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No. !ao(lO.c /✓���71 N'-�x•�p1 nJ ��1 Q���1?zl
C®MMO Ill OF MASSACIIUSETTS
Board of Health, Y&9&0- 0-04 , MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgradef�Abandon() - ❑'Complete System ❑ Individual Components
Location R I' I L5
Owner's Name
Map/Parcel# 7 4 !
Address
/� • ( L.l7 �—
Lot#
Telephone#
Installer's Name �` 16rrS ny/� Cp
Designer's Name
Address 3 IV&4gAddress
j3a0L
/,Uot- '1
Telephone# S
Telephone#
Type of Building
Dwelling - No. of Bedrooms
Other - Type of Building _
Other Fixtures
Design Flow (min. required)
Plan: Date
Title
Description of Soil (s) 5
Soil Evaluator Form No.
i
No. of persons
Lot Size.- 1,0.,A;,7 sq. ft.
Garbage grinder AIS'
Showers ( ), Cafeteria ( )
gpd Calculated design flow &''' 7 Design flow provided gpd
DESCRIPTION OF REPAIRS OR ALTERATIONS Sy P Q,�,V ' A4.0i Aj
The undersigned agre o install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to o lace e m ' e�a Certificate of Compliance has been issue the Board of Health.
Signed Date
Inspections
CG i,...:- ., v -SOC.. C, : 7.0-0 :..;.JOO-fi.JOd.D,.�AC—Jn.J;f.'J."-_,.�_J..10 �._J_^..:.}�.�_.i i.J ::.. :.� �J-`.;; '---D 0 "1 J.J�
� -- COM MONWEALT I ®E FEE MASSACHUSETTS
Board of Health, %ryl o u 4 MA.
CERTIFICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) /�Womplete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded)ej,'Abandoned ( )
by: I. 1�r Pcaal t'�n�J
at
has been installed in facZordanc(
application No.f5 be--I<-r
Installer E � _� ` u` ' C'
:Fie provisions of 310 CMR 15.00 (Title 5)
I
_ 27 Approved Design F1oW
e.ISJ. x�ry z
the approved design plans/as-built plans- relating to
Designer: 0 07 h �� sem:,. '� �S Inspector: Date:
r
The issuance of this permit shall not be construed as a guarantee that tfie system will function as designed.
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No. �C ../' FEET rZI
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COMMONWEALTH OF MASSACHUSETTS
Board of Health, YIW-M 0 y rhL , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission ris hereby granted to; Construct( ) Repair( ) Upgrade( Abandon( ) an individual sewage disposal system
r r 4
at ��( L'J Z "rS ig, �c
n y , VL,P S�� as described in the application for
Disposal System Construction Permit No. dated
Provided: Construction shall be completed withmltihree- s of -the date of this permit. All local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown, MA Date Z Z ? Board of Health 4/-� L
I
. No.:BOHDC-15-1171 �
Commonwealth of Massachusetts FBe
555.00
' Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Complete System
Location: 2 WAGTAIL LN,WEST YARMOUTH, MA 02673 Owner:
SIMMONS GEORGE W
Map/Parcel#: 076.124 2 WAGTAILLN
WEST YARMOUTH,MA 02673
Phone:
Septic System Installer Designer
ELLIS BROTHERS PUNKHORN SERVICES
23 ENTERPRISE ROAD P.O.BOX 483
YARMOUTHPORT, MA 02675 SOUTH DENAIIS,MA 02660
Phone:
(5081564-8379
Type of Building:Dwelling Lot Size:0.23 Acres
Dwelling-No.of Bedrooms:4 Garbage Grinder:
Other Type of Building: No.o[persons: Showers:
Other Fixtures:
PlanDate: 12/11/20t4 Numbero[Sheets: l Cafehria:
TiUe:PROPOSED SEPTIC DESIGN 2 WAGTAIL LANE Revisioo Date:
Design Flow(min.required): gpd Calculated design flow:440 gpd Design How provided:45521 gpd
Description of Soi1s:SEE PLAN �
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation: 12/t0/2014 �
, TERRY HAYES,R.S.
DESCRIPTTON OF REPAIRS OR ALTERATIONS:REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,6 HIGH CAPACITY
� INFILTRATORS W/STONE:48'X 11'X]0"
The unde�signetl agrees to insfall the above tlescribed Individual Sewage Dlsposal System in accordanee with the provisions of
TITLE 5 and further aarees not to olace in ooeration until a Certifitafe of Comoliance has heen issued hv fhe Board of Heakh.
Signed Date
Inspecdons :
• Cammonwealth of Massachusetts
Board of Health, Yarmouth, MA F�
DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00
Permission is herby granted to;
� ELLIS BROTHERS GONSTRUCTION,23 ENTERPRISE ROAD,YARMOUTHPORT, MA 02675
To perform:Upgrade an individual sewage disposal system.
' Owner: SIMMONS GEORGE W
2 WAGTAIL LN
If
WEST YARMOUTH,MA 02673
LocaYipn:2 WAGTAIL LN, WEST YAR.MOUTH,MA 02673
� 17isposal System Construction Permik No.:BOHDC-IS-1171 ,Dated:February 27,2015
� Provided:ConsWction shall be c,�>mpleted within six morths of the date of this permit. A(l local conditions must be met.
Conditious
1. REPAIR-I'ROPOSED 1500 GAL SEPTlC TANK, DBOX, 6 HIGHCAPACCfYINFILTRATORS W/
STONE: 48`X 11`X 10"
2. MFC VARIANCE.•I. SETB�ICKS
3. ZnNE 17 MAXIMUM 3 BEDROt3MS � ����`y'J
Bna Murphy,MPH,R.S.,CHO t Amy l.von Hone,R.S.,CH6
Health Director/Assistant Health pi2ctar
T6e issuance ef this permit shali not be construed as a guarantee that the system wili£unMioo as designed.