HomeMy WebLinkAboutApp-Permit-ComplianceTHE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
Appliratirrn for Disposal Murks Tonsirurtiun 1hrutit
Application is hereby made for a Permit to Construct ( ) or Repair t- an Individual Sewage Disposal
System at:
.............. a-_7 . � 1. - ....... -;;..4----.................. ..............----....._... .... 7. I
Location - Address or Lot No. -� -
-------...tea.-----. ?.-_.�.?. C.._. ._._..... ... M AP -1.
dr
---------Pte.D�..
....... ..... N'!.S-_A. �k --------
Installer Address
Type of Building Size Lot ............................ Sq. feet
Dwelling — No. of Bedrooms__..................................Expansion Attic ( ) Garbage Grinder ( )
P4 Other—Type of Building No. of persons,.......................... Showers — Cafeteria
P4
Other fixtures -----------------------•------.. -
Design Flow.._......S �_____. __. gallons per person r day. Total dail flow ....� ......................gallons.
Septic Tank -L Liquid capacity! W q P ty �b�gallons Len;�--- ------- Width ... _--- Diameter________________ Depth ................
W
x Disposal Trench — No . .................... Width_ __._:_..__._._.... Total Length ............ Total leaching area ....... :........... sq. ft.
Seepage pinlet! ..... Total leaching area..................sq. ft.
See a Pit No________ ____________ Diameter_____/. _____.___. Depth below ....._
Z Other Distribution b6x ( ) Dosing tank ( )
1 4 Percolation Test Results Performed by..................................•-•----•-----------------...---•-•...... Date ........................................
a
Test Pit No. I................minutes per inch Depth of Test Pit_...._.........._... Depth to ground water ........................
f� 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....
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT1Z 5 of the State Sanitary Code — The undersigned further agrees not to place the system in
operation until a Certificate of Compliance haed y the board of heal
Sin .................. ----_V- ----- ---------- ------
<
--. _
t
ApplicationApproved By..... -....... ......................................................................... _.....Date
Application Disapproved for theowin",reasons_________________________________________________________________________________________________________________
............:-------------............................. - n._._..._..-•----...•---•----------•.---•-•--•----•-•-•-----•-----••----------•-•-- ............ ..................................
Date
Permit No ............... . Issued-.---`
`.. - . � l
Date............ ..................
o.
THE COMMONWEALTH OF MASSACHUSETTS'
BOARD OF HEALTH
TOWN of YARMOUTH
Trr#ifirab of fauutpliam
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by ..�..1,�4 .lP..�...i4l�c . s
Installer
at.........................Q� ...: � .J.C�.�l ..--------`-'---------- 1. .- .f W W1 D�........... ..........................
has been installed in accordance with the provisions of TIT The State Sanitary Cod . d scribed in the
application for Disposal Works Construction Permit No...._.___ . _-2.__.._..... dated........,?_.. _11.1 ..... ...........:.
THE ISSU NCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS ANT E THAT THE
SYST1 WIJ.I. F NG ION SATISFACTORY.
a
C `
DATE..:...... .................................... Inspector
_ �L ,_ ..,.... _ .:.., _..... ........:........_........-..._,.,._._ ....,...,...._,.., ...._�...... ..,......,... . u..p....., ..,..,..:.,„wr.,ar«.x...._.na..er..+....v..,.>...+.s . �:+_-�..,.:. ., ,.."'R""Tc�..�,-r^�!" .