HomeMy WebLinkAboutApp-Permit-ComplianceNo.Fss ......
} THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
Appliration for Disposal Works Tonstrurtiun Errant
Application is hereby made for a Permit to Construct ( ) or Repair (XX) an Individual Sewage Disposal
System at:
#3 Diane Avenue, South Yarmouth, Ma. �_oi G(o MA'P 40
................__----_-- ...................... ...-----•-._................... _.......... . ......- - -._... ---• ----- -------•--.._...--•-'--••--___.....-.-..........__.
Location - Address or Lot No.
Joseph Callahan _ _
. .. Owner.........................................
.......................................
•--•---------------•---•---...--•--- Address...._......................................
W Cash's Trucking, Inc.
Installer Address
Type of Building Size Lot ............................Sq. feet
�., Dwelling —No. of Bedrooms___________________________________ ______Expansion Attic ( ) Garbage Grinder
` 4 Other — Type of Building No, of ersons____________________________ Showers — Cafeteria
Other fixtures .................................... --
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W Design Flow --------------------------------------------gallons per person per day. Total daily flow.......... _..______________...._____________gallons.
WSeptic Tank —Liquid ca.pacity............ gallons Length ................ Width ................ Diameter ............... _ Depth .......... _.....
xDisposal Trench — No . .................... Width ................. ... Total Length ........... ...._.__. dotal leaching area .................... sq. ft.
Seepage Pit No ..................... Diameter ... ,............ .... Depth below inlet .................... Total leaching area ........... _...... sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
F'' Percolation Test Results Performed by------ ................... -................................ ................ Date ............................... •........
1.4 Test Pit No. 1................minutes per inch Depth of Test .Pit .................... Depth to ground water ................. .......
44 Test Pit No. 2 ---------------- minutes per inch Depth of Test Pit .................... Depth to ground water ........................
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0 Description of Soil -----------•---------••--•------------------...................... _--------•---•----------------................____-................... ._._......................
..
W
U-----------------------•-------------------------...---•--.._------...........------------•---•------......-----•---•---------•-----._.----........._......-•---'---'-..................
W---••--------------------------------------=-------------------------------•-------....-•--.....--------------------------------------......._..0.....--••-.............. .....,
U•. Nature of Repairs or Alter tons — Answer when applicab_ej.installink a 1 + 000 ballon _leaching—pit, 1'
E
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Agreement:
-Agreement: �U\
The undersigned agrees to install the aforedescribed Individual ge Disposal System in accordance with
the provisions of TIT11 5 of the State Sanitary Code — The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has beenjAjued by, the board&f 11pith. .,4
Application Approved By
Application Disapproved
Permit
01-27-92
Date
. r
• t_...7.-_ .9. .......
Date
I- Date
Issued.._......`.r.� ..... .........._
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
Trrtifirate of iffuutplinurr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( X)
by.., ............Cash's Tr:..kingt---Inc_-••--'•-•--•--.........-----.....---:..,........---•---•---.......-•••-•---.:...........--•---...........------.....--•--•-•----••.
Installer
#3 Diane Avenue', South Yarmouth, Ma. [Owner os- h Callahan
at................. .... ••--------.------------------•f . 1?. ...................................
has been installed in accordance with the provisions of TITkE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No ........ J'Z, .__ ........ dated ....... t..-. .."...?..Z .
THE ISSUANCE OF THIS CERTIFICATE SHALLND N RUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. �
1
DATE.......... �J:�................................ Inspec . - - __-- ........_------ ......