HomeMy WebLinkAboutApp-Permit-Compliance.... . ...... .
THE COMMONWEALTH OF MASSACHUSETTg
BOARD OF HEALTH
TOWN OF YARMOUTH
Appliration for Disposal Works Tonstrurtiun Prrmit
Descriptionof Soil ------------------------------------------------------------------------------------------------------------------------------------------------------------------------
------------------------- •------ -------------------------- •---------------------------------- _--------------------------------------------------------- •------------------- -•---------------•---
V Nature of Repairs or Alterations — Answer when applicable .... 10.CEW_... :YATEA]....... /99.Q. A:s:.... AAOX
Y' r ....................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT1E 5 of the State Sanitary Code — The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been • sued by the boarN , healt
Signed...... --- ---c'-- ---------------------•----
ApplicationApproved By ...... -- - --- -•--• ----•--------•-•....................•••----------...........--—
Date
Application Disapproved for t f owi reasons'----------------•---------------•---•------------------------•----•------------•---•------ •_____.....
................................................•-------•-----------•----•••----------•---.......--•••--- •--•....._.....--------••---•-•--------..._._.._•---•---------_..._...._....--•--•-•-------•---
Permit No .........
.
---------------_.__. Issued.....-"�Date
--- 5Z_..(B�.-----
Date
_ _ — — _ _ — -----
THE
---
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
Trrtifirabl of Tinfi rliaurr
THIS IS TO CERTIFY, That the I,p ividuSewage Disposal System constructed ( ) or Repaired ( �
...••• _...
by . . ............ _._.........
-----------......---•-..._._....-----------._......•-•---•-..._.._......------•-•---....._
.
-----....... ---•- -�/-Twl ___i. Ins Iler
has been installed in accordance with the provisions of TIT 5 of The State-Samta-ry_Code as c scrlb the
application for Disposal Works Construction Permit No.__ _--r___._ . dated__...!) .-_. �.........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE RUED UA ANTEE THAT THE
SYSTEM WILL F NC ION SATISFACTORY.
DATE ............ -...._ Inspector..,. •----
5 __�._ E -------••------------•-. ..--
Application is hereby made for a Permit to Construct ( ) or Repair ( L_�r an Individual Sewage Disposal
System at :
...L..IQ_.-� F9_JVdA A- u4:.. �'E4r..vev&,tua _+4...........................
�__._oy:-_ A 1p n_aP-1-5---••.
1
Lo tion -Address
or Lot No.
Owner �-�
-------------------------------------------------------------------------------- q 2....La._t
Addres
aril.. c�. ....... .a�f�°k9w�alLj
Installer
Type of Building
Address
Size Lot ............................ Sq, feet
aDwelling
—No. of Bedrooms ............ 3............................:Expansion Attic ( ) Garbage Grinder ( )
p,
Other — Type of Building ............................ No. of persons ............................
Showers ( ) — Cafeteria ( )
a
Other fixtures ............................ .
W
Design Flow ............. 11.C? ------------------------- gallons per person per day. Total daily flow ______._.3.x._57 ......................... gallons.
Length Width Diameter Depth
WSeptic
Tank — Liquid' capacity../_r.attgallons ................ ................
................ ................
x
Disposal Trench — No ..................... Width .................... Total Length .................... Total leaching area .................... sq. ft.
Seepage Pit No ..................... Diameter .................... Depth below inlet ....................
Total leaching area .................. sq. ft.
Z
Other Distribution box ( ) Dosing tank ( )
'4
Percolation Test Results Performed by .......................................................................... Date ....................... .................
,`4a
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 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------
------------------------- •------ -------------------------- •---------------------------------- _--------------------------------------------------------- •------------------- -•---------------•---
V Nature of Repairs or Alterations — Answer when applicable .... 10.CEW_... :YATEA]....... /99.Q. A:s:.... AAOX
Y' r ....................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT1E 5 of the State Sanitary Code — The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been • sued by the boarN , healt
Signed...... --- ---c'-- ---------------------•----
ApplicationApproved By ...... -- - --- -•--• ----•--------•-•....................•••----------...........--—
Date
Application Disapproved for t f owi reasons'----------------•---------------•---•------------------------•----•------------•---•------ •_____.....
................................................•-------•-----------•----•••----------•---.......--•••--- •--•....._.....--------••---•-•--------..._._.._•---•---------_..._...._....--•--•-•-------•---
Permit No .........
.
---------------_.__. Issued.....-"�Date
--- 5Z_..(B�.-----
Date
_ _ — — _ _ — -----
THE
---
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
Trrtifirabl of Tinfi rliaurr
THIS IS TO CERTIFY, That the I,p ividuSewage Disposal System constructed ( ) or Repaired ( �
...••• _...
by . . ............ _._.........
-----------......---•-..._._....-----------._......•-•---•-..._.._......------•-•---....._
.
-----....... ---•- -�/-Twl ___i. Ins Iler
has been installed in accordance with the provisions of TIT 5 of The State-Samta-ry_Code as c scrlb the
application for Disposal Works Construction Permit No.__ _--r___._ . dated__...!) .-_. �.........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE RUED UA ANTEE THAT THE
SYSTEM WILL F NC ION SATISFACTORY.
DATE ............ -...._ Inspector..,. •----
5 __�._ E -------••------------•-. ..--