HomeMy WebLinkAboutApp-Permit-ComplianceNo .... 8 4.-. 4R il ..... . ..............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........TO.................OF...... YARMOUTH
..................
......................................................
Appliration
for Bispaoal lgorko Tonstrudion Famit
Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal
System at:
YAVA . ............. ......... ..............
Location - Aess
ddL
... ................
or Lot No.
....................................... . .....
Owner Address
.............................. .... ............. ...... ...................
Installer
Address
Type of Building
1Z
Size Lot ............................ Sq. feet
Dwelling —No. of Bedrooms ......... .....;1 — ... --------------------------- 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........._..._......_...
.........................
Description of Soil ....................................
................................ ............ ....................................................................... I .........................................................................
Nature of Repairs or Alterations — Answer when applicabl Ac
.... � _)eVN.0 .........
V, �r -- ----- VIA?-
------ IA ......
................... 15 .. ..... .........
Agreement: 0
Svc
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TVIPUE 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 boar of i
igned---- � .... ..... ......... .. .......... ....... ........... .........
Application Approved By---- .. ......... .... ......
...
----- - ------- ----------- " -------- * --------------------- ...
...... .... ............
Dat
Application Disapproved for the followin ons: .... ..........................................................................................................
............................................................................................................................................... .........................................................
Date
Permit N
Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH 7-
.......... TOWN ................. OF ....... YARMOUTH......... ...............................................
Tntifiratr of Tomplitturr
THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed or Repaired (X
D
CAPE LANCONSTRUCTION
by----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
338 CAMP ST., W.Y. Installer
at------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
has been installed in accordance with the provisions of TITLE of The State Sanitary Cod a escribed in the
84-M 01,Y8 ��
application for Disposal Works Construction Permit No ......................................... dated___.__..:.._.:.__........__.............._......
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
-w ...........
DATE._ I" ....... Inspector...:., -0 ....... ..................................