HomeMy WebLinkAboutApp-Permit-ComplianceTHE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Town... OF............Yarmouth--------------------------------------.............--
Appliratiou for liivuual Worko Tonstrurfinn Frrulit
Application is hereby made for a Permit to Construct ( ) or Repair (XX) an Individual Sewage Disposal
System at:q I ,n
23 Outwardreach Yarmouth orS� 2— 1"l
t
Location - Address or Lot No.
Paul Marsh
Owner Address
J : P . Macmr
obe------------------------------------------------------------------------------•----......-•-•-----
Installer........ Address
Type of Building Size Lot ............................ Sq. feet
Dwelling X-XNo. of Bedrooms...............3.......................... 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' capacity.._.___..._.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 ------ ..................
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Descriptionof Soil ----------------•-----------------Sand...........................................................................................................................
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Nature of Repairs or Alterations — Answer when applicable................................................................................................
-----------------------------------------------------------------------------------------------•------------.1- 6 x 8 cesspoo1---packed---1 n• --stone......
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT 1,;;. 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 �y th/)boai� of health
A If
Application Approved By..........
Application Disapproved for the
---- --.---5- -.1.9/.88 _.....
t
Date
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`—D e
PermitNo ----- � s.. -................................... Issued .............. /.Y-�/--�-••-•--•--
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Town B Yarmouth
............. OF ....... .............................................................................
Trtifiratr of Toutplitturr
.TVTO CERTIFY, That the Individual Sewage Disposal -System constructed ( ) or Repaired :kX )
macomner
by...................................................................................................................... .....---•-----------••-------....•-•------......-•----..........--•-•-....---
23> Outward Reach Yarmouthpart Installer
at.----- ........................................................ ---•-----------------------------------------------------•---------------------------------------------------------------------------
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No ......................................... dated ................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® RANTEE THAT THE
SYSTE WILL FUNCTION SATISFACTORY.
DATE.. ." $--•-----•--•--•-•-------------------------- Inspect '------.