HomeMy WebLinkAboutApp-Permit-ComplianceNo. `�__...� Fxs...... Lam`_'...... .
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH���
TOWN OF YARMOUTH
Appliration for Disposal Works Tonstrur#ion jJamit
Application is hereby made for a Permit to Construct
System at:
....:Fy.........V_AjA ae..Z-4Au1 .........................................
/�Loca ion - Address
Owner
_...__ °..._._.................................---------------
------------_.............
Installer
Type of Building
Dwelling — No.
) or Repair (a, -<an Individual Sewage Disposal
...... A-4:
or Lot No.
n Addresse �
---Com..................._1� ... •.............
Address
Size Lot ............................ Sq. feet
of Bedrooms ................ .......................Expansion Attic ( ) Garbage Grinder (k,*"P
Other —Type of Building ............................ No. of persons ............................ Showers ( ) — Cafeteria ( )
Otherfixtures -•-------------------------------------•--•-----------......--•--•----•---....-----------•----------•-....----••---------........-•---•-•---------•---
Design Flow ............ LL_!P� ........................gallons per person per day. Total daily flow ............... :�Ma ................. gallons.
Septic Tank — Liquid' capacity..ZOP 2.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. 1................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 ......................................................................................
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Nature of Repairs or Alterations — Answer when applicable .... ,t. 4Ei.J_ __.A ...... ............
... !4...A:0Y_...... ............................. -=-.........................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT11 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 of h 11th.
Signed.---- . •. ............�-------- . T ........... ..................... / l`% psr ----
Application Approved By ... ._ , `---------•. .. ........... 1j Date
ate
Application Disapproved for the following reasons:_
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Iy / Date
Permit No. .....................��.�....___......_ Issued..................6�1_. � ._....
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
(9rrfifirate of Toutphatt r
THIS IS TO CERTIFY, That the,,Individual Sewage Disposal System constructed ( ) or Repaired (�}
—� Installer I
at........................................................... �'_..�t c:..�s r'=• - 4 ... &.I--s./�:.------...L::.i:.y ==
has been installed in accordance with the provisions of TITLEof The State Sanitary Code as desc jbed in the
application for Disposal Works Construction Permit No -------------- ___�_____ __. _... dated ...... 11 __,_ .__.._--�`�........
THE ISSUANCE OF THIS CERTIFICATE' SHALL NOT BE CONSTRUED AS A G ARAN EE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE ................ ..`----F�-:�.......... .......................... Inspector-- ': F .....__