HomeMy WebLinkAboutApp-Permit-ComplianceI?
No......1. ...
... .... Fzz—1
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
Appliration for Disposal Works Tonstrwtion 11trutit
Application is hereby made for a Permit to Construct ( ) or Repair A/('an Individual -e age Disposal
System at:
4'8-t--50 MV=-AC--ny
................ . . . .. . . ....... . .....................)Q.&. ..............................
Locatiog - Address
...................
Owner
... 1�c ............................................
Installer
Type of Building
Dwelling — No
Other — Type
46
J--C.r)- 11"I
. N ..............
................ ... 9 .... a2. ........ L..
or Lot No.
Address
3 c,,..2.....3AW-„— rrOIL
...Kjre5S
Size Lot ............................ Sq. feet
. of Bedrooms ........ S ...............................Expansion Attic ( ) Gaj)age Grinder ( )
of Building .-,AJA.axJZ .......... No. of persons......4 .............. Showers — Cafeteria ( )
Otherfixtures ------------------------------------------------------------------------------------------------------------------------------------------------------
Design Flow .............. 11m ...................... gallons per person per day. Total daily flow ..... SS.o ............................ gallons.
Septic Tank— Liquid'capacity/s—&z..gallons Len th ..... /a ..... Width.—C.'....,.”. Diameter ................ Depth ... y
9 ,4 .....
Disposal Trench — No. ..X.0 .......... Width -.-.Q...........: 2 .............
. 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. 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........................
Description of SoiY06AY,
........................................................................................................................................................................................................
Nature of Repairs or Alterations — Answer when applicable...............................................................................................
.............. ..............
CV!tZ-1 ------------------------
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 bee ssued y the board of health.
121-1
........................... * ...... * ...........
Sig & ............
ApplicationApproved By... ... ......... .................................................................... ..... i.:r ... ......
e'lowinlgre Date
Application Disapproved for the fo w* reasons ................................................................... ........... ..............................
Permit No .......... ..............
............................. .......... .... ......
Issued ...... 4.2 . . ...... Date
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
dfoo,
TOWN of YARMOUTH
(Entifiratr of Towltaurr
LYFYT
)90 CFRTI, hat the I d' id al Sewage Dispo or Repaired
licivi u sal System constructed
•
b•THIS
,
..........
f .......................
at.......... . I-0 ... ....... ., .................................................... ... w ...........
has been installed in accordance -i-Vti4th- 'the p" ...................... ..
5 f The State Sanitary Code as descri din the
dated ..... . .....
application for Disposal Works Construction mit No .... 9--Z ..... 4"C -3r
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONASTRU D AS A GUARA TEE YHAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.... ....................................... Inspector ....... .... ........... .. koo