HomeMy WebLinkAboutApp-Permit-Compliance0 C-ID7-rz-- K, 6 0341l
r gr COMMONWEALTH OF MASSACIIUSETTS
Board of Health, aUna , MA.
APPLICATION F®I, DISPOSAL SYSTEM CONSTRUCTI®N PERMI1
FEE cll�
Application for a Permit to Construl Repair( ) Upgrade( ) Abandon() �mplete System ❑ Individual Components
Location f' .c
Owner's NameW-4 I •- I
Map/Parcel# 5'�'
Address ll tyain S+- Sa 6 -
Lot# !
Telephone# �8, -36 a �-
Installer's NamePKIM
Address
Designer's Name !'�
I.J�lY I Address( g�'
Telephone# o
Telephone# �� - �- g'
�w� ^� P �/
Type of Building � l e ll a Lot Size "7 sq. ft.
Dwelling - No. of Bedrooms � Garbage grinder( )
Other - Type of Building No. of persons Showers( ), Cafeteria ( )
Other Fixtures
Design Flow (min. required) gpd Calculated design flow Design flow provided gpd
Plan: Date Number of sheets � Revision Date
j_ 0 C. �
Title G.
Description of Soils) // t %S 't�'
Soil Evaluator Form No. 101i1'0 c/ Date of Evaluation
Name of Soil Evaluator
A
The undersigned agrees to install the above des 'bed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to not to plac a op on until a Certificate of mpli e ham been issued by the Board of health.
Signed Date S
Inspections
No. ;»'" G�f FEE It 00
COMMONWEALTH Off' N ASSACIIUSETTS c�-�' i�0-
Board of Health, �i-lLi►liO tl", MA.
CERTIFICATt Of COMPLIANCE
Description of Work:
The undersigned beret
by:
at a
;a
has been installiri a7ed
applicationNo.
Installer Ilk [)1 l._€
❑ Individual Component(s) ❑ Complete System
iy certify that the Sewage Disposal System; Constructed (, Repaired( ), Upgraded ( ), Abandoned ( )
,-%4,, A. r^
e wifh hfe' ro-6stons of 310 CMR 15.00 (Title 5) and the proved design plans/as-built plans relating to
dated 1-3 "% �'Approved Design Flow (gpd)
Dgsigner: I ��! j!� Inspector: �i 4 �` Date: a %" %�
The issuance of this permit shall not be construed as a guar tee that the system will function as designed.
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No. 6 C —('5 - 6 8 'RC. H FEE A 101 00
COMMONWEALTH OF MASSACHUSETTS Ck�*' 57,07
Board of Health, YA19M 0 UTU , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system
at l.s�i CQ % n % !'A , 0 � - - C� +% as described in the application for
r/� _
Disposal System Construction Permit No. /7 01 dated
Provided: Construction shall be completed within. e wyeai-rof the date of this permit. All local conditionA must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown, MA Date' /�� Boarf I�e`alth s
No.:BOHDC-15-2818 ,
Commonwealth of Massachusetts Fee
$110.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:New Construction-Complete System
Location: 7 VIRGINIA ST,WEST YARMOUTH, MA 02673 Owner:
HABITAT FOR HUMAMTY OF CAPE COD INC
Map/Parcel#: 036.66.1 411 ROUT'E 6A SUITE 6
YARMOUTH PORT,MA 02675
Phone:
Septic System Installer Designer
PKM CONTRACTORS, JM O'REILLY&ASSOCIATES INC.
P.O. BOX 175 EAST DENNIS, MA P.O.BOX 1773
02641 BREWSTER,MA 02631
Phone: 508-896-6601
5083855993
Type of Building:Dwelling Lot Size:7,405.00 Sq.Ft.
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Fixtures:
Plan Date: 12/21/2014 Number of Sheets: 1 Cafeteria•
Tit1e:SITE&SEWAGE DISPOSAL SYSTEM DESIGN LOT 1(7F)VIRGINIA Revision Date:
STREET �
Design Flow(min.required):330 gpd Calculated design flow:330 gpd Design flow provided:340 gpd
Description of Soi1s:SEE PLAN .
Soii Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:09/11/2013
KIERAN HEALY,P.L.S.
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-NEW-PROPOSED 1500 GAL PLASTIC SEPTIC TANK,H-20
DBOX,3-500 GAL H-20 PRECAST CHAMBERS W/STONE 2.25'EMDS.2.5'SIDES:30'X 10'X 2'
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of '
TITLE 5 and further aarees not to olace in ooeration until a Certificate of Comoliance has been issued bv the Board of Health.
Signed Date
Inspections �
� ,
Commonwealth of Massachusetts
:
Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT $110.00
Permission is herby granted to;
PKM CONTRACTORS, INC., P.O. BOX 175, EAST DENNIS, MA 02641
To perform:New Construction an individual sewage disposal system.
Owner: HABITAT FOR HUMANITY OF CAPE COD INC
411 ROUTE 6A SUITE 6
YARMOUTH PORT,MA 02675
Location: 7F VIRGINIA ST, WEST YARMOUTH, MA 02673
Disposal System Construction Permit No.: BOHDC-15-2818 ,Dated: August 13,2015
Provided: Construction shall be completed within six months of the date of this permit. All local conditions must be met.
CONDITIONS:
1. SEPTIC DISPOSAL-NEW-PROPOSED 1500 GAL PLASTIC SEPTIC TANK, H-20 DBOX, 3-500 GAL
H-20 PRECAST CHAMBERS W/STONE 2.25' EMDS. 2.5'SIDES: 30'X 10'X 2'
2. BOH TO INSPECT SOIL REMOVAL
�U :
Bruce G. Murp , MPH, R.S., CHO/Amy L. von Hone, R.S., CHO
alth Director/Assistant Health Director
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
;