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No.:BOHDGI4-0638
Commonwealth of Massachusetts FeB �
555.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Complete System
Locallon: 17 SHORE SIDE DR, SOUTH YARMOUTH, MA 02664 Owner: �
PARMENTER HENRIETTA D LIFE EST
Map/Parcel#: 026.143 17 SHORE SIDE DR
SO YARMOUTH,MA 02664
Phone:
Sepfic System Installer Designer
CAPEWIDE JC ENGINEERING,INC.
153 COMMERCIAL STREET 2854 CRANBERRY HIGHWAY
MASHPEE, MA 02649 EAST WAREHAM,MA 02538
Phone: (5081273-0377
Type ot Building:Dwelling Lot Siu:Obl Acres
Dwelling-No.of Bedrooms:4 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Futures:
PlanDate: ll/17/2014 NumberofSheets: l Cafehria:
Tit1e:PROPOSED SEPTTC SYSTEM UPGRADE 19 SHORE SIDE DRIVE Revision Date:Ol/12/2015 �
Design Flow(min.required):440 gpd Calculated design tlow:440 gpd Design ilow provided:455 gpd
Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evsluator: Date of Evaluation: 10/15/2014 -
MICHAEL PIMENTAL,EIT
DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR- 1500 GAL SEPTIC TANK, 1000 GAL PUMP CIIAMBER,DBOX,26 ARC '
36 LOW PROFILE UIVITS W/OUT STONE:26.2'X 14.2'X 0.32'
The undersigned agrees to insfall the above tleseribetl Intlividual Sewage Disposal System in aeeordance wRh the provisions of
TITLE 5 and further aarees not to olace in ooeration until a Certificate of Comollance has heen issued M[he 8oard of Fieakh.
Signed Date
Inspections
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA FeB
DISPOSAL SYSTEM CONSTRUCTION PERMIT 555.00
Permission is herby granted to;
CAPEWIDE ENTERPRISES, LLC, 153 COMMERCIAL STREET, MASHPEE, MA 02649
To perform: Upgrade an individual sewage disposal system.
Owner: PARMENI'ER FIENRIETTA D L[FE EST
17 SHORE SIDE DR
SO YARMOUTH,MA 02664
Location: 17 SHORE SIDE DR, SOUTH YARMOUTH,MA 02664
Disposal System Construction Permit No.: BOHDC-14-0638,Dated:December 09,2014
Provided: Construction shall be wmpleted within six months of the date of this permit. All local conditions must be met.
Conditions
1. REPAIR-I500 GAL SEPTIC TANK, 1000 GAL PUMP CHAMBER, DBOX, 26 ARC 36 LOW
PROFILE UN1TS W/OUT STONE:26.2'X 14.2'X 0.32'
2. BOH TO INSPECT SOIL REMOVAL
3. PLUMBING PERMIT REQUIRED
4. ELECTRICAL PERMIT REQUIRED
5. MFC VARIANCES: 1. GROUNDWATER SEPARATION
i�/ ����
Bruce G. A�JCirph�R.S., CHO/Amy L.von Hone, R.S.,CHO
/Health Director/Assistant Health Director
The issuance of this permit s6a11 not be coustrued as a guarantee that the system will function as designed.
Commonwealth of Massachusetts
Board of Health, Yarmouth, 1�1H Fee
CERTIFICATE OF COMPLIANCE sss.00
Description of Work:Complete System
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:CAPEWIDE ENTERPRISES,LLC
at: 17 SHORE SIDE DR, 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-140638,dated Ol/14/2015.
Installer.CAPEWIDE ENTERPRISES,LLC
Address:153 COMMERCIAL STREET MASHPEE,MA Inspector:AMY VON HONE,R.S.
02649
Designer:JC ENGINEERING,INC.
Conditions
1.REPAIR- 1500 GAL SEPTIC TANK, 1000 GAL PUMP CHAMBER,DBOX,26 ARC 36 LOW
PROFILE UNITS W/OUT STONE: 26.2'X 14.2' X 0.32'
2.BOH TO INSPECT SOIL REMOVAL
3.PLUMBING PERMIT REQUIRED
4.ELECTRICAL PERMIT REQUIRED
5.MFC VARIANCES: 1.GROUNDWATER SEPARATION � ��/
c�r{
Bruce G. Murph P , R.S., CHO/Amy L.von Hone, R.S.,CHO
Health Director/Assistant Health Diredor
The issuance of this permit shall not be construed as a guarantee that the system will funMion as designed.
BO H_Disposal_Construction_CofC.rpt