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HomeMy WebLinkAboutApp-Permit-ComplianceLKIA NNW No. ��� to Bp FEs. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF YARMOUTH Appl ration for Disposal Works Tonstrnrtion f rrmit Application is hereby made for a Permit to Construct System at: _.35. Washington- Avenue, West Yarmouth, . Ma .. Margaret Brown Location - Address .- Owner Cash's Tr:,ucking, Inc. -.................................... ---------------- ....... --•--------------- Installer ) or Repair (X ) an Individual Sewage Disposal ----- .L07-:--6-3 (- -rnme- =. `-�=G--.------------ or Lot No. ................................................................................................ Address Type of Building Dwelling —No. of Bedrooms..........................................Expansion Attic Other — Type of Building ---------------------------- No. of persons............................ Otherfixtures------------------------------------------------------.......... •--------.............---- Address Size Lot ............................ Sq. feet Garbage Grinder ( ) Showers ( ) — Cafeteria ( )' 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........................ Description of S ----------------------------------------------------------------------------•---•-----------------•------------•-----•-------•--------.......--------------.........----•---------••--•-------••••--•... Nature of Repairs or Alterations—Answer when applicable___ add to existing system/ one flow ............................................................... diffusors stone packed t -•---•------------•-------•----------•----•--------•-•-••••-••.................. Agreement: The undersigned agrees to install the aforedescribe the provisions of ilTsIE 5 of the State Sanitary Code — operation until a Certifi Application Approved Application Disapprove d Individual Sewage Disposal System in accordance with The undersigned further agrees not to place the system in .:.:........•--------•------------------------------------------------------------------•-•--------------.....-•--------•-----------------------------------------------.............-•-................. Permit No ....... .--�,--------------------------- Issued..... �©�' .....hdu...... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN of YARMOUTH Trrtifirate of fanntplianu THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (XX) by--------------------- X ......................... ]...... � 17�.'_ ...' r=,killcq---.Inc................................................................................--------.... -•Installer #35 Washin ton Avenue, West Yarmouth, Ma. [Margaret Brown] at....................... - --- .......... has been installed in accordance with the provisions of TITI� of Th State Sanitary Code as d cr�'bed in the application for Disposal Works Construction Permit No......... -.1.1-2.t 7-..----- dated ... �.-�=_6f:%_L (...:............... THE ISSUANCE OF THIS CERTIFICATE SHALL NST ONSTRUED SAG R NTEE THAT THE SYSTEM WILL FUNCIUON SATISFACTORY. DATE...' 6_J _.....�............................. Inspector----.... ----.........