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r —Ai5 COMMONWEALTH OF MASSACHUSETTS
Board of Health, A9MO m4
APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTION PERMIT
plication for a Permit to Construct( ) Repair( ) UpgradeK Abandon() - ❑ Complete System *Individual Components
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wner's Name
Map/Parcel#
32
Address a f (% 0%S0,2
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Lot#
Telephone# &&0'SO-0
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Installer's NameDesigner's
Name
Address,
Telephone#
Address(
Telephone# Sfo4,
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cV1
Type of Building _ I, �7 Lot Size sq. ft.
Dwelling - No. of Bedrooms 3 -2 7 ev ' 41 Garbage grinder ( )
Other - Type of Building No. of persons Showers ( ) , Cafeteria ( )
Other Fixtures
Design Flow (min. required) t (a/,;; 33cl gpd Calculated design flow
Plan: Date 111I916�WIIf Aetl, 1a 111 Number of sheets
Design flow provided gpd
Revision Date
Title
Description of Soils)
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation
The undersigned agr s to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees t t tum ace then until a Certificate of Compliance has yen is ed by the Board of Health.
Signed Date !/�
of
No. FEE
—l1
COMMONWEALTH Of MASSACHUSETTS cyz C ` L'5- 2-q 3P 1
Board of Health, _ �fl� � 1J7 %f' , MA. /,"
CERTIFICATE Of COMPLIANCE
Description of Work:-Cndividual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded k4, Abandoned ( )
by; �rtli�� C- CC, 1.y< 1
at catl� ' p95 -c)
has been installed tuiaccordance wit the provisions of`310 CMR 15.00 (Title 5) and t �approved design plans/as-built plans relating to
application No. �� ~ dated /- -7- � � Approved Design Flow .`� � (gpd)
Installer L1 i,4 ,�� ter• �C„�'j., i '- / s
�(
Designer: P J Il 74 ' -v, C$ j Inspector: / � Date:
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
No. ® �jC - / FEE 95, • 00
/ ®3 COMMONWEAL114 OF MASSACHUSETTS c,k.- z4 ,3!
Board of Health, AR -m un+ , AiA •
➢FISP®SAI. SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgrade (Abandon ( ) an individual sewage disposal system
at a 31 G v t OA4 OLPS 4:i"'`'`'�� r`Yl f, as described in the application for -
Disposal System Construction Permit No. A " e 3 dated
Provided: Construction shall be completed within xkT4@-wars of the date of this permit. A 1 local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date %` 7- f CBoard of
Health r
No.: BOHDC-14-0743
� Commonwealth of Massachusetts Fee
$55.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Individual Component(s)
Locallon: 29 GLEASON AVE,WEST YARMOUTH, MA 02673 Owner:
PRINCTPE,WILLIAM F
M8p/PB�C¢I#: 037.43 29 GLEASON AVE
WEST YARMOUTH,MA 02673
Phone:
Septic System Installer Designer
ELLIS BROTHERS PUNKHORN SERVICES
23 ENTERPRISE ROAD P.O. BOX 483
YARMOUTHPORT, MA 02675 SOUTH DENNIS,MA 02660
Phone: (5081564-8379
Type of Building:Dwelling Lot Size:0.18 Acres
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building:DUPLEX(2 BEDROOM/1 BEDROOIvn No.of persons: Showers:
Other Fixtures:
Plan Date: 11/19/2014 Number of Sheets: 1 Cafeteria:
Tit1e:PROPOSED SEPTTC DESIGN 29-31 GLEASON AVE. Revision Date: 12/OS/2014
Design Flow(min.reqoired):330 gpd Calculated design ilow:330 gpd Design tlow provided:351 gpd
Description of SoiIs:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation: ll/19/2014
TERRY HAYES,R.S.
DESCRIPTION OF REPABS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-EXISTING ]000 GAL SEPTTC TANK,SECONDARY
]000 GAL SEPTIC TANK,DBOX,4 I-IIGH CAPACITY INFILTRATORS W/STONE: ll'X 36' 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 untll a Certlficate of Comoliance has heen issued hv the Board of Health.
Signed Date
Inspections
. Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMTT 555.00
Permission is herby granted to;
ELLIS BROTHERS CONSTRUCTION, 23 ENTERPRISE ROAD,YARMOUTHPORT, MA 02675
To perform: Upgrade an individual sewage disposal system.
Owner: PRINCIPE,WILLIAMF
29 GLEASON AVE
WEST YARMOUTH,MA 02673
Location:29&31 GLEASON AVE, WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.: BOHDC-14-0743,Dated: January 07,2015
Provided: Construction shall be completed within six months of the date of this permit. Al]local condi[ions must be met.
Conditions
1.SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK, SECONDARY 1000 GAL
SEPTIC TANK, DBOX, 4 HIGH CAPACITY INFILTRATORS W/ST�: 11'X 36'I`�
. Bruce G. rp y, MPH, R.S., CHO/Amy L.von Hone, R.S., CHO
Health Director/Assistant Health Diredor
The issuance of this permit shall not be consMued as a guarantee that the system will Function as designed.