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No.�>Ot3 l�C-l"7 %/ FEE
COMMONWEALTH Of MASSAC14USLITS
Board of Health, Y&(Llf1 00-1-W '11M.
APPLICATION FOR ISIS SAI. SYSTEM CONSTRUCTI®N PERMIT
Application for a Permit to Construct( ) Repair( Upgrade() Abandon() - ❑ Complete System ❑ Individual Components
Location
Owner's Name
Map/Parcel# 050, 10'7
Address
Lot#
Telephone#
Installer's Name C e j.
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Designer's Name
AddressV.C)a 7
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Address
Telephone# cd✓ L Z/v t5bo
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Telephone#
Type of Building y Lot Size sq. ft.
Dwelling - No. of Bedrooms Garbage grinder ( )
Other - Type of Building No. of persons Showers ( ) , Cafeteria ( )
Other Fixtures
Design Flow (min. required)
Plan: Date
Title
Description of Soil(s) _
Soil Evaluator Form No.
gpd Calculated design flow
Number of sheets
DESCRIPTION OF REPAIRS OR ALTERATIONS
The unde ees to
further ees o o
Signed
Inspections
Name of Soil Evaluator
Design flow provided
Revision Date
Date of Evaluation
gpd
the abov ed IndijaCertificate
al Sewage Disposal System in accordance with the provisions of TITLE 5 and
the system' tion until of_Compliance has been issued by the Board of health.
Date
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Gr (C -rCL, -(C r tc>C-j Z✓' 4;1-,t
No.��C"�S"�Q��COMMONWEALTH
r -r. FEE 4
l ® ®N ITIS OF 1° ASSACH SETTI �``,9
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• Board of Health; MA.
CERTIFICATE OF COMPLIANCE 7�! �
Description of Work:Individual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired (erua
raded ( ), Abando/ned ( )
by: i� CP I t '� +6 -Q -P eb3 � 'S OrrT
at ' 7(, `Tc i\-, i? Word T) f --- -
has been installe tri aa ce_ ord
d' t e provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. . / a��ted 7 -/�j_'-"O t Approved Design Flow (gpd)
Installer �1 n _((_C' �TT')/l cc, EJP cad ; fr,v; r n .f% ec* , 6/1
Designer: """'"""" Inspector: J"JQ''V'"� ® Date:
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
No. . + r -1 _'� j C,APC- Co t> S en INN p. /t, eFoxe Sum; P-7 LLr- FEE 00
/COMMONWEALTH OF MASSACIIUSETTS
Board of Health, ��_ y� , MA.
DISPOSAL SYSTEM IONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgrade ( ) Abandon ( ) an individual sewage disposal system
at —7(R,-- t9 Dc as described in the application for
Disposal System Construction Permit No. %� , dated7—/6 /C
,'mac''- .�'� D c� I
Provided: Construction shall be corripLete_d within three years of the date of this per ifi�. l local conditions must be met.
Form 1255 Rev. 5196 A.M. Sulkin Co. Chadestown. MA Date 7 -l4 % pard of Health
,
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
CERTIFICATE OF COMPLIANCE $ss.00 '
Description of Work:Individual Component(s)
The undersigned hereby certify that the Sewage Disposal System; Repair-minor
by:BEFORE SUNSET LLC
at:76 TANGLEWOOD DR,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-15-0897,dated 07/17/2015.
Installer:BEFORE SLINSET LLC
Address:P.O.BOX 1466 HARWICH,MA 02645 Inspector:BRUCE MURPHY,R.S.
Designer:
Conditions
1.MINOR REPAIR-SEAL EXISTING SEPTIC TANK#2 TO EXISTING SEPTIC TANK#1 AND ';
3 FLOWDIFFUSORS ,� �� ��,n- '
L/ lJ�
Bruce G. Murphy, H, .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.
BOH_Disposal_Construction_CofC.rpt
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No.:BOHDGIS-0897
Commonwealth of Massachusetts Fee
ass.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Repair-minor-Individual Component(s)
Location: 76 TANGLEWOOD DR,WEST YARMOUTH, MA 02673 Owner: �
SCUDDER JOYCE W '
Map/Parcel#: 030.109 76 TANGLEWOOD DR
WEST YARMOUTH,MA 02673
Phone:
Septic System Installer Designer
BEFORE SUNSET LLC
P.O. BOX 1466 HARWICH, MA 02645
Phone:
Type of Building:Dweiling Lot Size: 10,019.00 Acres
Dwelling-No.of Bedrooms:2 Garbage Grinder:
� Other Type of Building• No.of persons: Showers: '
s
Other Fia�tures:
Plan Date: Number of Sheets: Cafeteria•
Title: Revision Date:
Design Flow(min.required):220 gpd Calculated design flow:220 gpd Design flow provided:220 gpd
Description of Soils:
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:
DESCRIPTION OF REPAIRS OR ALTERATIONS:MINOR REPAIR-SEAL EXISTING SEPTIC TANK#2 TO EXISTING SEPTIC
TANK#1 AND 3 FLOWDIFFUSORS
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of
TITLE 5 and further aarees not tn olace in ooeration until a Certificate of Comoliance has been issued bv the Board of Health.
Signed Date
Inspections
I
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Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT 555.00
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1 Permission is herby granted to;
BEFORE SUNSET LLC, P.O. BOX 1466, HARWICH, MA 02645
To perform:Repair-minor an individual sewage disposal system.
Owner: SCUDDER JOYCE W
� 76 TANGLEWOOD DR
a WEST YARMOUTH,MA 026'73
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{ Location: 76 TANGLEWOOD DR,WEST YARMOUTH,MA 02673
� Disposal System Construction Permit No.: BOHDC-15-0897,Dated:July 16,2015
� Provided:Construction shall be completed within six months of the date of this permit. All local conditions must be met.
Conditions
1. MINOR REPAIR-SEAL EXISTING SEPTIC TANK#2 TO EXISTING SEPTIC TANK#1 AND 3
FLOWDIFFUSORS
` �C� ���L��'.�
�
Bruce . Mu phy, 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 witl function as designed.