HomeMy WebLinkAboutApp-Permit-ComplianceIlk
No.--•4Q---�� _ FSR
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
k�
TOWN OF YARMOUTH
Appliration for 11isPosal Works Cnonstrurtion ' Ibrutu
Application is hereby made for a Permit to Construct ( ) or Repair (X)D an Individual Sewage Disposal
System at:
353 Main Street, Yarmouthport
�...-
�
•...............______--------•-- •- -• - ... -.. --------------------- T --= .. ----•_Yr PP,.. 110 _...
-Location -•Address or Lot No.
,�;_, F r ed e ri c k•. J :---Thacker - ........................ -- ............. .-----•-• -----......._.........._
• --...--.... ......
s Tru c ki
Owner Address
a:Cash'n ----- - - - .....- - ................
Installer Address
Type of Building Size Lot ............................ Sq. feet
aDwelling —No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons.., .......................... Showers ( ) — Cafeteria ( )
Other fixtures ...........................................
---------------------------------------------------
•----------
•-----------•---...-------------
W Design Flow...........................................gallons per person per day. Total daily flow ............................................
WSeptic Tank — Liquid' ca.pacity...._..._._.gallons Length ---------------- Width ................ Diameter ................ Depth ................
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 ( )
aPercolation 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 ........................
....-------•-•-----------------------•-•--.....--------•------......----------•---------......-----• .........................................................
0 Description of Soil ........................................................................................................................................................................
W
U......-----•.................................•--------------------•---------------------------...--------------•------------------...------------•---•------...-•------...----..................---•-
W
U Nature of Repairs or Alterations — Answer when applicable ..... n a t.a 7.l J.n f _-.1-, 0 QQ_..Zallo n...b.Q1d"... t ank,
g---l,_QQQ_..,a11nn.._leacha-z�g._ �........stAne_...paeked.,.._distri-bution_..bnx_...
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLL 5 of the State Sanitary Code — The undersigned further agrees of to place the system in
operation until a Certificate of Compliance has b >µ_s?ed by the board o heal
Si d.. _ 10-15-90
..........••..... ..... _
D._...
ApplicationApproved By....---- ......................... .......... ....:....-•-------------------------------•-•.. .......i -.---•-
ate
Application Disapproved for the following re ons: ----.....--•-....-•---------•-•------•--•-•------•.............•-•••-•-•---•------•------•....-•--•-----....... "
--- - - 2. .... d. (l De : - ...
t -%..Permit No....... ... - - ......---•----•-• Issued-------- .
------ ........----•- ----
Date 'N
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
Titrfifirate of 09nntplia"r
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (X)
by....---.....Cash!.s Tru cking..............................................................................................................................................
Ina ler.
at ......... 3.53..Main Street, Yarmouthport, iia. (Frederick J. Thacher)
---.----------------- --------------------------------------------------•-••----....--------•------
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 CONSTRUED GUARANTEE THAT THE
SYSTEM WILL fUNCTON SATISFACTORY.
DATE.... zz...�'l ?................................... Inspecto ..... .------.---- ..--------------------------- -----------------------