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� No.: BOHDGI4-0606
' ` Commonwealth of Massachusetts . Fee
sss.00
Board of Health, Yarmouth, MA.
j APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-
i Location: 156 WINSLOW GRAY RD,WEST YARMOUTH, MA 02673 Owner
I Map/Parcel#: 040.80 Name:
. FRASIER MARGARET S
� GO CHARLES&JEANNETTE CLARK 160
WINSLOW GREY RD
Phone:
Septic System Installer
Name:
ROBERT B. OUR COMPANY INC.
Address:
P.O. BOX 1539 HARWICH, MA 02643
Phone:
Type of Buildiog:Dwelling Lot Size:0.21 Acres
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building: � No.of persons: Showers: Cafeteria:
Other Fixtures:
Plan Date:07/31/2014 Number of Sheets: 1
TitIe:SEPTIC SYSTEM DESIGN 156 WINSLOW GRAY ROAD Revision Date:
Design Flow(min.required):330 gpd Calculated design flow:330 gpd Design flow provided:333 gpd
Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:07/03/2014
. STEPHENIiAAS,PE _
, DESCRIPTION OF REPAIRS OR ALTERATIONS: I500 GAL SEPTIC TANK
DBOX
LEACH FIELD:22.5'X 20'X 6"
. The undersigned agrees to install the above tlescribed Individual Sewage Disposal System in actordance with the provisions of
TITLE 5 and further aarees not to olace in ooerotion until a CertHicate of Comoliance has been issued 6v the Board of Nealth.
Signed Date
Inspections
�
Commanwealth of Massachusetts
Board af Health, Yarmouth, MA. Fe�
DISPOSAL SYSTEM CONSTRUCTION PERMIT ass.00
I Permission is herby granted to;CHRISTQPHER OUR Address:P.Q.BOX 1539
� HARWICH,MA 02643
i
To perform: Upgrade an iadividual sewage disposal system.
� Owner: FRAStERMARGARETS
C/0 CHARLFiS&7EANNETTF CLARK
760 WINSLOW GREY RLS
WEST YARMOUTH,MA 02693 �
Location: i5b WINSLOW GRAY RD,WEST YARMpUTH,MA 026'13
Dispasal System Conshuction Pertnit No.: BOHDC-14-0606,Dated:November 10,2014
Provided:Construction shall be completed within six months of the date of[hrs permit. All local conditions must be met.
j Canditions
t.BQH to inspect soid removal
� 2. Redocared Waterline
3.MFC Yariance: !. Groundwater Sepcararion
i 4. 1400 ga2 Septic Tank, DBox, Leach Fietd. 22.5'x 20'x 6"
^U '���
Sruce G. . rphy,MPH,R.S.,CHO t Amy L van Hone, R.S.,CHO
Healtb Diredor!Assistant Health Diredor
The issuance of this permit shall not be constraed as a guarantee t6at the system will faoction as designed,