HomeMy WebLinkAboutApp-Permit-Compliancea
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
. ppliratinn for Disposal Works Tonstrurtion rerun#
Application is hereby made for a Permit to Construct ( ) or Repair ()o an Individual Sewage Disposal
System at:
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Owner
E! G - f} � / D.je ............••••••..•...
Installer
Type of Building
»Mo -p..! I .-.--•----..--»-.....»--•-»--
or Lot No.
t.....��....»....`t.'l/2/I!I.OU�....
es
.... 'PA>- 2...2? Add �
Address
Size Lot ............................ Sq. feet
Dwelling —No. of Bedrooms ........... 3 ..........................Expansion Attic ( ) Garbage Grinder ( )
Other —Type of Building ............................ No. of persons ............................ Showers ( ) — Cafeteria ( )
Otherfixtures............................................................••••----•••----.....•-••-••----•••-•-----•-•-------•--•---........-•--•--•-----•......----
Design Flow ............ .-5-_`:1 ..................... gallons per person per day. Total daily flow ............ ��_.����................... gallons.
Septic Tank —Liquid ca.pacityZO�?.gallons Length _--��----'-...... Width --- �........ Diameter ................ Depth.. -4.
Disposal Trench — No- -------------------- Width .................... Total Length .................... Total leaching area ................... sq. ft.
Seepage Pit No ------ Z_.......... Diameter ..... !2.__..... Depth below inlet ....... 4L --- '........ Total leaching arealf ,_3 ..... rr4t. G PD
Other Distribution box (Y,) 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 Soil ..........................................
------------ --------•-----.... ----------•- ------ ----........... . -- .... ..........
Nature of Repairs or Alterations — Answer w en applicable.___t..s____________________l�.t,?vo ��1,�J� c �a �•/C...,
......•• •....---•-•----------------- .........
Agreement: O'v ^r -� F.' f c=- S
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT1Z- 5 of the State Sanitary Code — The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been -isssuje�d by the board of health.
Signe _....•--_._/. `.l.` �J I! { .t �---...•...... � ���D �G� �.._....
Application Approved By...........
_ 3 ��
---• .... .......................................... - ..........................
Date
Application Disapproved for the
Permit No ........ /. . ............»----
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
(Urtifirate of Tout phatt e
sO/� ----»Date
Date /„(/
* c�317lLT
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (�)
by........_FA6 ...... L'. !v:7?.R .T..0 :----------------•--................---...---........................__.......:.:::.:................ .»..........
Installer
at ....... y ....G ----
U ............................................ef.)r------------------- •----.•.---------------
has been installed in accordance with the provisions of TIT 5 e State Sanitary: -Cod . descr' ed in the
application for Disposal Works Construction Permit No.___.. .^. ...__...... dated.....'' .. .... .�_7--.---_--.-.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT- CONSTRUED AS ANTE THAT THE
SYSTEM WI �U �TI/QN SATISFACTORY. ('
DATE...... .... ......... ...1.... .... .-..................................... Inspect ./--••-----............... .._........ ....._........ .................