HomeMy WebLinkAboutApp-Permit-ComplianceNo....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
Appliratinn for Disposal Works Tonstrurtiun Jrrmit
Application is hereby made for a Permit to Construct
System at
................ LQC-Q.52-.....- i5 ..................................
Lotion - Address
—
......---\ 1 G l_:G.....s .ih. !.�-------------------------
Owney
W�..i i.Nlos_
-----------------. . .......J..
Installer
) or Repair (4 an Individual Sewage Disposal
"-�
..........................................
or Lot No
..............!s. �5.1. N!\Q. ` .` • ...........................
ddress
Address
Type of Building Size Lot ............................ Sq. feet
Dwelling —No. of Bedrooms__..................................Expansion Attic ( ) Garbage Grinder (1,40
Other — Type of Building ............................ No. of persons ............................ Showers ( ) — Cafeteria ( )
Otherfixtures...............................•---•------•-------•---......---------------•-•----------------------•-•----------------------------•--••-------.......
Design Flow......... X5__5.....................gallons per person per day. Total dail flow .... CC0.........................gallons.
Septic Tank -t Liquid' ca.pacity.,Q00gallons 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 ........................
Descriptionof Soil...................................•-----.......--------•--------•------......-----------------------------
•---•-----------------------------•----.....--•----•--•--•-•-------...._..--•---------------._.....---...........----------•--._... t 9 ' .....
Nature of airs or Aerations — Answer when applicable _._ETl� _t.._..� �?�?Q...��?-� !�f�l....�.
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Agreement : P, jT-
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 board of health.
Application Approved By
Application Disapproved
the following reasons:
at
�n'-
e
Date
--------------•-------------••----------------------.............----------------------.............----- ---•----------•-•----•-•--------•--•----•--•----......--------.................--•---......----
te
Permit No.------... ........ ----•..............._ Issued -------------- f .. .. a......
Date
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
Trriifirate of T-nutphttnrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ()
b
y-------•---•-------- -----•---------............... -• - - :.... - .::.__S._... - ._:.._....... - .._._.............._...... - ...........�
tt dd InstallerIj
,
10
has been installed in accordance with the provisions of TITIN _5 of The State Sanitary Code as de sc ib�ed-'in the
application for Disposal Works Construction Permit No._..._�."S____ _ .. .......--- dated........_f... __ r�._1----------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GU RAN EE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE...... .��..._............ �,.-�..............•-•--------...........---- Inspector--- .............. ...... Gl lf.....