HomeMy WebLinkAboutApp-Permit-ComplianceNo. 1&O4V C 4 5-V ` f3 r1-( / o L- � FEE '�6 - O-0
r—rV/ �S _ �q�C®MINI® I.TII ®ir NI&SSA-CHUS]CTTS CJ42-485
S ��l Board of Health, L 00 i W , MA.
�A PLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Appli tion for P;%
er 't to Construct( ) Repair( ) Upgrade�O andon- Complete System ❑ Individual Components
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Location 1AH 9 44141 i by r�
Owner's Name
Map/Parcel#
Address
Lot#
Telephone#
Installer's Name CQil�
Designer's Name /'bl
Address
Address '7, ' y
Fork'n iQ4 r�.•-+�
Telephone# 3 01
Telephone#
-.Tiff L./ ', p 01
Type of Building A Lot Size W sq. ft.
Dwelling - No. of Bedrooms 1,5 Garbage grinder
Other - Type of Building No. of persons Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow (min. required) 3 30 gpd Calculated design flow Design flow provided gpd
Plan: Date `'�--�� Number of sheets ! Revision Date
Title
Description ofSoil (s) `-
Soil
Soil Evaluator Form No
DESCRIP'T'ION
OR ALTERATIONS
Name of Soil Evaluator e,104V,42-4-41 Date of Evaluation
The undersigned agr s td
The the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to to ace the tem ' o e a Certificate of Compliance has been issued by the Board of Health.
Signed Date
Inspectionsx•76'/z %zl' wllw l%'IL
No. + M)C 2-q ll, ak- q 0
C®MINI®NI.TI� Of Nl[�4SSCIUSETT �``�'`''��
/ f - ly
Board of Health, y i)U:M , MA.
CERTIFICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) .Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded LAbandoned ( )
..max- .
by: �"`" G!`j's 011- 71' . G Iry i's
has been installed iiia o da/, e v;th t ki R Bions 6/310 CMR 15.00 (Title 5) and the -approved design plans/as-built plans relating to
application No..2+r 15 dated -2 --47 L. Approved Design Flow "' (gpd)
Installer/ = r� a' t'Lt> - - - - ' F� b t- i Ar4(41�LL1 i '
Designer: �l'-'+�-A,�% `�� • Inspector: Date:
The issuance of this permit s call not be construed w a guar tee f�hat the system will function as designed. --
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No. ;f 1 j, t FEE J.55, 06
/�- / `. COMMONWEALTH OF MASSACHUSETTS C,�-'.4 2-`i 9"5
Yr l F
Board of Health, �1�iZMnUTu^ , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) UpgradeAbandon( ) an individual sewage disposal system
at !.-1 1`n kkni r It I �^� r�E jam, �� r ,-,, �asidescribed in the application for
Disposal System Construction Permit No., dated
Provided: Construction shall be completed within tbx&c=aU of the date -of this permit. All local conditions must be met.
C L'✓� i
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown, MA Date 7" �� Board of Health
No.: BOHDC-15-2478
� Commonwealth of Massachusetts Fee
ass.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Complete System
Location: 124 PAWKANNAWKUT OR, SOUTH YARMOUTH, MA Owner:
02664 PRIOR GEORGE T
Map/Parcel#: 025.46 PRIOR JOAN M
� 124 PAWKANNAWKUT DRIVE
SOUTH YARMOUTH,MA 02664
Phone:
Septic System Installer Designer
ELLIS BROTHERS MORAN ENGINEERING ASSOC_LLC
PO BOX 59 YARMOUTHPORT, MA 94l MAIN STREET
02675 HARWICH,MA 02645
Phone: 508-432-2878
Type of Building:Dwelling Lot Size:8,712.00 Acres
Dwelling-No.of Bedrooms:3 Garbage Grinder.
Other Type of Building: No.of persons: Showers:
Other Fixtures:
Plan Date:Ol/14/2015 Number of Sheets:2 Cafeteria:
TitIe:SEPTIC SYSTEM DESIGN PLAN 124 PAWKANNAWKUT DRIVE Revision Date:07/14@O15
Design Flow(min.required):330 gpd Calculated desigo Oow:330 gpd Design ftow provided:374 gpd
Description of Soiis:SEE PLAN
Soil Evaluaror Form No.: Name otSoil Evaluator: Dah of Evaluation: 10/21/2014
DAN CROTEAU,P.E.
' DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED I500 GAL SEPT[C TANK, 1000 GAL
PUMP CHAMBER,20'X 16'X 6"PRESSURE DOSED LEACH FIELD
The undersigned agrees W install the above described Individual Sewage Disposal System in accortlanee with the provisions of
� TITLE 5 and further aarees not to elace in oneration until a Certificate of Comolianee has Aeen iasued bv the Board of Heakh.
Signed Date
Inspections
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA F�
DISPOSAL SYSTEM CONSTRUCTION PERMIT E55.00
Permission is herby granted to;
ELLIS BROTHERS CONSTRUCTION, PO BOX 59,YARMOUTHPORT, MA 02675
To perform: Upgrade an individual sewage disposal system.
Owner: PRIOR GEORGE T
PRIOR)OAN M
124 PAWKANNAWKUT DRIVE
SOUTH YARMOUTH,MA 02664
Location: 124 PAWKANNAWKUT DR, SOUTH YARMOUTH,MA 02664
Disposal System Construction Permit No.: BOHDC-15-2478,Dated:July 17,2015
Provided:Construction shall be completed within six months of the date of this permit. Al]local conditions must be met.
Conditions
1. REPAIR-PROPOSED I500 GAL SEPTIC TANK, 1000 GAL PUMP CHAMBER, 20'X 16'X 6"
PRESSURE DOSED LEACH FIELD
2. ELECTRICAL PERMTl REQUIRED
3. ENGINEER TO INSPECT AND CERTIFY SOILS, INSTALLATION, CLEAN WATER TEST
4. MFC YARlANCE APPROVALS a. SETBACKS b. GROUNDWATER ADJUSTMF,NT
Bruce . Mu 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.