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HomeMy WebLinkAboutApp-Permit-ComplianceN . ..... U ..... 7 . ...... /U Finc ... $ ... 159,.29 ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................... own . ------..---OF....... Yarmouth .........--•-------------------------------------------•--------...----- Appliration for Uispniitt1 Work.5 Tonotrurtinn jinmit Application is hereby made for a Permit to Construct ( ) or Repair ( x) an Individual Sewage Disposal System at: `. 6 Off Le ..,.. We_._xaxAlsuk��.._M2�.....Q�67.3......................X f-© ®r,®,. ) Location -Address •. or Lot No. Diane Cloutier....------•-----•---•------------------------•-----......_......t�...HVa.U" Q4L .2! l.....Q.?! 1n.................... Owner Address A & B CesSpo_ol Se>t�vice 128 Bishops__TerraceS_.Hy_annis,___MA_-___02601____ ---........- ----------------------•------------------..._ Installer Address Type of Building Size Lot -__________________________Sq. feet Dwelling —No. of Bedrooms --------------------- 2._................ -_Expansion Attic ( ) Garbage Grinder ( ) Other — Type of Building ............................ No. of persons ............................ Showers ( ) — Cafeteria ( ) Other fixtures .. Design Flow............................................gallons per person per day. Total daily flow ............................................ gallons. Septic Tank — Liquid capacity ............ 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 ........................ Description of Soil ............ Sand -----------------------------------------------------------------------------------------•---------------------------------------------•---------- .................................................... Nature of Repairs or Alterations—Answer when applicable... -installation_ of_ a. 600.__ gallon-.= e -cast,. stone eked leach pit (oyerflow� . Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TAI T1Z 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. p Application Approved BY a!! .... l� l%82 -------- ---------------- Date Application Disapproved for the following reasons: ----------------- ----- -----•----•----------•-...-•-•-----------------------------------------------------------------••-------- --------•••----•---------------•------------------------------------------•---------------•---- Permit No....82-....< / 7/2 - Issuedl ................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................... ',I:,wn........ OF .............. Y=zwth................................................. TrriifiraU laf Tuutpfianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( X) bY-------------------- A. ..g.. 9Si3�24G1.., erY. �.�_.-� 2$ h.4 �I'� �, ��i!�Jrii7 B, -----021601... VInstaller at ' ff . c _ XA 47 2 -...I? l t3$_. I.n> 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....82 ......................... dated.V..?�g-.2------------ .-------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WI L fUNCTION SATISFACTORY. DATE ._... .Inspector.....7 .. -7 :: a