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COMMONWEALT14 Of M ASSAC14USETTS
Board of Health, )693e YlC un) , M.
APPLICATION FOR DISPOSAL SYSTEM C7TRUCTIOuNPERMIT
Application for a Permit to Construct( ) Repair( ) Upgradek Abandon() -pleteSystemIndividual Components
Location�'f L� 1 J U
Owner's Name 11a 4
Map/Parcel# �� dZ
Address
Lot# 7
Telephone#
Installer's Name IL4Designer's
Name
Address -7 4Address
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Telephone# _. `t
Telephone# 7S r d M
Type of Building
Dwelling - No. of Bedrooms
Other - Type of Building
Other Fixtures
Design Flow (min. re(uired) 2 gpd Calculated design flow
Plan: Date - �� ` �� Number of sheets
Title
Description of Soil(s) _
Soil Evaluator Form No.
Name of Soil
DESCRIPTION OF REPAIRS OR ALTERATIONS
No. of persons
Lot Size CJ r�,L
Garbage grinder ( )
Showers ( ),.Cafeteria ( )
Design flow provided �"7&0 gpd
Revision Date
Date of Evaluation x-7,1* /
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to nW tojpLaceth
peration until a Certificate of Compliance has been issued by the Board of Health.
Signed 1 Date
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COMMONWEALTH
No. � 7I tJ OF SS �'1.H�1J�(TS ETT'
Board of Health, A�e)07 4 , MA.
CERTIFICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) &'Complete System
The undersigned hereby certify th e Sewage Di osal System; C nstructed ( ), Repaired ( ), Upgraded ( ), Abandoned ( )
by:I,C
at
has been installer4"iYf �Ecor�anL�e4 V ovisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. / "/r�- , dated '->61;r/ A. Approved Design Flow .2 (gpd)
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Installer 14 / -F $ ti4 ld If" a"Q
Designer: h L-�Gy i �G° Inspector: Lam/ Date:
The issuance of this permit shall not be construed as a guaran a that the system will function as designed.
No. �C "� (o 791 j C� S " ; FEE 00
2- COMMONWFALT14 OF MASSACHUSETTS C"(0368
Permission is hereby granted
at
Board ofHealth, yx�rz.�rxx * , MA.
DISPOSALS SYSTEM CONSTRUCTION PERMIT
Construct( ),,11 Repair( )
Y/l'. / [ll.
Upgrade P Abandon( ) an individual sewage disposal system
as described in the application for
/C r2-
Disposal System Construction Permit No. dated
Provided: Construction shall be completed within4:ee-y�-4 .of the date�f this permit. All local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date %- '/ Board of Wed?'
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No.:BOHDC-16-7918 I
� 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:44 PHYLLIS DR, SOUTH YARMOUTH, MA 02664 Owner:
DIGNAN JiJDITH E TR
Map/Parcel#• 087.50 JUDITH E DIGNAN REVOCABLE LVG TRUST
� 44 PHYLLIS DR
SOUTH YARMOUTH,MA 02664
Phone:
Septic System Installer Designer
BOSETTI SEPTIC RONALD J.CADILLAC,PLS,RS,PC
199 CHURCH STREET EAST P.O.BOX 258
HARWICH, MA 02645 WEST YARMOUTH,MA 02673 '
Phone: 508-775-9700
5084300812 '
Type of Building:Dwelling Lot Size: 10,019.00 Sq.Ft. f
Dwelling-No.of Bedrooms: Garbage Grinder:
i
Other Type of Building• No.of persons: S6owers: i
F
i
Other Fixtures: 4
�
Plan Date:O1/15/2016 Number of Sheets: 1 Cafeteria•
Tit1e:SITE PLAN FOR 44 PHYLLIS DRIVE Revision Date:
�
. Design Flow(min.required):220 gpd Calculated design flow:220 gpd Design flow provided:230 gpd
�
Description of Soi1s:SEE PLAN '
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:O1/07/2016 '
RONALD J.CADILLAC,RS
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,8 ',
ADS ARC 36HD UNITS W/OUT STONE IN A TRENCH CONFIGURATION:40'X 2.8T X 0.89' '
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 o�eration until a Certificate of Comoliance has been issued bv the Board of Heakh.
Signed Date
Inspections
1
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f
Commonwealth of Massachusetts
t
Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT 555.00 ;
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Permission is herby granted to; �
BOSETTI SEPTIC SYSTEMS, 199 CHURCH STREET, EAST HARWICH, MA 02645
To perform:Upgrade an individual sewage disposal system. ,
Owner: DIGNAN NDITH E TR '
JUDITH E DIGNAN REVOCABLE LVG TRUST
44 PHYI,LIS DR
SOUTH YARMOUTH,MA 02664
Location:44 PHYLLIS DR, SOUTH YARMOUTH,MA 02664
Disposal System Construction Permit No.: BOHDGI6-7918,Dated:January 20,2016 '
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,8 ADS ARC 36HD UNITS
W/OUT STONE IN A TRENCH CONFIGURATION:40'X 2.87'X 0.89' i
2.ZONE II MAXIMUM 2 B EDROOM
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�
Bruce G. M hy, PH, R.S., CHO/Amy L.von Hone, R.S., CHO �
Health Director/Assistant Health Director '
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The issuance of this permit shall not be construed as a guarantee that the system will function as designed. �
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