HomeMy WebLinkAboutApp-Permit-ComplianceNO."` 3 ........ 5Z CJ
THE COMMONWEALTH OF MASSA SETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
Appltration for Disposal Works Tonutrution f rrnti#
Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal
System at:
78 Mattachee Road, South Yarmouth, Ma. La -r .t5 0-1
......John J........... . . . ..
.•• Mullen Location - Addzess.................................. ............... ....... •-•----........ I ot.N....................................
or
0.
.........................................................................................................-••---....-----........................................---...............................
Cash's Trucking ( riSign S. Cash) Address
............................................................... --•-................ .......-----------------------•----..........................---------............................
Installer Address
Type of Building Size Lot ............................ Sq. feet
Dwelling — No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other — Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Otherfixtures ....................................•--------...........-----------.....---....--------...........----------------......----------------••--•••-..----
Design Flow............................................gallons per person per day. Total daily flow ............................................ gallons.
Septic Tank Liquid ca.pacity............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. l ................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 ............................................................................................
..-----•-•---------••--••---...----•--•-------•.........................••--•---------...-•----...------•--•--•----------------...---...--------------------------------------------- ------ -
Nature of Repairs or Alterations—Answer when applicable-.1D-.gal..._holding.tank:_ Install
a _l, 000 clal: holding tank/a pump chamber: Install TWO (2) flow diffusors`3 stone
Agreement: packing.
............ ..•--.... ...--.._. ......... ........ .........
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITIE 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 and �qf h lth.
ned. r
S. ............................ Ir-,�....�.
V_�Application Approved By ..... ............ ---=-- - ----------•- -Y----••--------. .. ..,........--•--d5-....-----�'-•--...._....... - -
Date
Application Disapproved for the following reasons:--•................•----........--••---•------....-•---•--......-----••-••.........--........................
......................................••----..... ..-------- j�•�.........---•--------•--......----.....-•--_.........................----- _....... •e�........Date..............
Permit No ......... ...-... ........ ................ Issued ........ ..U?... .....-•••-..
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
Tntifirtt#r of Toutpliana
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (X )
by_,___Cash! s Trucking _(Ensign_ S,:__ Cash) PO Box 7, Yarmothport,Ma.02675
--..........................................................................._
tatter
at......#78 Mattachee Road, South Yarmouth, a. (Owner/John J Mullen)
....... ......... ..................-•---.....----•-..............................--•-.....----...... ..... ....
has been installed in accordance with the provisions of TIT 5 of The tate Sanitary C /ANT
es i ed in the
application for Disposal Works Construction Permit No......_. -.. ���.5_... dated...............THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUA E NAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE...............................................................•-----........_.. Inspector .....................................................................................