HomeMy WebLinkAboutApp-Permit-Compliance~ OV
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THE COMMONWEALTH OF MASSACHUSETTS
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TOWN OF YARMOUTH
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Application is hereby made for u Permit to Construct { ) or Repair ( �-�~au Individual Sewage Disposal
System at:
.1411W .... L-tvz ----------------------------------------- --------- ujainywomm,&4 ---------- - .4 ... . ...
Location,,A,kddress r Lot No
Owner Add
Type ofBuilding Size Lot ............................ Sq. feet
Dwelling --No. of Bcdroomy. ............................ Expansion Attic ( ) Garbage Grinder
Other—Type of Building ..... ---- No. o6persons ............................ Showers ( ) -- Cafeteria ( )
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Other fixtures ------------------------------------------------------------------------------------------------------------------------------------------------------
Design Flow .-----'�x��---------'_�y�l000per person per day. Totadu�y8n`r-..----'Z���u_--'---' �
SepticTaok--Liquid loos Loocth-.------Width ................ Diameter ................ Depth ................
Disposal Trench --BTu.................... Width .................... Total Length .................... Total area -------------------- sq. ft.
Seepage Pit I0o.--------. Diaozetcr.-------- Depth below inlet .................... Total leaching arcu--------. sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
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Percolation Test Results Performed bv.......................................................................... Date ........................................
Test Pit No. 1 ................ minutes per inch Depth of Test Pit .................... Depth to ground =mtec.---.-_---
Test Pb No. 2 ................ minutes per inch Depth of Test Pit .................... Depth toground water ........................
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`/ Description o{Soil .........................................................................................................................................................................
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Agreement: '
The undersigned agrees to install the uforedescribed Individual Sewage Disposal System inaccordance with
the provisions of --��� ' of -_ State Sanitary- ---- The undersigned.further-agrees not to place -e system. - in
operation until a Certificate of Compliance has been issued }ythe board of health.
Date
Date
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THE COMMONWEALTH oF MASSACHUSETTS
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BOARD OF HEALTH
TOWN of YARMOUTH
THIS IS TO CERTIFY, That the Individual e,,A,ag isp al System constructed or Repaired ( 1,.r
Insfaller -14
has been installed in accordance with the provisions of TIT�! f as ri d
-The State Sanitary Co I d c ibe in the
application for Disposal Works Construction Permit 1._._ - ------_-- ------------_- d, ted-.. 3 -Ty
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.