HomeMy WebLinkAboutApp-Permit-Compliance�Fss.......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
Appliratinn for Disposal Works Tonstrurtinn Prrutit
Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal
System
at:
►..�:-..i&f4:�, Tk..---••......... ........... '..f ..... ` .:.�-- .......................
- -L tion - Address .-_- .•.-- or Lot No.
..............1.41 . ..x.. '..s�.....------.................----•••-•--•-----..........--------------....-•---•---•-•-•................................
Owner Address
Installer
Type of Building
Dwelling —No. of Bedrooms
Other — Type of Building ...
.............................................................................................................
Address
Size Lot ... 31ti.17Q..... Sq. feet
...........Expansion Attic ( ) Garbage Grinder ( )
No. of persons ............................ Showers ( ) — Cafeteria ( )
Otherfixtures----------------------------------------------------------•-----------------------------.............................................................
Design Flow ............... .Q.......................gallons per person per day. Total daily flow.......... �?....................gallons.
Septic Tank — Liquid capacity-A.OW..gallons Length.5.-(a.--.. Width-- {'--10--- Diameter ..... Depth.5 .-..
Disposal Trench — No. .................... Width .................... Total Length .................... Total leaching area ...................sq. ft.
Seepage Pit No ......... ........... Diameter ...... 1.0........ Depth below inlet .--.....`t_........ Total leaching area ... 24t.:9_sq. ft.
Other Distribution box Dosing tank ( )
Percolation Test Results Performed by.... .......... Date........... ......
Test Pit No: 1 .... � .Zt.... minutes per inch Depth of Test Pit ........ L Itl..... Depth to ground water...... .........................
Test Pit No. 2..... 'Z...minutes per inch Depth of Test Pit........ AZ`...... Depth to ground water ......... ...........
.r�
... ...,.. :.Description Soil�.
.. Z`..T�.. + .•`-fit '`�!Q4's'�' t� 42 Y_ L�.'.. ..�r�----.....--
..-----•...............................................................................•-••------••--.._.......----.....-•-------...................-•••----•-•--•----•-------••---•--•••••-•-..........
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 TITLL 5 of the State Sanitary Code — The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bgen) issued by the board of he44-
Disapproved for the following reasons: ...........................
THE COMMONWEALTH OF MASS�A.04U ETTS
BOARD OF HEALTF1 4
TOWN of YARMOUTH
�., k
(Irrtifiratr of Tomplinnwe
THIS JS TO CERTI , That t dividual Sewage DisposialM,S� te&'-contic�edu-(��
by................ .............4.,,..,_ ............_..........:...--....... ......................................................
at.. •--•-'----• „� ......••'��*►�•i - t Installer -- ..... .. •......................
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as escrib e
application for Disposal Works Construction Permit No_ ......_.�j.�' ..... dated.,, ..._„, _..�.,-
THE ISS NC OF THIS CERTIFICATE. SHALL NOT BE CO STRU AS GUAR TEE T AT THE
SYSTEM WI FU T O SATISFACTORY
DATF,. ................. ................ .... .............. Inspector........... ...._)"A
.. ... ..... ............