HomeMy WebLinkAboutApp-Permit-ComplianceNo.'`N-71
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COMMONWEALTH LTH Of M ASSAC14USETTS
FEE �J•�
Board of Health,�A1R N1 dy Tib , MA.
% A ICATI®N FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
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Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon( ) --.9 Complete System ❑ Individual Components
Location 13-3
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Owner's Name L
Map/Parcel# 4-1
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Address (,vq h
L,a lt4 /Lp1
Lot#
Telephone#
Ll ' 7S
Installer's Name
jo-pTed C A, C/
Designer's NameLti�
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Address23 /Z
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Address /30,
Telephone# S'q�
G '�j
Telephone# ;'
Type of Building
Dwelling - No. of Bedrooms
Other - Type of Building _
Lot Size sq. ft.
Garbage grinder ( )
No. of persons Showers ( ), Cafeteria ( )
Other Fixtures _
Design Flow (min. required _ gpd Calculated design flow % Design flow provided gPd
/6/
Plan: Date / !/ Number of sheets I Revision Date
Title
Description of Soil(s) .S of Sp{ )
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS &Q -to EP44�-1 Z U 4�
The undersigned ees tainstall the above desclibed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agre, not Iacp�he s3, �rn ntil a Certificate of mpliance has ben issue y the Board of Health.
Signed �� Date -- �7�
Inspections
COMMONWEALTH OF MASSACHUSETTS
Board of Health, YA12-MOUn , MA.
CERTIFICATE OF COMPLIANCE
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Description of Work: ❑ Individual Components)omplete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded ( ), Abandoned ( )
at'� 5 C,tCVV ( 1 %f P ��c vIV-' & IY" 0 U 1—Zl %A
has been installed in accorTc an d with theprovisions of 310 CMR 15.00 (Title 5) and t_1fe approved design plans/as-built plans relating to
application No. /—�/'; dated C Approved Design Flow gpd)
Installer [ 1 f r S 4 c ', s rc;)S)- t(:
: -
Designer: PL1 11 1(� c ` i �•n;-v�'1-� �' Inspector: Date: C?
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
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No. +� t�C -S5 "`! � FEE jt2 C0
COMMONWEALTH ALTH Of MASSACHUSETTS
fig ' Board of Health,D UTI+ , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgraded -7 -Abandon ( ) an individual sewage disposal system
at S. �i%.. A L-� 11 P �9c� �/ L' S f % ( C U%/? )q as described in the application for
Disposal System Construction Permit No. dated �.
; A. / �� �/
Provided: Construction shall be comple/c VW thin ifZ=ar. f the date of this r it. All local conditions must be met.
Form 1255 Rev. 5l96:A.M. Sulkin Co. Chadestown, MA Date -�1 / Board of Health
No.:BOHDGIS-4471
Commonwealth of Massachusetts Fee
� $55.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Complete System
Location: 83 SWAN LAKE RD,WEST YARMOUTH, MA 02673 Owner:
LARDEN JAMES M TRS
Map/Parcel#•049.12 247 LAWS BROOK RD APT 108
• CONCORD,MA 01742-2084
Phone:
Septic System Installer Designer
ELLIS BROTHERS PUNKHORN SERVICES
PO BOX 59 YARMOUTHPORT, MA P.O.BOX 483
02675 SOUTH DENNIS,MA 02660
Phone: 508-564-8379
Type of Building:Dwelling Lot Size: 11,761.00 Acres
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other T e of Buildin : No.of ersons: Showers:
YP g P
, Ot6er Fixtures.
Plan Date:09/16/2015 Number of Sheets: 1 Cafeteria•
Title:PROPOSED SEPTIC DESIGN 83 SWAN LAKE ROAD Revision Date:
Design Flow(min.required):330 gpd Calculated design flow:330 gpd Design flow provided:351 gpd
Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:09/16/2015
TERRY HAYES,R.S.
� DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,4
HIGH CAPACITY INFILTRATORS W/STONE:36'X 11'X 10"
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 Certiflicate of Comoliance has been issued bv the Board of Health.
Signed Date
Inspections
Commonwealth of Massachusetts '
s
Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT $55.00
Permission is herby granted to;
ELLIS BROTHERS CONSTRUCTION, PO BOX 59,YARMOUTHPORT,MA 02675
To perform:Upgrade an individual sewage disposal system.
Owner: LARDEN JAMES M TRS
247 LAWS BROOK RD APT 108
CONCORD,MA 01742-2084
Location: 83 SWAN LAKE RD,WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.: BOHDC-15-4471 ,Dated: September 21,2015
Provided:Construction shall be completed within six months of the date of this permit. All local conditions must be met.
CONDITIONS:
1. SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK, DBOX,4 HIGH CAPACITY
INFILTRATORS W/STONE:36'X 11'X 10"
2. BOH TO INSPECT SOIL REMOVAL
V(�����
Bruce G. Murphy,MP , R. ., CHO/Amy L.von Hone, R.S.,CHO
Health D'ector/Assistant Health Director
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:Complete System
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:ELLIS BROTHERS CONSTRUCTION
at:83 SWAN LAKE RD,WEST YARMOUTH,MA 02673
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-15-4471,dated 09/28/2015.
� Installer:ELLIS BROTHERS CONSTRUCTION
Address:PO BOX 59 YARMOUTHPORT,MA 02675 Inspector:AMY VON HONE,R.S.
Designer:PUNKHORN SERVICES
Bruce G. ur y,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.
BOH_Disposal_Construction_CofC.rpt