HomeMy WebLinkAboutApp-Permit-ComplianceNo._IL:.....J.. ��
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Town Yarmouth
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Appliration for Disposal Works Tonstrurtiun f rrntit
Application is hereby made for a Permit to Construct ( ) or Repair (V--ra—n Individual Sewage Disposal
System at: #33 Wood Road
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Locat Address 12 North Pond EYE '# Brewster
•Richard Knowles 3
... 1'6�""iti'fi11'" iZI"--RCZAddress S
W T.W.. Nickerson- inc.
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Installer Address
Type of Building Size Lot ............................ Sq. feet
aDwelling —No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
p,, Other — Type of Building _--•-•--••---------------•-- No. of persons ............................ Showers ( ) — Cafeteria ( )
04 Other fixtures
W Design Flow............................................gallons per person per day. Total daily flow ............................................ gallons.
WSeptic Tank —Liquid ca.pacity............ gallons Length ................ Width ................ Diameter ................ Depth ................
x Disposal Trench — No ..................... Width .................... Total Length .................... Total leaching area .................... sq. ft.
3 Seepage Pit No ..................... Diameter.................... Depth below inlet.................... Total leaching arm ................. sq. ft.
Z Other Distribution box ( ) Dosing tank( )
aPercolation Test Results Performed by .......................................................................... Date ........................................
a Test Pit No. 1................minutes per inch Depth of Test Pit .................... Depth to ground water ........................
(i, Test Pit No. 2................minutes per inch Depth of Test Pit .................... Depth to ground water ........................
Descriptionof Soil ................................................................................................. ----•---
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Kidd one 3fSti gaI tank with sewer
Nature of R airs or Alterations — An w wt�en a li b1e... ___.___�__..
.
line to existing_. 6_ Ft Z.ea pit (exss frig block leachpi"t'�"
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Agreement:
The undersigned agrees to install the aforedescribed Individual 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 hasbe6 )quejd by the board of health)
Application Approved By..l�t'(yl." .. _...._ . _
lo
Application Disapproved for the ' wing easons:............
a
Date
......... ............ ...... O Date -
Permit No. - ! f ^ - ---.. Issued...., .. �vJ j/.............
/Da;�te
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
................ O F...... :.:..!. ...................
...................... ............
Trrtifiratr of Toutphaurr
THIS -JS T CER F Y T e Ir dividu Sewage Disposal System constructed ( ) or Repaired
u'�� -------------------_..-
by.............j.---- Ins
� 2 w Installer
at................ =-I.::2 ............................... ---- --.........
has been installed in accordance with the provisions of TIT F 5 o State Sanitary Code/}�s descri n the
application for Disposal Works Construction Permit No..._.__�� .__.____. dated._...... 'Y ��.._.......
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT,BE CONSTRUED AS A GUAR NTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..............................................•--..........----••--••........... Inspector.