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, No.:BOHDGI4-0345
Commonwealth of Massachusetts F�
555.00
Board of Health, Yarmouth, MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERNIIT
Application for a Permit to:Upgrade-Complete System
Location: 11 TABOR RD,WEST YARMOUTH, MA 02673 Owner
Map/Parcel#:023.127 Name:
CONDE KATHLEEN S
Address:
51 PLYMOUTH LN MANCHESTER, CT
06040-4403
Phone:
Septic Sysbem InsWller
Name:
CHASE&MERCHANT INC.
Address:
P.O. BOX 5 DENNISPORT, MA 02639
Phone:
Type of Building:Dwelling Lot Size:0.26 sq.ft.
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type of Buildiog: No.ot persoos: Showers: Cafeteria:
Other Fixtures:
PlauDate: ]0/07/20t3 NumberotSheets:2
Title:SEWAGE DISPOSAL SYSTEM PLAN Revision Dah:09/16/2014
Design Flow(min.required):330 gpd Calculated design Oow:330 Design flow provided:350 gpd
BPd
DescripNon otSoils:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluatioo:09/18/2013
DAVID COUGHANOWR,R.S.
DESCRIPTION OF REPAIRS OR ALTERATIONS: 1500 GAL SEPTIC TANK
_ ]000 GAL PUMP CHAMBER
DBOX
20 ARD 36LP ADS BIODIFFUSORS W/OUT STONE:
20'X 14.167'X 3.8" �
The undersigned agrees to inshll the above described Individual Sewage Disposal System in aeeortlanee wkh the provisions
of TITLE 5 and fuRher aprees not to place in operatlon until a CeR'rfieate of Compliance has been Issued bY the Bwrd of Health.
Signed � Date
Inspections
� Commanwealth of Massachusetts
Board of Health, Yarmauth, MA. Fee
; DISPOSAL SYSTEM CONSTRUCTION PERMIT ass.ao
i
i
Permission is herby granted to;JAY MERCHANT Address:P.O.BOX 5
DENNISPORT,MA 02639
'. To perform: Upgrade an individuat sewage disposal system.
I Owner: C4NDE KATHLEEN S
�� 51 PLYMOUTH LN
MANCE�STER,CT {ib440-4403
I..ocation: 11 TABOR RD,WEST YARMQUTH,MA 02673
� Disposal System Construction Permit No.:BOHDC-140343,Dated:September 19,2014
� Provided: Construc[ion shall be campleted within six months of the date ofthis permi[. All local conditions must ba met. .
onditions
!.Board�f Heaith Agenr ta Irespeet Sait Removal
i2. Electrical Permit is reguired
I� 3. 1 S00 gal Septic Tank, 1000 gal Pump Chamber, DBox, 20 ARC 36LP ADS Bzodiffusor Units w/nut
' Stone:
20'x 14.16?'x 3.&„
Bruce G. u y,MPH,R.S.,CHO!Amy L.von Hdne,R.S.,CHO
Health Director/As&istant Health Director
The issuance of this permit s6all nat be construed as a guaraotee that t6e system will function as designed.