HomeMy WebLinkAboutApp-Permit-ComplianceYARMOUTH HEALTH DEFY.
1146 ROUTE 23 " FEE $ 50 . 00
S®. YARMOUTH, MA 026
COMMONWEALT14 OF MASSACHUSETTS
Board ofHealth, Yarmouth
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair (XX Upgrade( ) Abandon( ) - ❑ Complete System ❑ Individual Components
Location 40&42 Melville Road S. Yarmouth
Owner's Name Mildre Walsh & Tom Shipman
Map/Parcel# 89-R5A&R5B
Address 40&42 Melville Road S. Yarmouth
Lot# 89
Telephone#
Installer's Name J . P . Macomber & Son Inc.
Designer's Name
Craig Short
Address Box 66 Centerville Mass 02632
Address P
Telephone# 508-775-3338
Telephone# 508-398-8311 02660
Type of Building Duplex Lot Size
Dwelling - No. of Bedrooms 4
Other - Type of Building No. of persons
Other Fixtures
sq. ft.
Garbage grindedi Q)
Showers ( ), Cafeteria ( )
Design Flow (min. required) 440 gpd Calculated design flow 4 x 1 1 0 Design flow provided 4 5 2
Plan: Date 10/21 /98 Number of sheets 1 Of 1 Revision Date
Title
Description of Sdil(s) _
Soil Evaluator Form No.
Name of Soil Evaluator
DESCRIPTION OF REPAIRS OR ALTERATIONS Installi
2' of 12" stone.
Date of Evaluation
4 330 cultec recharaers packed in
gpd
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agr es to not p ce a syste in eration until a Certificate of Compliance has been issued by the Board of Health.
Signed Date 11 /6198
A' Insections
No."COMMONWEALTH OF MASSAC14USETTS FEE50-00
� 3 -
Board of Health, Yarmouth MA. C 3
t
CERTIFICATE OF COMPLIANCE
Description of Work: ❑ Individual Component(s) X'Yj Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), RepairecINN, Upgraded ( ), Abandoned ( )
by J.P.Macomber & Son Inc.
at 40&42 Melville Road South Yarmouth,Mass.
has been installed inn accord ce with the }provisions of 0 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. /6 — ,dated /''a AV Approved Design Flow pd)
Installei+7 •
P Macomber &-Son Inc
Designer: Craig Short Inspector: Date: � �' �� ��•'�
The issuance of this permit shall not be construed as a guarantee that the system function as designed.
No. 7 C !
COMMONWEALTH Of MASSAC14USETTS
Board of Health, Yarmouth , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
FEE$ 50.00
coi 33� Z
Permission is hereby granted to; Construct( ) Repair(XX) Upgrade( � 'Abandon( ) an individual sewage disposal system
at4®&42 Melville Road South YarmouittoMass. as described in the application for
Disposal System Construction Permit No. 4d dated
Provided: Construction shall be completed within three years of the date of this FeFmit. All local conditions must be met
Form 1255 Rev. 5/96 A.M. Sulkin Co. Boston, MA Date I dBoard of Health