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COMMONWEALTH
rOf MASSAC US S
Board of Health, MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) UpgradeAbandon() - �i Complete System ❑ Individual Components
Location � j "� �
Owner's Name A V I
Map/Parcel# Lr l a 19 I
Address d o 5-c7.,AP, r
Lot# a3
Telephone#
Installer's Name 2 r-jv r Co , T,
Designer's Name Z'VeC epa jite-11,A .
Address RO-Gok IS247Address
R0,&V"
Telephone# q5,01K — L 'Z a — 0
Telephone# 1 S IfiAq Q a, j
Type of Building
Dwelling - No. of Bedrooms
Lot Size gt '442 sq. ft.
Garbage grinder ( )
Other - Type of Building No. of persons Showers ( ), Cafeteria ( )
Other Fixtures 1—�" E—
Design Flow (min. required) t4-10 gpd Calculated design flow 44D Design flow provided gpd
Plan: Date S l as l Number of sheets L% Revision Date
Title
Description of Soil (s) A/12 /40 i 1 ZO.N .S — (. Ani SA N Cy C. Nlp r lZ .A�,-r N e— S
Soil Evaluator Form No. Name of Soil EvaluatorA+MN) VCV HQJQe Date of Evaluation S
DESCRIPTION OF REPAIRS ORALTERATIONS IS 0C-) 0 04 • _rA N K , 0-6 O lal Soo QQ 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 not to ace the in operation until a Certificate of Compliance has been issued by the Board of Health.
SignedmfJ Date /
Inspections
No.( of ICJ" 2_y 1 �7/� (.�"i�• fiavi.FEE
COMMONWEALTH OF M SSACHUSETTS
Board of Health, � YAP:tAb OT -4 OT-4MA.
A OF
CEPITIFIC
Description of Work: ❑ Individual Com onent(s)' Complete System COMPLIANCE
P P
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( Upgraded ( ), Abandoned ( )
by:
at
has been install— et
application No.
Installer Csl21S'tm
wif?-"te p%visions of 310 CMR 15.00 (Title 5) and thea roved design plans/as-built plans relating to
dated 6 --12.. % Approved Design Flow (gpd)
Designer: k'A ,S Inspector:
Date:
The issuance of this permit shall not be construed as a guara2�ee that'_the system will'function as designed.
220600000.100700000000GQ.00000 �'.O^(+VOOOOOCO��O'0O 000GU UOOOOOOO OO GG`OOGO(i�
No. ) 0 VA- 15 - 2- FEE 55, o
COMMONWEALTH OF MASSAC14USETTS 17
Board of Health, _Yil+r' pop , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgrade�.-"''Abandorr ) an individual sewage disposal system
at 10 & )A4Q -r w- as described in the application for
Disposal System Construction Permit No. /+'"//, dated -X-411-
Provided: Construction shall be completed within .yzeass of the date of this permit. f,�lI local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date✓SBoard of Health �'%�
No.:BOHDGIS-2481
� Commonwealth of Massachusetts Fee
ass.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Apptication for a Permit to:Upgrade-Complete System
Location: 10 SUNSET DR,SOUTH YARMOUTH, MA 02664 Owner:
JACOBS AVIS E(LIFE EST)
Map/Parcel#: 042.89 10 SUNSET DR
SOUTH YARMOUTH,MA 02664
Phone:
Septic System Installer Designer
ROBERT B.OUR BASS RIVER ENGINEERING
P.O. BOX 1539 HARWICH, MA 02643 P.O.BOX 1163
Phone: EAST DENNIS,MA 02641
508-385-3426
Type of Building:Dwelling Lot Size:8,712.00 Acres
Dwelling-No.of Bedrooms:4 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Fixtures:
Plan Date:OS/21/2015 Number of Sheets: 1 Cafeteria•
Tit1e:SITE PLAN 10 SiJNSET DRIVE Revision Date:
Design Flow(min.required):440 gpd Calculated design flow:440 gpd Design flow provided:454 gpd
ri i n f Soi1s:SEE PLAN
I Desc pt o 0
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:OS/07/2015
THOMAS MCLELLAN,P.E.
• DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-PROPOSED 1500 GAL SEPTIC TANK,DBOX,3-500 GAL PRECAST
II CHAMBERS W/4'STONE:33.5'X 12.8'X 2'
• 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 oneration until a Certificate of Comoliance has been issued bv the Board of Health.
Signed Date
Inspections
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I Commonwealth of Massachusetts
� � Board of Health, Yarmouth, MA Fee
� DISPOSAL SYSTEM CONSTRUCTION PERMIT $55.00
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Permission is herby granted to;
ROBERT B. OUR COMPANY INC., P.O. BOX 1539, HARWICH, MA 02643
To perform:Upgrade an individual sewage disposal system.
Owner: JACOBS AVIS E(LIFE EST)
10 SUNSET DR
SOUTH YARMOUTH,MA 02664
Location: 10 SUNSET DR,SOUTH YARMOUTH,MA 02664
Disposal System Construction Permit No.: BOHDC-15-2481 ,Dated:June 22,2015
Provided:Construction shall be completed within six months of the date of this permit. All local conditions must be met.
Conditions
1. REPAIR-PROPOSED I500 GAL SEPTIC TANK, DBOX, 3-500 GAL PRECAST CHAMBERS W/4'
STONE: 33.5'X 12.8'X 2'
i `/- V /
� Bruce G. Mu y PH, R.S., CHO/Amy L.von Hone, R.S.,CHO
ealth 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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