HomeMy WebLinkAboutApp-Permit-ComplianceNo.-q.'b:"
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
Appliration for Disposal Works Tonstrur#' n jrruti#
A lication is hereb made for a Permit to Construct or Re air �/ an Individual
pp y ( ) p ( ) Sewage Disposal
System at:
---- ..� _S14 rl.�. P A/ /f Pe.................................... .......... L_o-r- _ ice q -......-•-
• at on Ad or Lot No.
--. ... _ `'...................................... �._. ..-._..--•--------------.-_...._........
UOwner ^ ... Address ...................•...................._..
....1.. ._.��------------------.................................................... ---- -lam'----•---•---�'�'--
-----• -- - ---------
Installer Address
Type of Building –3 Size Lot ............................ Sq. feet
Dwelling — No. of Bedrooms ............................................ Expansion Attic ( ) Garbage Grinder ( )
Other —Type of Building ---------------- •......... No. of persons .....................••..... Showers ( ) — Cafeteria ( )
Other fixtures .. ------•--------....------
Design Flow ----------------------------------------- --gallons per p rson per day. Total daily flow ............................................ gallons.
Septic Tank — Liquid' capacity___.__ ____g s
Le h ................ Width ................ Diameter ................ Depth ................
Disposal Trench — No .................
... Wi ..._..._..._... Total Length ....................
Total leaching area .................... sq. ft.
Seepage Pit No .....................
Di meter--_..._ _....._._..
Depth below inlet .................... Total leaching area .................. sq. ft.
Other Distribution box ( )
D sin
tank ( )
Percolation Test Results
erformed y....
.....................................................................
Date ........................................
Test Pit No. 1 ................ inutes per nch
Depth of Test Pit....................
Depth to ground water........................
Test Pit No. 2................nI
utes pe inch
Depth of Test Pit ....................
Depth to ground water ........................
Descriptionof Soil..................................................•----------•--•----------•---------------------••-----...------•---•--•----......---•------......
.7 ..................................................................................................................................................................................
-•---------- ------------ ----------------------------- ----............. ----•• . i -
Nature of Repairs or Alterations — Answer Jw�hen a�licable,%
.......................................................... Q r u.. `--�----- /-cX.-..........................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT 1Z 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 b boayo of health.
Sig – °V
Vat'
Application Approved By---.••.......--•..................•---------........---......---•-•--•••-. ----
Application Disapproved for the fol win r asons:.................................•--...-------•----.............---••--•-•----...._..------ •----......--._....
Permit No ........... .l...O _^. IF. .......... --....
---------------
-----------
Issued......--- ��- z -`rte - -- -��-
Date .•••.....�
THE COMMONWEALTH OF MASSACHUSETTS F
BOARD OF HEALTH'
TOWN of YARMOUTH
Trr#ifiratr of faoutplittnrr
THIS IS TO CERVf That th Indi 'dual Sewage Disposal System constructed ( ) or Repaired (t/f
y.................................... .........((.//...--- ----------------------------------.---.-.----.----------.------- -.--._-------•----------------------•------------
In... ler
at c��Q._....._.rY....�..................... j... `........ ... ........
has been installed in accordance with<the provisions of TIT 5Rf The State Sanitary Code s desc i in the
application for Disposal Works Construction Permit No .......... ---..... .t? ........ dated........ ..._��j .........
THE ISSU NC OF THIS CERTIFICATE SHALL NOTtBECONSTR D A GU ANTE THAT THE
SYSTEM WIsLL FUNCTION SATISFACTORY.
DATE.... ........1. � �y---- ....................... ................... Inspecto . --------...---........-----.....' ..............