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No.:BOHDC-15-O851
• Commonwealth of Massachusetts Fee
$55.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Complete System
Location: 19 PAINE RD,SOUTH YARMOUTH, MA 02664 Owner:
COADY IAMES
Map/Parcel#: 101.149 COADY ELIZABETH A
19 PAINE RD
SOUTH YARMOUTH,MA 02664
Phone:
Septic System Installer Designer
CHASE&MERCHANT STEPHEN HAAS.PE
P.O. BOX 5 DENNISPORT, MA 02639 P.O.BOX 16
Phone: SOUTH DENNIS,MA 02660
(5081362-8132
Type of Building:Dwelling Lot Siu:031 Acres
Dwelling-No.of Bedrooms:3 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Fiatures:
Plan Date: 12/Ol/2014 Number of Sheets: 1 Cafeteria:
TitIe:SEPTIC SYSTEM DESIGN 19 PAINE ROAD Revision Da[e:
Design Flow(min.required):330 gpd Calculated design ilow:330 gpd Desigo flow provided:448 gpd
Description o[Soi1s:SEE PLAN
Soil Evaluator Forro No.: Name of Soil Evaluator: Date of Evaluation: 10/21/2014
STEPHENIfAAS,PE
DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-NEW 1500 GALLON H-20 SEPTIC TANK, t000 GAL H-20 PUMP
CIIAMBER,DBOX.2-500 GAL PRECAST CHAMBERS W/4'STONE:33'X 12.5'X 2'
The untlersfgnetl agrees to insWll the above described Indivitlual Sewage Dlaposal System in accordance wkh the proviaions of
TITLE 5 and fur[her aarees not to olace in oceration until a Certificate of Comoliance has been issued 6v the Board of Heakh.
Signed Date
Inspections
Commanwealth of Massachusetts
� Board of Health, Yarmauth, MA F�
DISPOSAL SYSTEM CONSTRUCTIQN PERMIT sss.00
Permission is herby granted to;
CHASE&MERCHANT ING., P.O.BOX 5, QENNISPORT,MA Q2639
To perform:Upgrade an individuat sewage disposal system.
Owver: COADY JAMES
COADY ELI7.ABE'fH A
�. ]4 PA3Nfi RD
�� S(7UTH YARMOUTH,MA 02664
Locarion: ]9 PAINE RD,SOUTH YARMQUTH,MA 02664
Disposal System Construction Parmit No.: BOHDC-15-0851 ,Dated:January 16,2015
Provided:Construction shall be completed within six manths of the date of this permit. All looal conditions must be met.
Conditions
1.REPAIR-NEW I500 G.4LI,ON H-20 SEPTIC TANK 1000 G,dL H-20 FUMP CHAMBER, DBOX. 2-
500 C.AL PRECAST CHAMB�RS W/4'STONE: 33'X!2.$'X 2'
2. MFC VRRIANCES: 1. DEPTH2. SETBACKS
Bruce G. Mu hy,MPH,R.S.,CHO t Amy L. n Hone, R.S.,CHO
ealth pirector/Assistant Health Director
The issuance of t6is permit shall not�e construed as a guarantee that tha sysYem will funetion as designed.