HomeMy WebLinkAboutApp-Permit-ComplianceNo. �:r 11c) Fxs 3. L,:)
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............ 1.ow,j............... OF ..................... Y Y.?.K......................................
Appliratinn for Disposal Warks Tonst.rnrtiun rami#
Application is hereby made for a Permit to Construct (JO or Repair ( ) an Individual Sewage Disposal
Syst at
......_`..!��11`1.....Ca-Ow...................... �=- --2 CJ2)......
Location - Address or Lot, No.
.Obray__ and _Lisa Lyman . - - - - Box 1492, West Dennis, MA 02670
.... .--• ..... - - - - - -------•............................
Steven Cassell owner P.O. Box 186, Wes`ddMnnis, MA 02670
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... -
Installer Address
Type of Building Size Lot TP,.- el...__.._..Sq. feet
Dwelling —No. of Bedrooms .•............ 4 .........................Expansion Attic ( ) Garbage Grinder ( )
Other — Type of Building ............................ No. of persons ............................ Showers ( ) — Cafeteria ( )
Otherfixtures • ----•-••--•---------------------•-----p•--- •--.------......-----------------------------.............------------------••--------...----------
Design Flow ............ to .........................gallons per f%M er day. Total daily flow............. 4 4 .................... gallons.
Septic Tank— Liquid capacity ..gallons Length q. 7 ~-..... Width-'.q�:i94
--.. Diameter ................ Depth.""..__
Disposal Trench — No. ------ A............ Width ...... ........_... Total Length ------ Total leaching area .._ 32(0 ----_---sq. ft.
Seepage Pit No ..................... Diameter ............. ....... Depth below inlet.................... Total leaching area .................. sq. ft.
Other Distribution box (x ) Dosing tank ( )
Percolation Test Results Performed by ..... R :.l.. d W."tR.... !VV.0. ......... Date....
Test Pit No. 1 ... !!t?�...... minutes per inch Depth of Test Pit ..... ....... Depth to ground water ........................
Test Pit No. 2 .... '-L-----•.minutes per inch Depth of Test Pit ...... 141....... Depth to ground water ....... 137-----------
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Description of Soil...............Z. Tts
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................ ..... ��'.
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Nature of Repairs or Alterations — Answer when applicable...............................................................................................
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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 undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bean jssued by 0-g board of health.
Application Approved By
Application Disapproved for the following reasons: ...........
Permit No..� ::.. -
THE COMMONWEA
BOARD
.......................................... OF. ..
(9rdifira
THIS IS TO CERTIFY, That the Individual
by
?-j
----------------------------
Date
1
•'-%� ate
Issued-.--- `- �_ ...........
Date
LTH OF MASSACHUS TTS
F HEA T
...............................................................
#rT.umplialta
Se ge Disposal System constructed ( ) or Repaired ( )
Installer
at------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
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 AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector