HomeMy WebLinkAboutApp-Permit-ComplianceI�o..::S.2.-.1.5.7..... F�s..�.1.5...II.Q........
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF ............... YARMOUTH
App iration for UWVoiial Vork.5 Cnunutrnr#ion Famit
Application is hereby made for a Permit to Construct ( ) or Repair lk ) an Individual Sewage Disposal
System at
25 ,_-SACHEM PATH., W : Y . � c..T Ko 1�/L
System
--- - M..........................-• ---• - ....- ......__.
Location - Address or Lot No.
HARRISON
..-------•-•--------. - - - - -- .....-- r----•------•----------------------------• Address -... -•--
Owner Address
K. B . H . _r....INC ............................•-=-•-......
Installer Address
Type of Building Size Lot _--•----------------------Sq. feet
Dwelling —No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other — Type of Building ............................ No. of persons ............................ Showers ( ) — Cafeteria ( )
Otherfixtures --------------------------------------••---•----------.------------------------------------------------------•----------....---•••------------..-•----
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 ........................................
jTest Pit No. l..............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 Repairs or Alterations—Answer when applicable ..__2 --- FLQ..aI FUSERS• --5/.L--------------------
•-------•-----------•-------------•-------------•----------•----------------------------•-----...... ----------------------------------------•-----------------------------------------------•---••------
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 b issued by the board lealth.
<- ...61.23 /-.8.2..-
Signed... _., .
Date
ApplicationApproved By---------- ------------------------------------------------------------------------------------
Application Disapproved for the following reasons: ....................................................
Permit N
---,.._
Date
.................. -
......................
Date
Issued--------------------------------------------------------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............ TOWI3................. OF ................. XA Ulu .............................---------....
Tntifira tr of Tompliattrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ] )
K.B.H., INC.
t2 5 SACHEM PATH, W . Y . Installer
a•- --------------------------------------------------------------------------------------------------------------------------------------------•-------------------------------------•---------------
has been installed in accordance with the provisions of TIT r r of The State Sanitary C'6223/82
d as described in the
2 X15 7 -------------- dated------- -- % 2....2
application for Disposal Works Construction Permit No ---_----------------
._.______..___.__.. ........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT B ON TRUERAS,,A GUARANTEE T T THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE 6 / 2318-2 .............................................•------• Inspect ----- --- .......-----
--....... ••.