HomeMy WebLinkAboutApp-Permit-ComplianceNo.. �g:.. ..�.10, 00.....
..... / Fus.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........... .......... T.own..----..OF.... Yarmouth
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Appliration for Disposal Worko (UmIrnrtiun ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal
System at:
87- Iroquois -Blvd, , Voest Yarmouth
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Chippa Martin I& tg6o T shd Gruber 40 Atheron Rd. ; LB3F6Qkline, Ma.
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A & B Cesspool Sg ice 128 Bishops TerVkete , Hyannis
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Installer Address
Type of Building Size Lot ............................ Sq. feet
Dwelling —No. of Bedrooms -------------------- 2 ----------.-_..------Expansion Attic ( ) Garbage Grinder ( )
Other — Type of Building ............................ No. of persons...._ 2_..._._......._._... Showers ( ) — Cafeteria ( )
Otherfixtures--------------------------------------------------------------------------------------------------------------------------•-----•--•------------------
Design Flow............................................gallons per person per day. Total daily flow ............................................ gallons.
Septic Tank — Liquid' ca.pacity....._......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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Description of Soil ....... 5AZId--------------------------------------------------
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Nature of Repairs or Alterations—Answer when applicable ..... InstalZatlon... af... a..I-,.0.0.0... S.ept.i C...tank,
distribut o --b-Q c-,--- r�d...�--- 1_Q�x u o '------- s�x�e----p t� a --w tY�..extra.....tonaj.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITTLE 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 - e boartith. 6/ 1/79
Signed._ -'�---------•------------------.....................
Signed_.,.,
ApplicationApproved By .................................................................................................. -----------6 ....................
Date
Application Disapproved for the following reasons-----------------------------------------------------------------------------------------------------
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Date
PermitNo --------------79-----------------------------------
Issued----------------- ..................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...................... Tow,.......oIyarmau................................................
C�ilex#iiirtt#le aaf (�um�rlittnrle
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or, R' (X)
by- ._ :.: $La*.®1.. r . .0.... 3 _Big _ rr a ,� gy•,-------------- -----
nstaller
.............................. Ctf? G�i— ..i. t3.i9 _ _ I b i ....... .................
has been _ installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No ------- ____ � ... dated ...... ..__.. A .. .....:.........
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT B fZO�RUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE......... 61 ..... 179.................................................. Inspector ....................................................................................