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No.
COMMONWEALT14 Of M ASSAC14 JSETTS
FEE 455WO
6k-45Bcf
Board of Health, Yaghlp :L 'Am. t
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair(I,/Upgrade( ) Abandon( ) - ❑ Complete System ® Individual Components
Location q/ LE/
Owner's Name
Map/Parcel# 7 `CW 1,)-5
Address
Lot# ��
Telephone#
Installer's Namef�a ✓
Designer's Name
Address 9 L�G 5
Address 44'
Telephone# 11 b 19 % Z
Telephone#
Type of Building
Dwelling - No. of Bedrooms Is -10,
Other - Type of Building�4ar>les
Lot.Size sq. ft.
%tJ 2 Garbage grinder ( )
4ko. of persons Showers ( ), Cafeteria ( )
Other Fixtures -y
Design Flow (min. required) d gpd Calculated design flow -!500_ Design flow provided y / gpd
Plan: Date 2-0 Number of sheets Revision Date
Title
Description of Soil (s)
Soil Evaluator Form No. Name of Soil Evaluator92�,, i D ate of Evaluation _ , d �J
DESCRIPTION OF REPAIRS OR
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to not top ce a tem in operation until a Certificate of om ance has been issued by the Board of Health.
Signed � Date
-- 1-r
Inspections
No. > 0 i k lr C ^1 -1)' FEE `^2 00
/ /U 3 COMMONWEALTH OF MASSACHUSETTS 4. ,6 i6 —1S
Board of Health, YM-mO crn+ , MA.
CERTIFICATE Of COMPLIANCE
Description of Work: "dividual Component(s) ❑ Complete System
The undersigned hereby certi that th-eage Disposal yttem; Constru ted ( ), Repaired ( ), Upgraded,(/Kbandoned ( )
by: o Tf'/ /.w/� S;/� t
at % L1 /S St, l i Uhl li! /% r
has been installed in accordance with the p o�isions of 310 CMR 15.00 (Title 5) and thea proved design plans/as-built plans relating to
application No. /'� —� U�, dated (0 `� Approved Desienn Flow `'�&�Ppvw
(gpd) / /
Installer vl /� , l [� liF/ ///c,_ .(/ej`��'�"1//UIlwS to
Designer: '/ - Inspector: /,:/ Date:
The issuance of this permit shall not be construed as a guarantee the system will function as designed.
No.C FEE '` . f !a
i
COMMONWEALT14 Of MASSACHUSETTS (a' -
Board of Health, Y&E-M O X77 4 , MA.
DISE®SAI. SYSTEM[ CONSTRUCTION PERMIT
Permission is hereby granted to; Construct ) Repair( ) Upgrade (Abandon( ) an individual sewage disposal system
at 99 .> t. //11 Va A%4 as described in the application for
Disposal System Construction Permit No. -3, dated
/7�
Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown, MA Date Board of Health
�
j No.:BOHDGIS-2361
I
' ' Commonwealth of Massachusetts Fee
i $55.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Individual Component(s)
Location: 94 SULLIVAN RD,WEST YARMOUTH, MA 02673 Owner:
MCDERMOTT DOROTHY A
Map/Parcel#: 047.125 94 SULLIVAN RD
WEST YARMOUTH,MA 02673
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: (5081775-9700
Type of Building:Dweliing Lot Size: 17,424.00 Acres
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Fixtures:
Plan Date:OS/20/2015 Number of Sheets: 1
Cafeteria:
Tit1e:SITE PLAN FOR 94 SULLIVAN ROAD Revision Date:
Design Flow(min.required):330 gpd Calculated design flow:33 gpd Design flow provided:479 gpd
Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:04/08/2015
RONALD J.CADILLAC,RS
DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-EXISTING 1000 GAL SEPTIC TANK,DBOX,27 ADS ARC 36HC
CHAMBERS W/OUT STONE:45'X 8.67'X 0.89'
' The undersigned agrees to install the above described Individual Sewage Disposal System in accordance wkh the provisions of
TITLE 5 and further aarees not to olace in ooeration until a Certificate of Comoliance has 6een issued bv the Board of Health.
Signed Date
Inspections
�
; Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT $55.00
Permission is herby granted to;
BOSETTI SEPTIC SYSTEMS, 199 CHURCH STREET, EAST HARWICH, MA 02645
I
To perform:Upgrade an individual sewage disposal system.
Owner: MCDERMOTT DOROTHY A
94 SULLNAN RD
WEST YARMOUTH,MA 02673
Location:94 SULLIVAN RD,WEST YARMOUTH,MA 02673
� Disposal System Construction Permit No.: BOHDGIS-2361 ,Dated:June 08,2015
Provided: Construction shall be completed within six months of the date of this permit. All local conditions must be met.
Conditions
1. REPAIR-EXISTING 1000 GAL SEPTIC TANK, DBOX, 27 ADS ARC 36HC CHAMBERS W/OUT
STONE.• 45'X 8.67'X 0.89'
2. MAXIMLJM 3 BEDROOMS-NO ADDT170NAL BEDROOMS ALLOWED IN BASEMENT WITHOUT
FURTHER REVIEW BY B UILDING AND HEALTH DEPARTMENTS
Bruce . rphy, MPH, 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.
i '
.
(
I �
e �,�,•,�...
Commonwealth of Massachusetts
! Board of Health, Yarmouth, MA Fee
CERTIFICATE OF COMPLIANCE $55.00
Description of Work:Individual Component(s)
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:BOSETTI SEPTIC SYSTEMS
at:94 SULLNAN RD,WEST YARMOUTH,MA 02673
Has been installed in accordance with the provisions of 310 CMR 15.00(Title 5)and the approved
design plans or as-built plans relating to application No.: BOHDC-15-2361,dated 06/10/2015.
Installer:BOSETTI SEPTIC SYSTEMS
Address:199 CHURCH STREET EAST HARWICH,MA Inspector:AMY VON HONE,R.S.
02645
Designer:RONALD J.CADILLAC,PLS,RS,PC
Conditions
1.REPAIR-EXISTING 1000 GAL SEPTIC TANK,DBOX,27 ADS ARC 36HC CHAMBERS
W/OUT STONE: 45'X 8.6T X 0.89'
2.MAXIMUM 3 BEDROOMS-NO ADDITIONAL BEDROOMS ALLOWED IN BASEMENT
WITHOUT FURTHER REVIEW BY BUILDING AND HEA PARTM N
�l
Bruce G. u y, MPH, 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.
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BOH_Disposal_Construction_CofC.rpt
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