HomeMy WebLinkAboutApp-Permit-ComplianceNo. .... 86 .630.. Ficim ...L5.00 .....
THE COMMONWEALTH OF MASSACHUSETTS
13 eXP—&aJ S`{BOARD OF HEALTH OCD MA -P ZI? D /oZ
TOWN...............OF YAR2dM-OUTH Map ,3 ��/
...
, ppliratiun for 11ispusttl Works Tanstruriiun �Jhrnti#
Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal
System at:
-13 EVERGREEN c^T--3 YARMOUTHj" t) iO2 �1p._..2_
•---...._...__...._......................... .................. -••--.......... - - . ...................
EUGENE KELLEY Location - Address or Lot No.
------------ -- -.___------.._....--- ...... - ._..._... .. ... •......-...-• .... -...---.........-
Owner
W BCK Address
Installer
Type of Building
Dwelling —No. of Bedrooms .................................
Other — Type of Building ............................ No.
Other fixtures
Address
Size Lot ............................ Sq. feet
........ Expansion Attic ( ) Garbage Grinder ( )
of persons ............................ Showers ( ) — Cafeteria ( )
---------------................................. •--------------•-----------------------------•••.....-----......-••-----•••-•---•---•-----
Design Flow............................................gallons per person per day. Total daily flow ............................................ gallons.
Septic Tank — Liquid capacity ............ 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 ........................
Descriptionof Soil ...................................................................... --................................. .....................
........................•---....._.._..._........_...----•----......_......----.............._._....----....__._...........---------•--•---..................................._..........._.............
Satlure of Repairs or Alterations — Answer when applicable. ---- 1000 GST - (2) S -TYPE FLOW DIFFUSERS
..••••-•••••••••••••-••••....•-••-•••••••••-••-•...•-_•••..............................................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITi.i� 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 health.
Signed. ................. -----.-----
Application Approved By----VI----------------------------------•------------------
Application Disapproved for the following reasons: ..........................
Permit No ...............• -86 -.S1t .....................
........................................ . 12/10/86 t`-----
....._
1,�/_��D
................... Date
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ate
Issu�.� l4� /9$ ... --
JJ��� -� THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOO t4 YA R14OUTEI
.......................................... OF .....................................................................................
Trrtifiratr of Toutphaure
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( } or Repaired (X
by ......... B 1
Installer
at I.3. EVERGREEN STREET _ _SoiI:rg3:• YARMQUTI-I-----------------•-•---------•.......................
has been installed in accordance with the provisions of TITLE5 of The State Sanitary1C described in the
application for Disposal Works Construction Permit No .... b __6;M .................. dated --- .�� _��` .......................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS,A GUAFANTEE THAT THE
SYSTEM -
WILL FUNCTION SATISFACTORY.
r.
DATE..�.Zu.,`�"/`? = f l 221 V ••= --- ...........................