HomeMy WebLinkAboutApp-Permit-Complianceq
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1-1 -7 q THE COMMONWEALTH OF MASSACHUSETTS
1 BOARD OF HEALTH
TOWN OF YARMOUTH
Appliration for Btgpasa1 Works (njanstrurr#inn 1hrmit
Application is hereby made for a Permit to Construct ( ) or Repair (✓) an Individual Sewage Disposal
System at:
.......... a __ �:1.. ...- • - •--.W.. 3 z ...............................
LIJ L
G if Loc tion - Address or Lot No.
...................... _........
�� ..-� - W'P4 --------------•-•------...........---
Nf /i Owner /C Addres
-(.........--f.........�....................J..-•-----•------...----------------------........... _.. -- ..............................................
Installer A ress
Type of Building
Dwelling — No. of Bedrooms..�-----------------------
Other —Type of Building --_---_._--_-------------
Other fixtures ---------_------------- --------
Design Flow............................................gallons per
Septic Tank —Liquid capacity ............ gallons c
Disposal Trench — No ..................... Widt .........
Seepage Pit No ..................... Diameter........... 1
Other Distribution box ( ) Dost t
Percolation Test Results Perfor ed y ...... ....
Test Pit No. 1................minute er ch De
Test Pit No. 2________________nrinutes inh De
Description of Soil ..............................
.--------------------•---------......--•-••---------.....------
Nature of Repairs or Alterations — Answ w
----- T(
'ze Lot ............................ Sq. feet
( Garbage Grinder
....-- ... Showers ( ) — Cafeteria)
Lily flow............................................ gallons.
.......... Diameter ................ Depth ................
....... Total leaching area....................sq. ft.
......... Total leaching area..................sq. ft.
--•-•--------- Date ........................................
Depth to ground water ........................
Depth to ground water........................
-----•.---•-----•...............................••------....----
r•------• •----------••------------••----------------• •---
..........................................................
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-----•--•-------------------------•-
G✓ J
Agreement: 7
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITi..i� 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 he bo -d of health.
Signed... •�.� c�-
i
Application Approved BY-�t'�S' ..
Date
Application Disapproved for the following reasons: -•--- .---•--••--•---------•--•--------••-------------------------•-------•----------...---........-•-... .
....................................•----•---•--.....-------•------------...--------------.....-----............------------......------------------------..............................................
Permit No ..... .�_
_ ..`..._..... /....._.. Issued.- — ._•... ..... ate
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
Trertifiratr ,af fauntphaurr
THIS IS TO CE Y, That tag In ' idual Sewage Disposal System constructed ( ) or Repaired
by......... ......... �......--...L.= Q.. ---- ...............•------------------.....-----.........----------------------•-------------------
I�nsta e
at. ....Z'.r 1 `' ?et 1.'l r --•--------------------------------------------- -- ••. .
has been installed in accordance with the provisions of ITLE of Tehe State Sanitary Code as described in the
application for Disposal Works Construction Permit No. �.�-_-- —+ .�........... dated--7$�.... y.: , ...................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector ....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
N0..1F .....L/7
Permission is hereby granted_.._ ..... ]
to ConstructJ or/ �Re a}'r �n I
atNo ........... >.-.- V'L_Z....... f �=..--...
as shown on the application for Disposal W
DATE•-• ........ ---------
TOWN of MO TH.
r qtr ion rrntit
ft
ividual S wa Di sal Sys
�.,
Street �� (/ ^
/ S Z
wr s Co uction ermit No.--_-- ...---.._- Dated..:3,
•......................... •--------- ---•------------------.---•--
Board of Ile h
(! L A>, 0 1 � c Its 0 -�,C, q-•/ <cd L I s M KA A.e (,I -r --e �(� � -:� � IA (INdr-, A I 0�_ o N,