HomeMy WebLinkAboutApp-Permit-ComplianceP9
No.... ..... . ....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
Appliration for Disposal Works Tonstrurtion frrmit
Application is hereby made for a Permit to Construct
Sysum at:
Location - Address
...............
Owner
did. ................
I ller
Type of Building
) or Repair (01"an Individual Sewage Disposal
..............
or Lot No.
Addres
09 -
Address
Size Lot ............................Sq. feet
Dwelling —No. of Bedrooms ......... :15J-1 .......................Expansion Attic ( ) Garbage Grinder
Other—Type of Building ............................ No. of persons ............................ Showers ( ) — Cafeteria
Otherfixtures ......................................................................................................................................................
Design Flow............//..Q........................gallons per person per day. Total daily flow ..............2,4-0 .................. gallons.
Septic Tank — Liquid'capacity_.J.Vv4.gallons; Length ................ Width.........._..... Diameter.............._. Depth................
Disposal Trench — No ..................... Width.................... Total Length.................__. Total leaching area .................... sq. ft.
Seepage Pit No ..................... Diameter................._.. Depth below inlet.................... Total leaching area .................. sq. ft.
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by .......................................................................... Date ........................................
Test Pit No. I ................minutes per inch Depth of Test Pit.................... Depth to ground water..................._....
Test Pit No. 2 ----------------minutes per inch Depth of Test Pit............._...... Depth to ground water......_.................
Descriptionof Soil ............................................................................................
........................................................................................................................................ ;7 ..............................................................
Nature of Repairs or Alterations — Answer when applicable ..... #45.J ... SC74qv -
..rjd_g ...... -71
.tv
.. i1cj4 C
.... ... ........ ..... 3
Agreement:d-P 1,
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code — The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board qf health.
Signe. ............................ ... 7...
0/3
Application Approved By--- ... .............. .... ......... .. ............. ................. ...... ........ .. ... ... ..... ...........
Signe
a
ie
�L�� .......... ................... a
ate
Application Disapproved for the following reasons: ... ........ ................................................... ............ ......................... . ..
................Permit No ................. L................................................. ...............................................................issued .............................................................. ........ f5 ----- - ..........................
C . . ....... . . ....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
Trrtifiratr of T-amplinurr
THIS IS TO CERTIFY, That the Indii ual Sewage Disposal System constructed or Repaired ( &4'
I.C.. . ................................................................................... .
Uy................................................ . Installer j
at........................ ................................ ---------W #..•-----•---....------...........--•...... ----------------
NT
\ATHAT
has been installed in accordance with the provisions of TIT I7' -5 of The State, Sanitary Cok. descr ed in the
application for Disposal Works Construction Permit No ........... fz;;� ... . ... ... 7 dated....... :5e� 5 .... ..........
THE ISSUANCE I?F THIS CERTIFICATE SHALL NOT BE CONSTRUED 0 NTE THE
SYSTEM WILL FUN;
\SATISFACTORY.
DATE ......................... \
......... ...... ............................ Inspector ............................. ...................