HomeMy WebLinkAboutApp-Permit-ComplianceNo—j".. ..F$ OV
THE COMMONWEALTH OF MASSACHUSETTS
` T f
BOARD OF HEALTH
TOWN OF YARMOUTH
Appliration for Disposal Works Tonsirixriion 11rruti#
Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal
System #33 Trowbridge -Path,._ South .Yarmouth,._ Ma : .......................�T._ ../C¢j;?....... .1%7i�� &&
.__ -• .... ............. ..
Location - Address or Lot No.
Charles M. Schooner
Ensign S. Cash, d/0/),'9"Cash Trucking Address
Installer Address
Type of Building Size Lot ............................ Sq. feet
Dwelling —No. of Bedrooms....... 11211 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 area .................... 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. I................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 ......................................................................................
........................................................•--•--•---------......----•-•--•----........------.....----------••----......................-•----.............................................
Nature of Repairs or Alterations — Answer when applible...install a 1,000 gallon holding tank.
Install a 1,000 gallon leaching plt� stone packed:.......**--
...........................................................•--------...............----...--•--•------------------................-•------.................................----------------.............
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITI.1 5 of the State Sanitary Code — The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has beepjssued by the bWrd of healtk.
Application Approved
Application Disapproved
Signed.
the following reasons:....
Permit No . ---...1m:... 7.9 ............................
11-15-93
a Cash Trucking)/' --/D. to
te
............................................................••-------•-•...
//- pp Date
Issued ...........:1(! ....... 1-_Z ....................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH -
TOWN of YARMOUTH
Trrfif iratr of T-nutpiiatta
EnS1gnl T C asliRTd/FbY/AaT�as�h�i"Ir c�%ig $ �a e0Dis�os S oeul he Ysi ruci . (O� r� Repaired (X )
by........................................•--..........................................._.........._......---...............................................................--.--------------••---...-
t�33 Trowbridge Path, South Yarmouth, Mlle�owner: Charles schooner)
at......................................................................................................................................................................................................
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as d cri in the
application for Disposal Works Construction Permit No.__.'Tj.... 1521 ................ dated ..................... -----_-----
THE ISS, UA E O THIS CERTIFICATE. SHALL NO A TE THAT THE
SYSTEM WI L NCT ON ATISFACTORY.�7DATE.. . ... ..................................... Inspector.....7TRUOSAI
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