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HomeMy WebLinkAboutApp-Permit-ComplianceNo._-l..Q 3 2. b THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF YARMOUTH Fss ....'5- .�..Y .... Appliration for 11isposal Works Tonstrttr#iatt ijrrmft Application is hereby made for a Permit to Construct ( ) or Repair (V/) an Individual Sewage Disposal System at: -•� 1X/ �'`T- ------ ___..__. ....- ...-'•.................. . •- .......... - - ---- ------ ----- ...---• • - ........ ............. ocation ddress -- . .---.- or. Lot No. .._ _� �.... ...... wnec ... K.Y... .................... ...... .� �1l.SJ��L. S.. ss.1XMl.l�i�:.Y. l�.✓...lM�`�—S) L! � .�.... _ Installer Address Type of Building Size Lot............................Sq. feet Dwelling — No. of Bedrooms -----.S --------------------------------- Expansion Attic ( ) Garbage Grinder ( ) Other Type of Building ............................ No. of persons........................--.. Showers ( ) — Cafeteria ( ) Otherfixtures------------------------------------•-----------..............--...........--.....------------------....-----•----...--••-----...................__.. Design Flow .......:.-:A ......5.5___.gallons per person per day. Total daily flow------------------:110........---gallons. Septic Tank—Liquid-capacity.GW.0.gallons Length._'? :.ems--..- Width_ -�i.:.5---_ Diameter ................ Depth. 4...�.S..... Disposal Trench — No . .................... Width ...... :............. Total Length............,,...... Total leaching area ................... sq. ft. Seepage Pit No ...... I.......... Diameter......1.0 ....... Depth below inlet ...... `.t........... 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 ........................ ....... . ........................ - -- • ...... Descriptionof Soil..............•------------•----------.........---•-----•--------......-------•----------------....----.....------------•--•-------------.........-------••--•--•....... .....................••----•--•-------•-•--.......................----........---•--•-----•-•------....-----••---•---...-------•-------•-----.....---•---•---•---•--................---..........-------- ----•--•-•---------------•-----------------•-------------------------..--...--•---------•---------•---------------•---------.....-•-•--------------................---•--•.................---- .--.. nn Nature of R airs or Alterations — Answer when applicable-- . q.. *4 . k .....Q -.of � � � z�----------------------------------------------------------------------------------------- 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 not to place the system in operation until a Certificate of Compliance has been issued by the board of health. g 'Y�'l �? csv e . � ,- ` 1. a Signe Date Application Approved By..-- --------------------------------------•----------------- ate Date Application Disapproved for the fog' ng easons:-------•-----••-••----------•--•-•------•••-----•._...-•................•--.......--••-.._............----...... ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Permit No... c� .. 3......................... _.... Issued... -- Date Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN of YARMOUTH (9rrufirate of T%antpiittnrr � THIS IS r'O CARWY, That tAe jndividual. Sewage Disposal System constructed ( ) or Repaired Installer atl � ot....-----...........---•-..----------------------------------------------••-•--•-----•----------•-------•---.............. has been installed in accordance with the provisions of TITLE of The State Sanitary Code as described in the application for Disposal Works Construction Permit No ..... � ....._..3 ............... dated......`�-.5` ..R .............. THE ISSIJAN E OF T IS CERTIFICATE SHALL E CONSTRUED AS vARANTEE THAT THE SYSTEM WILL f U CThON S ISFACTORY. DATE...................................... .......................... Inspecr......_- .....