HomeMy WebLinkAboutApp-Permit-ComplianceIR,n V
No ....82-./ 1�... FEs....... $15-00
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH to
...................T.CK..n---------.OF............Ya=O.0th.....---------------------•----....------....-----•----•-
Appliration for Disposal Works Tonstrurtion thrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( X ) an Individual Sewage Disposal
System at: f
`34 ... ---- 0262.3 .............. ADS � i(� ----- - -----------------------------
Location - Address or Lot No.
...Margery_- --------------------------------------------------- ....02673
Owner Address
aA_ &B -Cesspool --Service............................................ 12$__Bishops__Terr4ce_,_.3yannis_,__.MA 02601
Installer Address
UType of Building Size Lot___ _________ __________Sq. feet
., Dwelling—No, of Bedrooms ............. 3............................Expansion Attic ( ) Garbage Grinder ( )
� Other — TyPe of Building --------•---------••-------- No. of persons............ 3......... Showers
( ) —Cafeteria ( )
Otherfixtures-----------------------------------------------------------------------------------------------------•--...._....--------------------------.......---•
W Design Flow............................................gallons per person per day. Total daily flow ......................... :_.t ............... gallons.
WSeptic Tank — Liquid' capacity......_..._.gallons Length ................ Width ................ Diameter__-_____.__..--. Depth_._..._..._..._.
Z Disposal Trench — No ..................... Width .................... Total Length .................... Total leaching area.,,_.____....._sq. ft.
Seepage Pit No_____________________ Diameter .................... Depth below inlet .................... Total leaching area ----..--_---_-____sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by .......................................................................... Date ........................................
aTest Pit No. I................minutes per inch Depth of Test Pit .................... Depth to ground water ........................
fi, 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... nstaljati.on... of' -a--1,0.00 --- gal-fan---se-ptia__tank,
.... and ---3-•f.1owdiffus=s*---sta.ne---pa.cked.-.................................................................................... -........ .....................
Agreement
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
-,the oiovisions of TITLE 5 of the State S nitary Code — The undersigned further agrees not to place the system in
operation until a Certificate of Compliance fl s been issued by the board of lth. `
i
Signed-----------------�-----..... � '...... -----5/26/82.---------
Date
ApplicationApproved By ...................... ------------------------------------------------------------------•-•--------------------5/2-6/82 ..........
Date
Application Disapproved for the following reasons---------------••.-_-_---------.-•_---__-____-_-_--_-
....---------------------------------------------------------------------------------------------------------•----•-----•---•-•-•-•--------••-------------------•----•-•------...
Date
Permit No........... 82- Z --------------- Issued .-•--s126182------.
•--- ..................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
................................ T.O..WnO F..........1EXXXXX %..... Y.asmouth......................
uprr#ifiratr of Toutplianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( X)
b, A _& .B -Cesspool Service. -128 Bishops -Terrace, Hyannis, _MA 02601
---
Installer
---------
at.,3D kliRd. xt., West _Yarmouth, -MA ..... -Margery K. Stergis------------------------------------
--
has been installed in accordance with the provisions of TITLE5,9f The State Sanitary Cod . as described in the
application for Disposal Works Construction Permit No827..Ia.ff..................... dated__.._. -5 2682___..___._.._.._.____...
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................•---•.... Vl,-•A2-••.....------...-------•----...... Inspector ....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS �i,Q sl"/ Y
n � / w
BOARD OF HEALTH
..................T QWM............ OF .......... X�,7IC1Mth.---............----------------------------..........
No.._.....82_=__ FEE....�..15:00...
Disposal Works Tonotrudion Vprrnfit
Permission is hereby granted ----- ee__________________•_---------.......................................................
to Construct ( ) or Repair ( X) an Individual Sewage Disposal System
at Na MA
. . .. W - . s .._ _-YStreet ._.
as shown on the application for Disposal Works Construction Permit 82.=9.-_::._... Dated ........... ..............
................. -------------------•-
DATE.
5//82 Board of Health
--- -- .............. --•------------..........._ v
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS