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COMMONWEALTH LTH ®f MASSACHUSETTS ZgB16
Board of Health, �i1 "101�Ti
APPLICATION FOP, DPOSAL SYSTEM CONSTRUCTION �I�MIIT
plication for a Permit to Construct( Repair Upgrade( ) Abandon( - ❑ Complete System Individual Components
Location
Owner's Name 1 y, b ek b e- i -141
Map/Parcel#
Address
Lot#Telephone#
Installer's Name C -( CCa
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Designer's Name
Address Boy- ).166GG-
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Address
Telephone# to -US (;/0 `J 7V %Z
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Telephone#
Type of Building
Dwelling - No. of Bedrooms
Other - Type of Building
No. of persons
Lot Size
sq. ft.
_ Garbage grinder ( )
Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow (min. required) gpd Calculated design flow Design flow provided gpd
Plan: Date Number of sheets Revision Date
Title
Description of Soil(s) _
Soil Evaluator Form No.
Name of Soil Evaluator
DESCRIPTION OF REPAIRS OR ALTERATIONS
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" `ll
Date of Evaluation
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The undersigned a es to ' tall thjabosacrib -Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to t ojthe sytion until a Certificate of Compliance has been issued by the Board of Health.
Signed'"' Date
Inspectionse0
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No. 60 x -is —4�553 FEE ZP 00
_ COMIM ONWEAI,TII OF MASSACHUSETTS Ff
Board of Health
CERTIFICATE Of COMPLIANCE
Description of Work: /Individual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System; constructed Repaired (tJ�pgraded ( ),Abandoned ( )
by: �I lc"C(Q �� (1 �. i Q ) ( X40! SP,t�r� G �iY'��V'10
at C, 1' 1 L) 1(av -
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has been installed - accorG'1ce with the pro��sions of 310 CMR 15.00 (Title 5) and the ap roved design plans/as-built plans relating to
application No. �`� �!- dated r� ! Appr ved Design Flow '� --2>(gpd)
Installer �G(' Q)� s� 0c -L Cape (06 5.001ir- c Qj
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Designer: Inspector: ,� 7r`� ; ` _ Date: S
The issuance of this permit shall not be construed as a guarantee that a system will function as designed.
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COMMONWEALTH EVI Of MASSACHUSETTS
Board of Health, YAg&O e!"(* , MA.
DISPOSAL SYSTEM[ ®NSTRUCTI®N PERMIT
Permission is hereby granted to; Construct( ) Repair( Upgrade ( ) Abandon( ) an individual sewage disposal system
at 9 ,fktu h tv0. I
as described in the application for
Disposal System Construction Permit No. f FSS' dated
Provided: Construction shall be comp eted wtthi thn` ree ears_of the date of this 2permit All local conditions must be met.
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Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown,MA Date !fir �� Board of Health v
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No.:BOHDC-15-4593
Commonwealth of Massachusetts F�
$55.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
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Application for a Permit to:Repair-minor-Individual Component(s)
� Location: 9 THRUSH TRAIL,YARMOUTH, MA 02675 Owner:
BEEBE PETER J
Map/Parcel#: 144.36 DOWLEY CAROLD B
7 OLD MAYFAIR RD
SOUTH DENI�IIS,MA 02660
Phone:
jSeptic System Installer Designer
j BEFORE SUNSET LLC
�i P.O. BOX 1466 HARWICH, MA 02645
Phone:
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� Type of Building:Dwelling Lot Size: 13,504.00 Acres
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Dwelting-No.of Bedrooms:3 Garbage Grinder•
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Other Type of Building: No.of persons: Showers:
Other Fixtures:
Plan Date: Number of Sheets: Cafeteria•
Title: Revision Date:
' Design Flow(min.required):330 gpd Calculated design flow:330 gpd Design flow provided:330 gpd
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Description of Soils:
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTTC DISPOSAL-MINOR REPAIR-REPLACE DBOX AND RESEAL EXISTING
SEPTIC TANK
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 been issued bv the Board of Heakh.
Signed Date
Inspections
�
, .
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
� DISPOSAL SYSTEM CONSTRUCTION PERMIT $55.00
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Permission is herby granted to;
BEFORE SUNSET LLC, P.O. BOX 1466, HARWICH, MA 02645
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To perform:Repair-minor an individual sewage disposal system.
Owner: BEEBE PETER J
i DOWLEY CAROLD B
i 7 OLD MAYFAIR RD
SOUTH DEI�INIS,MA 02660
;
Location:9 THRUSH TRAIL,YARMOUTH,MA 02675
! Disposal System Construction Permit No.: BOHDC-15-4593,Dated:October 08,2015
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Provided:Construction shall be completed within six months of the date of this permit. All local conditions must be met.
' CONDITIONS:
{ 1. SEPTIC DISPOSAL-MINOR REPAIR-REPLACE DBOX AND RESEAL EXISTING SEPTIC TANK
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� Bruce G. h , MPH, R.S., CHO/Amy L.von Hone, R.S.,CHO
Health Director/Assistant Health Director
i The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
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