HomeMy WebLinkAboutApp-Permit-ComplianceYARMOU
Town
/Tg�.S-outh YamOul. A OZ,
7 H COMMONWEALTH OF MASSACHUSETTS
BOARCr PF HEALTH
~ �.°°
' Appliratio�� �� Disposal Works To4struatatt ranfit
� ^~ is 6esc6v made for a Permit to Construct (><) or Repair _- Individual Sewage
System at:
Jecali�n,.. ddress or Lot No.
Address
Installer Addless
�
Type of Building Size feet
Dwelling—No.of Attic Garbage Grinder � )
Other —Type of Building ............................ .BJo. ofpersons ............................ Showers ( } -- Cafeteria ( )
� Other fixtures
~� -----------
---------------_----_---------_--------------------------------'
Dou'�n I�ovv---------------------�u]oou ��rper000per day. To�l6o�v8o�............................................ .
Septic Tank -- Liquid - ............ gallons Length ................ Width ................ Disposal Trench Z)�uo�cter-----'�--D����-------..
-- No---------- l����-'--------' Total I.�o8tb---------- Total leaching area .................... sq. 8.
Seepage Pit 2Vo---------- Diameter .................... Depth bclo� �oleL---------' Total leaching area -----'---sq. 8.
Z (]�erD�tribo6onbox ( ) Dosing tank[ �
~~ Percolation Test Results Performed br.......................................................................... Date ........................................
Test Pit No. l ................ minutes per inch I}ep8z of Test I,it---------- Depth to ground water ....................
,-
Test Pit, No. 2 ................ minutes per inch
.............................
0 ------------------------------------ ---------------------------------------------------------
Description
ol
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-----__._-_--_---.------------------------_'---------------------'----_-'--'--'------'_-_--'--__---'
UNutore of Repairs or Alterations --Answer when applicable ---'--------------_--------------------'----__-
----'--------------'--'------'-------'---------'---'--------'--------'---'---'-------'------------
Agreno/ent:
\
The undersigned agrees to install the uforedescribed Individual Sewage Disposal System inaccordance with
\ the provisions ofTIT IS 5ofthe State Sanitary
Qertificate cc has bee iss ed by the board of health.
ign
jDate
Applicat�ionpproved y.... Lo'
Date
Application Disapproved for the reasons: ..............................................................................................................
\ _----_---------'-----'-'-'----------'--_--_-__-------'__--------__'___'__-_'-_---'-----._'--'--__-
`
Date
\ Date
J
THE COMMONWEALTH OFMASSACHUSETTS P,��vCu���._
' BOARD OF HEALTH
[
\ ' ----,-'--_---- F ......... X.
\
THIS IS \^ or Repaired
r
V
--
has been installed in accordance with the provisions of TITLE 5 of The State Sam "'� Codeyas 4escrjbed in the
.
application for Disposal Works Construction Perozit.zwo_-'+--'_2 .'---- dated . � --'--
THE ISSUANCE OF THUS CERTIFICATE SHALL NOT BE CONSTRUfb AS A GliARANTEE THAT THE
SYSTEM ��KLLFFACTORY.
/ �/�IIL----L�����---------------'------ Inspector
���2�'�l-'�-��.1'1l'----'-'-----_-------
, / ' , --'-�- �-- -r-'- .
c -k' 5c yo
z y
No . ...�:I'
THE COMMONWEALTH OF MASSACHUSETTS
BOARD. OF HEALTH
----......Town ................... OF............ armo-uth.----------------------------------------------------
Appliration for Disposal Vorko Cons rwtion 1hrntit
Application is hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal
System at:
................ --..uahatex ..�ad,........................................ -•----•------...........__....L4: �1Q.1.. 2 6--•-----•---••.......••-............._...
•-
Lo Address or Lot No.
---------------- — ---- --•----- ._l .............. . ....... ............................ _.._...--------------..............---••--•----....._.........--•---.._........................_.
_ Owner Address
-------------------------------------------•---------...........--------•-•-'-----------.........---....----------•---•----------••--•--------•-.._........_...............-----•--•.._...._........
Installer Address
Type of Building Size Lot....14 7 6 0 -------Sq. feet
Dwelling— No. of Bedrooms ......... 3 --------------------------------- Expansion Attic ( ) Garbage Grinder (nc)
Other —Type of Building ____________________________ No. of persons ............................ Showers ( ) — Cafeteria ( )
Otherfixtures ..................... -------------•-•-•-----------•--•------••--------------•-----•-•---•--•-------•---•----•---•------•--------•--•---........_._...
Design Flow .......... 5 ............................. gallons per person tper day. Total daily flow ........ 3 3 0 ............................ gallons.
Septic Tank — Liquid capacity_ 1000 -gallons Length g._ 6 Width ... 4. 10 Diameter________________ Depth...___,�_4 _.
Disposal Trench — No. .....2 ............. Width --- 1__�___....... Total Length.... 60 ft: Total leaching area .____ 10_.._.._sq. ft.
Seepage Pit No ..................... Diameter .................... Depth below inlet .................... Total leaching area .................. sq. ft.
Other Distribution box ( ) Dosing tank ( ) 1/11/84
Percolation Test Results Performed by ..... 4C. ap-_4 C- ed - - Siar. vey._.Cerns:L+3.tants, •••- Date .:................... 8.1_.___________-.
Test Pit No. 1____2____.___.minutespperinch Depth of Test Pit ..... Depth to ground water_______
Test Pit No. 2___________ #
_minutes
sp r inch od L amo, est 31..... 9 ............ Depth to ground water_..
U- -_____............. " u_ subsoil,
_..... --
Description of Soil__ -.30"-108" med.-fine sand; TP T.
0-12" iaood�oam, 1 "_v3�"__sU5 A L
....................•---___---•---•--------------_____--•----------•-----------------------•:.._--- Willi; iEwu
30"-108" mea. -fine sand R
................................ --•----•-----•---------•------------------------•------•--------..-•--•----•----------------=------•_____......---•------•......... .
Nature of Repairs or Alterations — Answer when applicable .......................................................... _______
------------------------------------------------------------------------------------------
Agreement : I '
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordancwI
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 of health.
Application Approved By....
Application Disapproved for
----•----•-•-•--•------------------------------------------•--•-----•--------...----..._..-_.....-----------...------------•------------------•---......----------------...--•-------•---
- Date
Permit No - l...•---• ................ Issued .............. �' � -
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.......................................... OF .....................................................................................
Tntifiratr of Tontplinnrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by--•----•------•-----•-------••-------•------•--•-------------•------------•-•------------------ -----------------•------•--•-----•------•-------------•-------•••---•-•--•---•-•--••-•--------
Installer
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® AS A GUARANTEE THAT THE
SYSTEMA WILL FUNCTION SATISFACTORY.
DATE-------------------------------------------------------------------------------- Insnector ------------------------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
>, BOARD OF +HEALTH
.......................... o s
No......... _......-•---•••• FEE..-- •_•.............
i offalko r ' n pr it
Permissioi hereby gra--•--- -- _--------------- ------------------•------•---------•• •---------•----•-•------- ........... --...._
to Const q (� or R-Aair' id al Sewag Di posal Sy em
at No..---A-•---_-•------------•----� ------•----------- ----••--. Stree---as shown on the application forrks Construction Permit o. -------------- ( Dated_______ .._.........
Board o e th
DATE... /....... -_ --• ----- ------------------------------------ -