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2.VD1 LC COMMONWEALTH EALTH OF MASSACHUSETTS
Board of Health, Yarmouth, h14
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct()Repair(/Upgrade()Abandon()-4/Complete System❑Individual Components
3 J P4�k�t l 1J SO.y,,,,,,,,t4 Owner's Name C9 �Q!/PJLLn2lLocation Map/Parcel# a,s'/.5/I Address , 1 c{hC}S :,0,z) �46,7
Lot# Telephone# �� , y5�j- 5�ya •J `J
Installer's Name �jr�� 6S (UC�'t �, Designer's Name( , 440W Wily r 441C
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Address P �k rx)4 Novi i/►vA Y l o axo yj Address 9 3q Maim
Telephone# 50%- r)f)J — 9399 Telephone# 3 •34,2• Lin/
Type of Building _Lot Size 7 OOv + sq.ft.
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Dwelling—No.of Bedrooms Garbage grinder( )
Other—Type of Building 3 No. of persons Showers(),Cafeteria()
Other Fixtures
Design Flow(min.required) 330 gpd Calculated design flow Designflow provided 13"1 gpd
Plan: to i• ,i . - • ._• -_ Number of sheets I Revision Date
Title P evy, 31 r r a Rd. S• .. lu.. vct
Description of Soil(s) cies4- -. IQ or vvV
Soil EvaluatorForm No. Name of Soil Evaluator Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS 0750) l e (bpy{rinimi'• MO kink/ p dA2 z...),a
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.The undersigned agrees to in ove described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
_. further agrees to n• • p ace th• : stem in operation until a Certificate of Complian has been issued by the s.oard of Health.
Date V v� i
Signe it' MAR 3 1 2021
Inspections
No.I �
!� `• 2 1S FEE
COMMONWEALTH OF MASSACHUSETTS S N: s�' .
Board of Health, Yarmouth, MA ! .• A .1.Agri
MillinirtdDISPOSAL SYSTEM CONSTRUCTION PERMIT , r ,;.
Permis .on is hereb gran ed to; Con uct( ) Re.:it(3-Upgrade() Abandon() an individual sewage disposal system at
1 4 `.0 .” `! i• s i/4//// // as described in the application for
lisposal System Construction Piv) it No. Z1'01 Le , dated 5'3( 24 .
Provide : Co struction shall be complete. w.thi are ears - to of is permit. All local conditions must be met.
Date 4 1 21 (bard of Health l OP,
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Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
CERTIFICATE OF COMPLIANCE $55.00
Description of Work: Complete System
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by: BORTOLOTTI CONSTRUCTION INC.
at: 31 PARKWOOD RD, SOUTH YARMOUTH, MA 02664
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-21-2695, dated 3/31/2021
Installer: BORTOLOTTI CONSTRUCTION INC.
Address:P.O. BOX 704 MARSTONS MILLS, MA 02648 Inspector: Daniel A. Ojala, PE. PLS
Designer: Down Cape Engineering
•
Bruce G. Murphy, MPH, R.^., C /Mallory R. Langler, R.S.
Health Dir--"ctor/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