HomeMy WebLinkAboutApp-Permit-ComplianceNo. 4%�
COMMONWEALTH OF MASSACHUSETTS
Board ofHeallh, Yarmouth AIA.
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APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION RERMIT
Application for a Permit to Construct( ) Repair( ) Upgracle( ) Abandon( ) Xj*omplete System 0Individual Components
Locations Old Church
Owner's Name zDiane M. Coulstrin
Map/Parcel# 124/55
Address 80,BeechuStxeetRockland,Mass .
Lot#
Telephone# 781-878-8985
bnstaller'sNameJ.P.Macomber & Son Inc
Designer's Name Ronald J. Cadillac
Address Box 66 Centerville Mass 02632
Address P.O.Box 258 W.Y 02673
Telephone# 508-775-3338
Telephone# 508-775-9700
Type of Building
Dwelling - No. of Bedrooms
Other - Type of Building _
Ocher Fixtures
No. of persons
Lot Size 22,000+ sq. ft.
Garbage grinder ( )
Showers ( ), Cafeteria ( )
Design Flow(min. required) 550 gpd Calculated design tlot6$,j10-550 Design flow provided 554 GPD gpd
Plan: Date 5/17 /02 Number of sheets Revision Date
Title.
Description ofSoil (s) 0n -46n loamy sand to sand3, Air," -132° Med'um sand
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS Omit -ti ng_exi sting sanoaga r Installing
1-1500 gallon septic tank 1—Distrihnt;nn bnx and 4-500 gallon 1 6j,,8
chambers.41.4'X12.83'X21.
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to not pi a thtem in per 'on until a Certificate of Compliance has been issued by the Board of Health.
Signed d. a Date 7/25/02
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COMMONWEALTH Or MASSACIIUSLTTS
Board of Health, Yarmouth ,141A.
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CERTIFICATE OF COMPLIANCE
Description of Work: ❑ Individual Component(s) )'CIomplete System
The undersigned hereby certify that the Sewage Disposal System; Constructed( ), Repaired (X)� Upgraded ( ),Abandoned( )
by,J.P.Macomber & Soa Inc.
at 8 Old Church Straet YarmoutlDort Mass,
.
has been installed in accordano with the provisions of 310 CMR 15.00 (Title 5) andtl�tC 1 proved design
_ • 91
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plans/as-built plans relating to
application No.? ,dated 6 .. Approved Design Flow (gpd)
Installer J.P..nlacomber 'Z Soni Inc.
Designer: Ronald J. Cadillac Inspector: ✓/a', L' " Date:
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_ The issuance of this permit shall not be construed as a guarantee thatdie system will function as designed.
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COMMONWLALTII OI. MASSACHUSETTS
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Board ofHealtly Yarmouth iWA
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DISPOSAL SYSTEM CONSTRUCTION PERMIT
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Permission is herebygranted to; Construct( ) Repair( ) Upgrade..(X) Abandon( ) an individual sewage disposal system
at u Old Church Serer /—horn.alas as described in the application for
Disposal System Construction Permit No. ��. ` r dated -�5 "(,l G%
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Provided: Construction shall be completed withht_duee�V ar of the date of this perunt. All local conditions must be met.
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---'-j Farm 1255 Rev. 5195 A.M.Bulkln Co. Boston, MA Date 1. Board of Health