HomeMy WebLinkAboutApp-Permit-Compliance�� . -o
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
Appliration for Disposal Works Tonstrnrtion 1rrnti#
Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal
System at:
...#10. Sunset Drive, Bass River, Ma..... _........... .... CAT. _ .N_a 3..—rn A-P_aa.s,?.................._..-•---..._..
.............
Avis ac
Location - Address or Lot No.
--- J___o_Jacobs _ _
..Trucking �•. IrieY`.ner.................................................. -•------------•-------------------•-----•...Address._.............................. ».».....
Cash's
. ...:................•- •- --.......- - ...._._...._............................... -•--••......-----•--•--•--.....--•-----._.........._.....•----•--•----•---•----...-------------•--
Installer Address
Type of Building Size Lot ............................ Sq. feet
Dwelling —No. of Bedrooms. -.-_ --------------------------------------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 ca.pacity............gallons Length ................ Width ................ Diameter ................ Depth ................
Disposal Trench — No. -------------------- Width ......:............. Total Length .................... Total leaching arm ................... 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. 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 ..........................................................................................................
5i I ------------------------------ •------------------------------------------------
.....---•-----------_...----------------------------------------------------------
U Nature of Repairs or Alterations — Answer when applicable_.1, 000 gallon holdinc tank. Install
_1,000__gallon leachinq pit, 31 stone packed.
-------•-••...................................................••----••---......
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code — The undersig d further ees not to place the system in
operation until a Certificate of Compliance has been, ed 1}y the boar o healt .
Signed.... \v Or27-92
- _
......._......................
a e
licationApproved BY . .......- ......... _.................................................. `5'. z ......__.
Date
tion Disapproved for the f ollowin re s------------------•-•----....--•-----•---...---•--.........-------•----. -----
Date
Permit
Permit No.----•E-�:.. �_`.��-.-•..............•-----.........._.__.......------•----....---'Issued_.....-•----- �1...��.�.�-.....----....--- -
baft
THE COMMONWEALTH OF MASSACHUSETTS N t-
BOARD OF HEALTH ec,�5�
TOWN of YARMOUTH
0tr#ifutttr of (l omplinurr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( X)
bR- - .Cash's•_Truckinq, Inc•------•........................••------•--....._......._......._......
y........................ ... .- -...
#10 Sunset Drive,assr River, Ma. [Avis Jacobs]
at ..........:....
•....................................----.._-•----•-----••-•-•--•-----•---. -----...-••---•-------•--------........-----•-----•.._.......................I......_......--•-
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 ----- � _-Zed .................. dated ---..5 -� �,....�-.>._.:...._._........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOTE BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FU CT ON SATISFACTORY.
DATE.... .. 3...r' L .... .. Insiiector..._