating to application(N�o.� X datted`-4 7-�/^�. Approved Design Flow�4 pd) Installer ti~'lt-/11 �_o/�t f�G�i�("S J +1 C— '..? 1 Designer: -Sumtse rjjq Inspector: l.�'�--�� Date: ✓� The issuance of this permit shall not be cons d as a gua antee that the system will function as designed. VC9Gir ,Cb'�?oJ UD�LLGno'OO O J.—.J o60, ,^ ?*o0,0")ao'C. O O C• O o 4, C. o o r, c, o G o 0�` p oCr)�� CC,,. -o M1O"»-p ei r,-3c.�U(�o(."1-, 0 o n<��T? t'-©-ciO C�ce]O oc, Cin eOC>' J�,_..t, o 0 f��s�7:i^"CS Jv No. KP C. �� f -� ` ["� FEE / C®�l MON ALT14 Of MASSACHUSETTS WI's -.2.,00 Board of Health, Y1 P -M O Uzi{ , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct,. Repair( ) Upgrade( Abandon( ) an individual sewage disposal system at as described in the application for' Disposal System Construction Permit No. %tel , dated -7 Provided: Construction shall be completed within iftre&Teftrs of the date of this permit. l local conditions must be met. oe % / n Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown, MA Date /7 /;Board of ealth No.:BOADC-15-1527 � � Commonwealth of Massachusetts F� a++o.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERNIIT Application for a Permit to:New Construction-Complete System ' Location: 64 HEMEON DR,WEST YARMOUTH, MA 02673 Owner: MILLER ROBERT F 7RS Map/Parcel#: 038.87 MILLER VIOLA E TRS 21 WELLESLEY AVE NEEDHAM,MA 02194-1821 Phone: SepNc System Installer Designer PKM CONTRACTORS, SWE 313 HOKUM ROCK ROAD EAST P.O.BOX 713 DENNIS, MA 02641 SOUTH DENrIIS,MA 02660 Phone: (508)385-6900 Type of Building:Dwelling Lot Siu:0.38 Acres I Dwelling-No.of Bedrooms:4 Garbage Grinder: ( Other Type of Building: . No.of persons: Showers: I I Other Fiztures: �, Plan Date:03/25/2015 Number of Shats: 1 Cafeteria: '�. II Tit1e:PROPOSED SEPTIC DESIGN 64 HEMEON DRIVE Revisioo Date: I Design Flow(mio.required):440 gpd Calculated design ilow:440 gpd Design flow provided:463.48 gpd I I Dacripfioo of Soi1s:SEE PLAN � i Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:03/25/2015 I ROBIN WILCOX,PLS ' I - I DESCRIPTION OF REPAIRS OR ALTERATIONS:NEW CONSTRUCTION- 1500 GAL SEPTIC TANK,DBOX,6 HIGH CAPACITY INFILTRATORS W/STONE:48'X 11'X 10" �� . The undersigned agrees W i�refall the above deseribed Individual Sewage D'aposal System in aeeordanee wilh the provisiona of ; TITLE 5 and fur[her aareea not to olace in ooeratian undl a CertiFlcafe ot Comoliance has heen issued bv the Baard of MeaMh. � Signed Date Inspections • Commonwealth of Massachusetts I Board of Health, Yarmouth, MA F� ', DISPOSAL SYSTEM CONSTRUCTION PERMIT s++a.00 i Pernussion 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. MIGLER ROBERT F TRS �� I�IILLER VIOLA E 1RS � 21 WELLESLEY AVE '. NEEDfIAM,MA 02194-1821 ��.. Location:64 HEMEON DR,WEST YARMOUTH,MA 02673 Disposal System Coastruction Permit No.: BOHDC-1S1527,Dated:Apri107,2015 Provided: ConsWction shall be compieted within six mon[hs of the date of this permit. All local conditions mus[be met. Conditions 1. NEW CONSTRUCTION- I500 GAL SEPTIC TANK, DBOX, 6 HIGH CAPACTlY INFILTRATORS W/ I STONE: 48'X 11'X IO" i v�r Bruce G u hy,MPH, R.S., CHO/Amy L.von Hone, R.S.,CHO Heaitli Director/Assistant Health Director �� The issuance of this permit shall not be coostroed as a guarantee that the system will fuoMion as designed. i i � � � i . � I Commonwealth of Massachusetts ! Board of Health, Yarmouth, MA F� I! CERTIFICATE OF COMPLIANCE s++o.00 Description of Work:Complete System The undersigned hereby certify that the Sewage Disposal System; New ConstrucNon by:PKM CONTRACTORS,INC. at:64 HEMEON DR,WEST YARMOUTH,MA 02673 Has been installed in accordance with the provisions of 310 CMR I5.00(Title 5)and the approved ': design plans or as-built plans relating to application No.: BOHDC-15-1527,dated OS/13/2015. ! Installer.PKM CONTRACTORS,INC. Address:P.O.BOX 175 EAST DENNIS,MA 02641 Inspector:AMY VON HONE,R.S. Designer:SWE Conditions 1.NEW CONSTRUCTION- 1500 GAL SEPTIC TANK,DBOX,6 HIGH CAPACITY ' INFILTRATORS W/STONE: 48'X 11'X 10" ��� !, Bruce urphy, MPH, R.S., CHO/Amy L.von Hone, R.S., CHO Health Diredor/Assistant Health Diredor � The issuance of t6is permit shall not be construed as a guarantee that the system will function as designed. � BOH_Disposal_Construction_CofC.rpt ', I