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% A . I AT ON FOR DIS®SAL SYSTEM CONSTRUCTION HERMIT
Application for Permit to Construct( ) Repair( ) Upgrade(X-AbandonCl Complete System individual Components
Location'
Map/Parcel#f �a ^-
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Owner's Name
Address
Lot#
Telephone# D
Installer's Name
Designer's Name t
Address
1 j%
Address
Telephone# ,�
�/
Telephone# , js
Type of Building
Dwelling - No. of Bedrooms
Other -Type of Building _
Other Fixtures
Lot Size sq. ft.
Garbage grinder ( )
No. of persons Showers( ), Cafeteria( )
Design Flow (min. required) 330 gpd Calculated design flow Design flow provided gpd
Plan: Date Number of sheets Revision Date
Title A -
Description of Soils) --aed r
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation
q
DESCRIPTION OF REPAIRS OR ALTERATIONSff
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agre to not to place the system in opera ' n until a Certificate of Co /m�liance has b� issued by the Board of Health.
Signed Date / P / �
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No. 60.0 � c - 1-5— 0 015-
FEE �00
X COMMONWEALTH OF MASSACHUSETTS
Board of Health, , MA.
CERTIFICATE Of COMPLIANCE
Description of Work; „Q-Tndividual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded J,),, Ciandoned ( )
by:1 i
at /i
has been installer -12M c t a c Itli7the ovisions of 310 CMR 15.00 (Title 5) and �e a roved design plans/as-built.plans relating to
application O. dated % . Approved Design Flow. (gpd)
Installer i/
Designer: r nspector: r ` ate:
The issuance of this; permit s not be constras a guarantee t the system will function as designed.
No. ?0WV) C—l5— lO
FEE tz: 06
COMM, ONWEA :TII OF MASSACHUSETTS
Board of Health, �ftmfd\d l 1'C'i i MA.
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DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to.; Construct( ) Repair( ) Upgrade.(-�bandon ( ) an individual sewage disposal system
at
Disposal System Construction Permit No. 4 b Uv dated !:/
Provided: Construction shall be complete wiffli Uhr
p hr,� , tea,, fy/�t'he date of this
Form 1255' Rev. 5/96 A.M. Sulkin Co. Chadestown, MA r Dat _ %. - ,1 V Board o Me t 5
as described in the application for
No.:BOHDGIS-7025
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)
Location: 24 WINCHESTER AVE,WEST YARMOUTH, MA 02673 Owner:
NEAL SUSAN
Map/Parcel#: 022.247 CAROLAN JAMES
12 GRANDVIEW DR
SOUTH YARMOUTH,MA 02664
Phone:
Septic System Installer Designer
CHASE&MERCHANT DM ENGINEERING
P.O. BOX 5 DENNISPORT, MA 02639 24 SCHOOL STREET
Phone: WEST DENNIS,MA 02670
5083982116 508-398-7710
Type of Building:Dwelling Lot Size: 16,117.00 Sq.Ft.
Dwelling-No.of Bedrooms:2 Garbage Grinder:
Other Type of Building: No.of persons: Showers: '
Other Fixtures: '
Plan Date:02/16/1998 Number of Sheets: 1 Cafeteria: '
Tit1e:SITE AND SEWAGE PLAN 24 WINCHESTER AVENUNE Revision Date:
• Design Flow(min.required):220 gpd Calculated design flow:330 gpd Design flow provided:344 gpd
Description of Soi1s:SEE PLAN
' Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:Ol/14/1998
THOMAS MCLELLAN,P.E.
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-EXISTING 1500 GAL SEPTIC TANK,EXISTING
1000 GAL PUMP CHAMBER,PROPOSED DBOX AND 5 STANDARD INFILTRATOR CHAMBERS W/STONE 4'SIDES,3'ENDS:37.25'
X11'X7"
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 Certificate of Comoliance has been issued bv the Board of Heakh.
Signed Date
Inspections
Commonwealth of Massachusetts
' Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT 555.00
Permission is herby granted to;
CHASE&MERCHANT INC., P.O. BOX 5, DENNISPORT, MA 02639
To perform:Upgrade an individual sewage disposal system.
Owner: NEAL SUSAN
CAROLAN JAMES
12 GRANDVIEW DR
SOUTH YARMOUTH,MA 02664
Location:24A WINCHESTER AVE,WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.: BOHDC-15-7025,Dated:January 11,2016
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-EXISTING 1500 GAL SEPTIC TANK, EXISTING 1000 GAL PUMP CHAMBER,
PROPOSED DBOX AND 5 STANDARD INFILTRATOR CHAMBERS W/STONE 4'SIDES,3'ENDS: 37.25'X 11'X
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2. BOH TO INSPECT REMOVAL OF FAILED SYSTEM
3. MFC VARIANCE APPROVAL:a. GROUNDWATER SEPARATION b. GROUNDWATER ADJUSTMENT
4. MAXIMUM 2 BEDROOMS PER GROUNDWATER VARIANCE APPROVAL
Bruce G. rph ,M , 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.