HomeMy WebLinkAboutApp-Permit-ComplianceNo._....... 89.- �3 FiEs.L1 .00.._....._
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF..................YARMOUTH
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Appliratiun for %pawl Works Tonstrurtion 'pJrrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal
System at
............10 GEN
10 ...Y .................................. ........... ... UT ----C ............. r�iRp,- - .- - ......
Location - Address or Lot No.
............ ANL_.DEW.•.-MAN G HIS ..... . ........................•----....------------------....•..............--------........-------•----.......................
����- Owner Address
BCK - GEN. CONTRACTOR
Installer Address
Type of Building Size Lot ............................ Sq. feet
Dwelling —No. of Bedrooms ............................................ Expansion Attic ( ) Garbage Grinder ( )
Other — Type of Building ............................ No. of persons ............................ Showers ( ) — Cafeteria ( )
Otherfixtures --•------------------------------------•------------------------------
Design Flow............................................gallons per person per day. Total daily flow ............................................ gallons.
Septic Tank — Liquid' capacity..__......_.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. 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 ........................
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Descriptionof Soil ........................................................................................................................................................................
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Nature of Repairs or Alterations — Answer when applicable_. 1500_G81_D-:Box 1000 GLP..W/STONE
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Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITIL 5 of the State Sanitary Code — The urlders' ed ur her agrees not to place the system in
operation until a Certificate of Compliance s been issu d by the boa o '111t
Sh e ...... ...... .........5/8/89
Application Approved B...........
Y--- :cP�....�........................................................... ...........
..� .......Date------..
Application Disapproved for the following reasons: .......................................................................... �/ __._.
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g9 P35 J� e} Date
Permit No. ............. Issued . - . ! �.1.. ..._......
ate
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............ TOWN .............. OF ................... YAR QUIH.....................................
f�rriifirtt�le of f1��am�rlitt�tr�e
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( } or Repaired (X)
by-........ ----------------------------------------------•---------------......-----•--------------.........--------------------
Installer
at........... .S.QUTH. YA.IJ 0UTH--------------------------------------------•-----IG'
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has been installed in accordance with the provisions of TITL ..}}r of The State Sanitar de + d�j prib d in the
application for Disposal Works Construction Permit No g7_.IJE.................. dated_`.-�-/-...._..-.._...THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS ARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE .................. 7- -- .: Inspector... 1 A� � 4��` �, ...