HomeMy WebLinkAboutApp-Permit-ComplianceNo. -OL ........ Q..--•-- Fim......
.........
..0 0
- -
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Town
................... .. ..............OF..............:Yarmouth---...........................................
Appliratiun for Uhnpos al Works Tomitrurtion motif
Application is hereby made for a Permit to Construct ( ) or Repair (X)) an Individual Sewage Disposal
System at:
15 Hazlemoor Road� (o i
f - ,�1-�a- -
.....---•----------------------------------------------•------.........--------.._..__..._.......------------------------'2
Shaw Kwasie Location - Address or Lot P; o.
Owner Address
J. P .Macomber........................................................ --------•...------------------------------....------•-----------..........------------•-----------
4 Installer Address
PQ
Type of Building Size Lot ----------------------------Sq. feet
aDwellingXX No. of Bedrooms.. ............ 3 ........................... Expansion Attic ( ) Garbage Grinder ( )
p, Other — Type of Building ............................ No. of persons ............................ Showers ( ) — Cafeteria ( )
P4 Other fixtures -------------------------------- .
W Design Flow............................................gallons per person per day. Total daily flow ............................................. gallons.
WSeptic Tank — Liquid capacity ............ gallons Length ................ Width ---------------- Diameter ---------------- Depth ................
x 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. 1________________minutes per inch Depth of Test Pit .................... Depth to ground water ________________.._-___.
0i4 Test Pit No. 2................minutes per inch Depth of Test Pit .................... Depth to ground water --_-_--__.---_________
a-----------------------------------------------------------•----•---------------------------------•- .........................................................
0 Description of Soil ................................................................................................................. -------------------------- ---------------------------
V---------------------------------------•-•----------------------------------Sand--------•-----•-----------------------------------------------------------------------------------------•--------
W
VNature of Repairs or Alterations — Answer when applicable...............................................................................................
............................... ----------------------------------------------------------------------------•--1-1.....0---tank-----...-- ------ 1. -IIID 0- Pit..
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposall'System in accordance with
the provisions of �- i LE 5 of the State Sanitary Code — Th undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b n issue by e b rd of hea
gned. . -- ,_--- ---- - ----- ' -------------- -----------
Application
8
Application Approved BY ------- ----- - -------------------------------------------------- y/ v
Date
Application Disapproved for the f owing r asons- ------- ----------------------------------------------------------------------------------------------------•---
---......-•---•--------------•--------------------------------------•-----------------.....--••-------------------------------------------- ---------------------------------------------------.._...---
c� Iy Date
Permit No._6_0 _���....................•--•------------ Issu.......
..............Zl66-------
3iSiL
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........ .o.wn........... Bat %€
O F.............:.......................................................................
AT
w -En ifirair of Tontplittnre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or RepairedX
bY..... J..-P-..Ma-cam#P_r-........................ ............................ ----•---------------------------------------•-----------------------------------------------------------
Installer
15 HazleinoorrRoa 1 South Yarmout i1
at ---------------------------`--- --------- --- ----------------------------------------------------------------------- ----------------------------
has been installed in accordance with the provisions of TIKE - r5.of The State Sanitary Goy -as described in the
? pplication for Disposal Works Construction Permit No.� �...C-p'�A..................... dated .f ' .. '___� '__�......_._.__.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT TRS AS A GUARA E THAT THE
SYSTEM WILL FUNCTIONS ACTORY. �-
TE.... � ..` . ��.. ..............•--------- Inspect -- ----- . ---- ........................................