HomeMy WebLinkAboutApp-Permit-Compliancet
N8.1- 141 --- Fms...l..s
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.............................T own.O F..... Yarm outh---------
Appliration for Uhipai al Warks Tonitrnrtuon amit
Application is hereby made for a Permit to Construct
System at: Location - Address
.Glenn. S heI?d--------------•------------------------
Owner
--A-- ..B Cesspool_.Service...........................................
Installer
Type of Building
Dwelling — No. of Bedrooms......... 3 ..............................
Other — Type of Building ............................ No. of
Other fixtures
( ) or Repair (x ) an Individual Sewage Disposal
LoT - JCP rYA �- P - S3
.............................................................
- - - .....
or Lot No.
-'3.4..5 ta,ti an-.Ave--,..-SLuth..YaxmnlL.t h,.. ,U .... U6b4-
Address
128__�ish ogs__Terrace,_..H,yannis,--M�----- uLai....
Address
Size Lot ----------------------------Sq. feet
..Expansion Attic ( ) Garbage Grinder ( )
persons ...... 4___________________ 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. I................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 ........................
------------------------------------------------------------------------------------------------------•------•----•--••----•••---.....•-•----•--------•---_..
Description of Soil---Sand--------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Nature of Repairs or Alterations — Answer when applicable.______. nsta_11 ti.QrL..of __a --- ,00 --- ga1Lm. pre --cast ,
stone packed_ leach__pit-- by_eragm)-=-----•---------------------------------------------------------•.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Ti':'LE y g g p y
5 of the State Sanitary Code —The undersigned further agrees not to lace the system in
operation until a Certificate of Compliance has bpeep issuedA by th board o health.
/ Dat
Application Approved By .................... ------ - " ---- --------------- - --------- -------------6/Z .-•------
Date
Application Disapproved for the following reasons: ..................................... ......
------------- • - • -------------•........--------------
...................................................
Date
Permit No._--.--- 81 ---� ��............................ Issued. -----._6,(a 481 -------•------•--------------•-
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........................................ wOFYarm Yarmouth
.. ..
..........................................................fit
....
wrdifiratr Of (91IMPlialtrr
T IS Lf TO CERTIFY, That 4f Inoi idual Sewa e Disposal System constructed ( or Re fired (�)
A B Cesspool Service, _lzt3 Bib ops Ter ce, Hyannis, M 02601 - 7,5-62W
by---------•-----------•••---------------- .. ---......._..._......----•---•---
34- Station Ave . , South Yarmouth, 02664'statlenn Shepard
at.................................................................................................... --------------------------------------------
has been installed in accordance with the provisions of T " Lr: j of The State Sanitary o e described in the
application -.for Disposal Works Construction Permit No._�7---_�_' i-7) .................. da.ted__-.�/._- 1 ----------------- ..........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE TRUED AS A GUARANTEE THAT THE
SYSTEM VlIILL U CTIOVSA SFA TORY.
DATE............... � ._.. Inspec r.. ................................................