HomeMy WebLinkAboutApp-Permit-ComplianceNo. V / / `/ &� FEE
COMMONWEALTH OF MASSAC14USETTS
YARMOUTH HEALTH DEPT.
Board of Health, r 14ra no[ j r- 28 , MA.
APPLICATION FOP, DIS-PMAYTIMMWMUCTION PERMIT
Application for a Permit to Construct() Repair( Upgrade( ) Abandon() - ❑ Complete System ❑ Individual Components
Location 25 Vacation Lane
Owner's Name Joseph Massua
Map/Parcel# ,fjf j1 %
Address 25 Vacation Lane
Lot#
Telephone#
Installer's Name J . P . Macomber & Son inc.
Designer's Name) _ P . Macomber & Son Inc.
Address Box 66 Centerville Mass.02632
Address Box 66 Centerville Mass.02632
Telephone#
Telephone#
Type of Building AWC 11 ] nn Lot Size
Dwelling - No. of Bedrooms
Other - Type of Building No. of persons
Other Fixtures
Design Flow (min. required)
Plan: Date
Title
Description of Soil(s) _
Soil Evaluator Form No.
gpd Calculated design flow
Number of sheets
Name of Soil Evaluator
sq. ft.
Garbage grinder ( )
Showers ( ), Cafeteria ( )
Design flow provided gpd
Revision Date
Date of Evaluation
;s
,DESCRIPTION OF REPAIRS OR ALTERATIONS Omitting collapsed line under the existing
deck. Omitting orangeberg pipe and replacing it with 4" Sch.40 4"
PVC pipe
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further afire s to nott 1 e tem in eration until a Certificate of Compliance has been issued by the Board of Health.
Signed Date 1/ 1 6103
In ections
No. (% -.Z COMMONWEALTH OF MASSACHUSETTS
FEE
Board of Health, Yarmouth,' MA.//�� %�`����
CERTIFICATE -OF COMPLIANCE
Description of Work: (0 Individual Component(s) ✓� ❑ Complete System N! ew Sewage line .from the }louse ou
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired (Kk Upgraded ( ), Abandoned_(,, )
114-a -'Oiu der .- Son Inc.
at ?q Vpg-,)Finn T.Ana T4—zi- VarmniiFl,Magc
has been installed in accordance -with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. 0 3 `1 3 , dated / -a2 -3-0 3. Approved Design Flow (gpd)
Installer J.P. Macomber & Son Inc.
DesignerJ. P. Macomber & Son Inc.Inspector: Lt L %ry Date: -2 ��-63
The issuance of this permit shall not be construed as a guar 'tee the system will function as designed.
No. U - J ,?✓Ir%Yd'�� FEE �.
Board ofHeaTlth, Yarmouth MA.
DISPOSAL SYSTEM STEM CONSTRUCTIO PERMIT
Permission is hereby granted to; Construct( ) RepairX? ){ Upgrade ( ) Abandon ( ) an individual sewage disposal system
at 25 Vacation Lane West Yarmoutb., Mass . as described in the application for
Disposal System Construction Permit No. Cl'J r,2 , dated
Provided: Construction shall be completed within tl vt - r of the date of this perpi . All local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Boston, MA Date _� 3 Board of Health % �T