HomeMy WebLinkAboutApp-Permit-ComplianceNo. 11200C-44-005
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f 7/ MMMOVUTFAITU OF MACCACHITCUTTS
FEE I b6'00
Board of Health, ygefflOmw , MA.
'LICATI®N FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon( - C omplete System ❑ Individual Components
Location j / " 441
~1 Owner's Name 010q7e
Map/Parcel#
Address
Lot#
Telephone#
Installer's Name
V Designer's Name Z
Address �!�� �
Address R,®3 SO-X1GA-*e X40-4-- j
Telephone# 34-Z,
Telephone#
Type of Building �'� 1 Lot Size 66�4444 sq. ft.
Dwelling - No. of Bedrooms _ Garbage grinder WO
Other - Type of Building No. ofersons Showers
p (),Cafeteria ( )
Other Fixtures
Design Flow (min. required) gpd Calculated desifgn flow s I Design flow provided _Z gpd
Plan: Date '-✓�� N
um
-ber of sheets f r Revision Date C,Title /Ve-4j ZIVW,0 2 s d.6- W . 6- w// -ale .d/,�--
Description of Soil(s) _
Soil Evaluator Form No.
DESCRIPTION OF REPAIRS OR ALTERATIONS
Name
Evaluator' ' f.7al Date of Evaluation .e—'7
Z,
The undersigned agre s to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to t lace l o on until a Certificate ofComp�ce has been issued by the Board of Health.
Signed Date `j
r
Inspections__ ia.- `� y- �V►J �� C�4'�4 r�
k .1 (- c c --c
til vycr t,. -,4 —
No. boqDc- fI / 1� /bar• n / �_..��_
COMMON LT14 ®f MASSAC14USETTS � .}
17 2 7 4 .t! 35-00
\ /
Board of Health, Aamoum , MA.
a CERTIFICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) ❑ Complete System
The undersigned hereby certif at the Sewage Disposal System; Constructed ( ), Repaired ( ); Upgraded ( ), Abandoned ( )
by;.5&„r1
at e,�CJ�r✓i// r
has been installed i nce�v' h flee' o1 sion o CMR 15.00 (Title 5) and the roved design plans/as-built plans relating to
application No. '.1 dated�r[� ,?Approved Design Flow�(gPd)
Installer st ./�.W'✓ c„-cdv 5 �-wv_-.
Designee: 146W.If 146W.,JiiL...� Inspector: j, .�/—r} Date: 1 IJ
a
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
No. GQ N 1�C" (`f ���� FEEJ • QQ
COMMONWEALTH OF ASSACIIUSETTS41.
Board of Health,VAV-MOVIR MA.
" DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgrade#) Abandon( ) an individual sewage disposal system
at "/lo"�w�,/ as described in the application for
Disposal System. Construction Permit No. dated �'� �'
Provided: Construction shall be
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown, MA Date/.
•years the date of this . //rfi1`t; All local con
nd' 'ons must be met. .
Board oHealth V ���
No.: BOHDGI4-0609
= Commonwealth of Massachusetts FeB
$55.00
Board of Health, Yarmouth, MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-
Location: 56 VNLLIAMS RD,WEST YARMOUTH, MA 02673 Owner
Map/Parcedf: 030.71 Name:
PRUSSMAN WALTER R
139 MURDOCK ST
Phone:
Septic System Installer
Name:
ELLIS BROTHERS CONSTRUCTION
Address:
23 ENTERPRISE ROAD
YARMOUTHPORT, MA 02675
Phone:
Type of Building:Dwelling Lot Size:0.15 Acres
Dwelling-No.of BMrooms:3 Garbsge Grinder:
Other Type of Building: No.of persons: Showers: Cafeteria:
Other Fixtures:
Plan Dah:07/23@014 Number of Sheets: 1
Title:PROPOSED SEPTIC DESIGN 56 WILL[AMS ROAD Revision Date: 1 U14/2014
Design Flow(min.required):330 gpd Calculahd design ilow:330 gpd Design Flow provided:351 gpd
Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:07/09/2014
ROBIN WILCOX,PLS
DESCRIPTION OF REPAIRS OR ALTERATIONS: 1500 GAL SEPTIC TANK
DBOX
4 I-QGH CAPACITY INFILTRATORS W/STONE:
36'X11'X10"
The undersigned agrees to inatall the above describetl Intlividual Sewage Disposal System in aeeoManee wifh the provislons of
TITLE 5 antl further aarees not to elace in ooeration until a Certifieate of Comoliance has 6een issuetl bv the Board of Fleakh.
Signed Date
Inspections
Commonwealth of Massachusetts
� Board of Health, Yarmouth, MA. F�
DISPOSAL SYSTEM CONSTRUCTION PERMIT E55.00
Permission is herby granted to;REID C.ELLIS,LARRY ELLIS Address:23 ENTERPffiSE ROAD
Yt1RMOUTHPORT,MA 02675
To perform: Upgrade an individual sewage disposal system.
Owner: PRUSSMANWALTERR
139 M[JRDOCK ST
BRIGHTON,MA 02135-2309
Location: 56 WILLIAMS RD,WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.: BOHDC-14-0609,Dated:November 14,2014
Provided:Construction shall be completed within six months of the date of this permit. All local conditions must be met.
CondiNons
1. Plumbing Permit Required
2. MFC Yariance. 1. Setbacks
3. I500 gal Sepric Tank, DBox, 4 High Capaciry Infiltrators w/Stone: 36'x I]'x 10"
�
Bruce G. rph , MPH, R.S., CHO/Amy L.v n 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.