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HomeMy WebLinkAboutApp-Permit-ComplianceNo. � � r�` THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF YARMOUTH Appliratiun for Disposal Works Tonstrur tion ' prrnti# Application is hereby made for a Per .t to Constru System at:: CRF77 t�60E -------•--.�`?---__-----....r.":&._4?b!s:!--•------_-_.15 --�-....-•---•---- ..L.�occation - Addre s ................ �- ZW 1 e 1.r`�...... - �` ...... Owner ................. Installer Type of Building ct ( ) or Repair (i,�an Individual Sewage Disposal eno to A0 `�,' ,�^ �p or Lot No. 1 .............�_9�"_V:.Y..� e.....------•--.............-----............................ Add �j, -5� --- L / ------------ Address Size Lot.. .............. ....... ..... Sq. feet Dwelling — No. of Bedrooms ....Z ....................................Expansion Attic ( ) Garbage Grinder ( ) Other —Type of Building ............................ No. of persons.-, ........................... Showers ( ) — Cafeteria ( ) Other fixtures.------•.........................•.......------------..-•---...... Design Flow ............................................gallons per person per day. Total daily flow ............................................ gallons. Septic Tank — Liquid' ca acity� ..gallons Length_.. X_ - Width 5.........._ Diameter ................ Depth ................ Disposal Trench — No.-3.-FIAP. width ----- Gf`�.......... Total Length ... aq. _'...... 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 .................................................................................... ------------------------------------------------•-•---------------...-•-•---•----------...........--------......----------------------------------..........------.........................-----•---••.. Nature of Repair or Alterations — Answer when applicable.... (&-tx...A-O.V_D ... 1 CSS .. TY ± ... -CLQ. tfS�4al2S....� ........................................................... 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 1,goard of he4th. Signed....– .............................................. igned.... Application Approved Application Disapproved for .......------•-•-----•---•----------------- --- Permit No..... :! ^ --- ............................. Date f Q2 d..^•�%...............•..^-..........Date I3sne...._ Date a THE COMMONWEALTH ,OF MASSACHUSETTS BOARD OF HEALTH TOWN of YARMOUTH Tier#ifutttr of fauntpliam THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by.............................•---- T:..•..--•-••---•?----•-••----..........-•---.......................------....--•--............... J Installer at .......................... s . (?�--��._:__.•:. - has been installed in accordance with the provisions of TIT5 of h tate Sanitary Code as d cri d�}'n the application for Disposal Works Construction Permit No...__._ .-__� ..._. _ dated....--..... P"' '"'. _..C......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED GUARANTEE THAT THE SYSTEM WIC. FU�TION SATISFACTORY DATE... _" C.�... q, - -............................... Inspector ........ ........