HomeMy WebLinkAboutApp-Permit-ComplianceNo.... FzZ C.......... ..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
Appliration for Disposal Works Tonstrurtion jrrmit
Application is hereby made for a Permit to Construct
System at
... `./..Y .... IIA?q- ........
Locatiop • Address
Owner
...... •--^ .------.•_---.....
Installer
Type of Building
Dwelling — No
Other — Type
) or Repair ( vY an Individual Sewage. Disposal
or Lot No.
-• ---------•...................................................•--•---•----.............--.-.....
Address r
Address
Size Lot ............................ Sq. feet
of Bedrooms.......... IF............................Expansion Attic ( ) Garbage Grinder ( )
of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Otherfixtures ..-----••---...---•--------------------•----...........--•---••-•--------............------........---....--•-•-----..............----...---.......---
Design Flow ..............? ZA...................... gallons per person per day. Total daily flow .............. 3.9n.. .................... gallons.
Septic Tank — Liquid' ca.pacity.Lew..gallons Length ................ Width ................ Diameter................ Depth ................
Disposal Trench — No ..................... Width .................... 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. I................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........................
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Descriptionof Soil.....................•---------------•--........------------........---•-------....------...........------
............................••---...---•---••---•--.._...----------•----......_.....................----------••----------------------...............................................
Nature of Repairs or Alterations — Answer , he lie ble. uJ�Tu1 ._ a%......tsmo--r �.... +9t,j" t......---.
Agreement:
The undersigned agrees to 'install the afore cribed Indivi 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 been issued by the board f health.
Application Approved By...... '�...�.?G ----
Application Disapproved for the following reasons:
Permit No .............. �.v �, C
7 ..... .................... ....... .. ........49
..
........................ .........
Date
... ----•---••-------------Issued......_.. � ate......-------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
Trrtif iratr of Tom littnrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( t,e
by............................................................... ..-•----.......------........................--•---............---•-••---•-•--•--•--•--............................---•--
Installer
at........................ ........................'76%. .... A C",P,- J -----44A,+. .......... L4.es1n.--5'.rhE.�wA--------..--------.----------..-.---------.-.-._-•--
has been installed in accordance with the provisions of TIT of The State Sanitary Code descri e(� m the
application for Disposal Works Construction Permit No.._._.___. _""-�•-- dated._.....,...
THE ISSUANCE OF THIS CERTIFICATE. SHALL N T BE CONSTRUED AS A GUAR NTEE HAT THE
SYSTEMA WILL\ FU' CTIO SATISFACTORY.
DATE --•_•--_. ,� -
...................................... Inspector....``::----- ..... ...: 1............................... - ......