HomeMy WebLinkAboutApp-Permit-ComplianceAkf 41
FIZZ
No.33J35 J
A l TWE" O W T OF MASSACHUSETTS
Gb BOARD OF HEALTH
4i' Q� I ' '
TOWN OF YARMOUTH
Applirattit ar Disposal Works Tonstrur#ion .Irani#
Application is hereby made for a Permit to Construct
System at:
..47
.....� �� ...4-A9-'..Pj...........................................
_.... ..
p Lgtion -/Address
.
.. :% .Ft.. ...................................... ....
Owner
................••-------- ---------------•--.•-•-•---•--...----
Installer
( Vf or Repair ( ) an Individual Sewage. Disposal
1-----•----------W.T`.L:8..... (.Y.lP
or Lot No.
...................•----...........---•.'�.................................------..............
- Addre
i@o- . t �..---...:....................
Address
Type of Building 2 Size Lot ............................ Sq. feet
Dwelling —No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other — Type of Building ............................ No. of persons ............................ Showers ( ) — Cafeteria ( )
Otherfixtures ..... ...............................................---•..........................•----------.....-----•----
Design Flow .............. /_I_Q............. _.......... gallons per7son per day. Total daily flow ...............Z�Lea.................. gallons.
,.Septic Tank — I.iquid' capacity./_Of1o..gallons L ngth................ 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` ........................ Date ........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water ........................
Test Pit No. 2................minutes per in Depth of Test Pit .................... Depth to ground water ........................
.................................................................................................................................................................
Nature of Repairs orp Alterations — Answer when applicable ... A.1 S_.S_yX4__a1�._...../.a�!A-_6-s7-.............
- ----------------•------------
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 has been issued by the board of Italth.
Application Approved By..
Application Disapproved for the following reasons------------------------------------------------------ ...................... ...............
........... ^. ......................................
....._.... -
Date
Permit No ....... .----...---••.... Is h i. __ ...............231
D e
THE COMMONWEALTH OF MASSACHUSETTd
by
BOARD OF .HEALTH
TOWN of YARMOUTH
(Intif irtt#P of (auntphaurr
THIS IS TO CERTIFY, That the Individu l Sewage Disposal System constructed ( ) or Repaired (�f'
at ........................................ R7....-. 7 .!et:- !ju..---te/tINC. / / .....................- ti++.:ae L.... --------------------------- --•------------
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as e-r'yd in the
application for Disposal Works Construction Permit No ...... .. °' �. dated.......... .................
THE ISSUANCE OF T IS CERTIFICATE. SHALL 12T ONSTRU A A NT THAT THE
SYSTEM WILL f UI CT�IAJISFACTORY.
11^ /t, en A