HomeMy WebLinkAboutApp-Permit-Compliance'q0 80-Z Fims............
THE COMMONWEALTH OF MASSACHUSETTS
Z'11 BOAR® OF HEALTH
," Town.... ..... OF ....... Yarmouth------- --------------------------------------------------•-
�. Apptiration for M -4p tial Works Towilrnr#inn ramit
Application is hereby made for a Permit to Construct ( ) or Repair (x ) an Individual Sewage Disposal
System at: Shore
14.2 Thacher rd., Yarmouth -Dort --------•-----.---••- ------•----••-------------------••------------•--•--•----••-•----...-----••------•------......----
...----••-----•--•--•---•---
Location - Address or t o.
Gerard R. McAuliffe 142 Thapber._5hor—e..Rd..-,...Yanno thpomt..112675
.
.................._._.....---...... __...--Owner-----...-------..._......_..._..._....---- Address
A & B Ce_ sspool Service .............................. l28 _ Bishops --'l e,=a �e.....Hyannis-,-..MA.......02601..
.............
Installer Address
Type of Building Size Lot ............................ Sq. feet
Dwelling — No. of Bedrooms_____________ ................
other—Type
Attic ( ) Garbage Grinder ( )
Other — Type of Building ............................ No. of persons...._ 4......_......__..._. Showers ( ) — Cafeteria ( )
PaOther fixtures-----------------------------------------------•----- ------------------------------------------------•------------------•---------•-----------------
gallons per person per day. Total daily flow .................................
WDesign Flow---•-----------------------•--- ------•----- -----•----- gallons.
WSeptic Tank —Liquid capacity ............ gallons Length ---------------- Width ................ Diameter.____._______.__ Dept ______.____.._..
x Disposal Trench — No. _--------_------- Width .................... Total Length .................... Total leaching area -.-_.•_-----__--__--sq. ft.
Seepage Pit No --------------------- Diameter__....._......_._... Depth below inlet .................... Total leaching area .................. sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by -------------------------------------------------------------------------- Date ----------------------------------------
'_l 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 ------------------_---
P4-------------------------------•-----------------•-•-----------...------------....------------•-----........................................................
ODescription of Soil -------------------------- Sand------------------------------------•-----------------------------------------------------•---------•-------------------------
-----------------------------------------
------------------------------------------------------------------------------------- ------------•----•-------------------------• ---------------
Nature of Repairs or Alterations — Answer when applicable ...... installa.tion,..o%..a--l.,-OOD--gal-1-o --pie-cast
stone..Facked leaoh_.pzt.. oy_erf ow)- ------•-------•---------------------------------------------•--------------------------------------•------------------
Agreement :
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of 'TTLE- - 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 boa d of health.
Sine
g a�� `4k - ------- 4/--2/BD--------
..._._
Date
Application Approved By ......... ...._--_ -----
Application Disapproved for the following reasons:....
--------------- W --- 2�g---------
Date
........................................................... ...................A..._...._..
....
Date
Permit No. - 80- Issued.---------- 2< 8Q---------------------------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..................... own........... OF ............. Yamwth..................................................
�ir�t���rtt#�e nrf (1�lant�ltttnrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( X)
by A & B Cesspool Service, 128 Bishops Terrace, H,y_annis�__NA 02601_ 77,.5_-6264__ __
Install
142 Thacher Shore Rd., Yarmouthport, MA b2675____ -___Gerard. R. McAuliffe
at.._-------•-------•-----•--- ----- ------------ ------------------------ - -
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as dscribed in the
application for Disposal Works Construction Permit No.........__��-7 ............. dated _.-.-_-.._-_-_-_-;/-_Z._80.............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE............ 4/2/80................................................... Inspector ....................................................................................