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y Board of Health,MA.
APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTION PERMIT
€k,.0 Ap ication for a Permit to Construct( ) Repair( ) Upgrade Abandon( ❑ Complete System 816; ividual Components
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Location yp NioJ��t�r`K R� •
Owner's Name pe-
ter
F. Le er
Map/Parcel# 1 o 7 Z-
Address y i
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{M u A
Lot#
Telephone#
Installer's NameRobe�"r , OUr �p
Designer's Name 'Bass
R , Ver En 1 E r
Address 2-4 it ec' - kjeStPsh_ 11 , Hat wi Ck, MA
Address V -0 -Roy 119S,
E. benn4S A D ?L y l
Telephone# g _ 3Z _ 0 S 10
I Telephone# SOS - 3 & 5 - 3 4 26
Type of Building d w e!
Dwelling - No. of Bedrooms
Other - Type of Building _
Other Fixtures
I.ot Size 1, 733 sq. ft.
Garbage grinder ( )
No. of persons Showers ( ), Cafeteria ( )
Design Flow (min. required) 330 gpd Calculated design flow Design flow provided - gpd
Plan: Date s"1 15 Number of sheets _ _ Revision Date NSA
Title Site Plor\
Description of Soil(s) L co.my S .Kl /Med1UM &-KA
Soil Evaluator Form No. Name of Soil Evaluator A-1-5 M- Lel Iwn Q E. Date of Evaluation S/7//S--
DESCRIPTION
/%//S
DESCRIPTION OF REPAIRS OR ALTERATIONS
The undersigned agrees
further agree not to
Signed
4
Inspections
described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
`+ 'on un ' Certificate of Compliance has been issued by the Board of Health.
7 Date S- ZI - 19
No. � _1, - a � COMMONWEALTH OF MASSACHUSETTS
/�- 7
Board of Health, &N1®ynL , MA.
CERTIFICATE Of COMPLIANCE
Description of Work: 'Individual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), F
by:
at
FEE
cA oo05Z
.�
Lr
ed ( ), Upgraded (,Abandoned
has been installed in_accor a ce with the provisions of 310 CMR 15.00 (Title 5) and t pproved design plans/as-built plans relating to
application No. /5 � 7 dated6 Approved Design Flow (gpd)
Installer kes,Pr*t R. nt if (n. G..4-E.d5T7)'f?tWL LA) . bUe-
Designer: 6 Jl 67 K Inspector: ca� Date:
The issuance of this permit shall not be construed as a guarantee (hat the system will function as designed. ti
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/� �--' �7 i COMMONWEALTH Of MASSACHUSETTS
Board of Health, ype,k'.M 0QT- EV , MA.
FEE
4400 4 75 Z,
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereb ranted to; Construct � 4, Repair U rade Abandon an individual sewage disposal system
at 40 " as described in the application for
Disposal System Construction Permit No. i , dated 6 /S.
Provided: Construction shall be completed within thxee_yearme c}�tg of this permit. All local cdnditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown, MA Date - /-S Board of Health
No.:BOHDC-15-2281
� Commonwealth of Massachusetts F�
so.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Applicatioo for a Permit to:Upgrade-Individual Component(s)
Location:40 HIGHBANK RD, SOUTH YARMOUTH, MA 02664 Owner:
LEGER PETER F
Map/Parcel#: 07072 40 I-IlGHBANK RD �
SOUTH YARMOUTH,MA 02664
Phone:
Septic System Installer Designer
ROBERT B.OUR BASS RIVER ENGINEERING
P.O. BOX 1539 HARWICH, MA 02643 P.O.BOX 1163
Phone: EAST DENNIS,MA 02641
(508)385-3426
Type ofBuilding:Dwelling Lot Size:9,147.60 Acres
Dwelling-No.of Bedrooms:2 Garbage Grinder:
Other Type of Building: No.of persons: Showers:
Other Fiztures:
Pleo Date:OS/14/2015 Nurober of Sheets: 1 Cafehrie:
TitIe:SIT'E PLAN 40 HIGHBANK ROAD Revision Date:
Design Flow(min.required):330 gpd Calculahd design flow:330 gpd Desigo tlow provided:349 gpd
Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:OS/07/2015
THOMAS MCLELLAN,P.E.
' DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR-EXISTING 1000 GAL SEPTIC TANK,DBOX,2•500 GAL PRECAST
CHAMBERS W/4'STONE:25'X 12.83'X 2'
The undersigned agrees to insfall the above described Intlivitlual Sewage Disposal System fn accordanee wilh the provisions of
� TITLE 5 and further aarees not to olace in ooerotion until a Certificate of Comoliance has heen isauetl bv Ne Board of Flealth.
Signed Date
Inspections
Commonwealth of Massachusetts
� Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00
Permission is herby granted to;
ROBERT B. OUR COMPANY INC., P.O. BOX 1539, HARWICH, MA 02643
To perform:Upgrade an individual sewage disposal system.
Owner: LEGER PETER F
40 HIGHBANK RD
SOUTH YARMOUTH,MA 02664
Location:40 HIGHBANK RD,SOUTH YARMOUTH,MA 02664
Disposa7 System Conshuction Permit No.: BOHDC-1S2281 ,Dated:June 02,2015
Provided: Construction shall be comple[ed wi[hin six months of the date of this pertnit. All local conditions mus[be met.
Conditions
1 REPAIR-EXISTING 1000 GAL SEPTIC T.9NK, DBOX, 2-500 GAL PRECAST CHAMBERS W/4'
STONE:25'X 12.83'X 2'.
Bruce G. Mu y,MP , R.S., CHO/Amy L.von Hone, R.S.,CHO
ealth Director/Assistant Health Diredor
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.