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HomeMy WebLinkAboutApp-Permit-ComplianceNo.._81: _44..._...... ULU Fimxv ...25�A0..... THE COMMONWEALTH OF MASSACHUSETTS;._ BOARD OF. HEALTH ......... OF ........ Y e,rZ7. }-----------•----------------•....-- ,� lint Uan for Disposal Warks Tonstrurtiun Famit Application is hereby made for a Permit to Construct V) or Repair ( ) an Individual Sewage Disposal System at: / _ ...... �G IfiS�Al .... r9 ........................... --.....11� _.... � ----- t --rn-gip-. ........... - AddresA.s P or _33 Owner Address / a ........ .'......! '. R..:__._...i/-�-!c-................................. - t!'1lEl __....� ....UIt i ...... ©2� Installer Address Type of Building Size Lot_ ..7r..ZO_.. _Sq. feet a4 Dwelling — No. of Bedrooms.........__' ............................. Expansion Attic ( ) Garbage Grinder ( ) Other — Type of Building ............................ No. of persons ............................ Showers ( ) — Cafeteria ( ) P4 Other fixtures-------------------------------•--- ----------------•-------•---------------•..._........-- �fi------• - ---_ ..----•------- W Design Flow ........ I`4? ............................ gallons per -g-er-�sea per day. Total daily flow.------...... � ��................. gallons. WSeptic Tank — Liquid capacity/ gallons Length' -----.• Widths =l !2-• Diameter ................ Depth....�_�'.�� x Disposal Trench — No. -----•-------------- Width .................... Total Length ..................... Total leaching area .................... sq. ft. Seepage Pit No ......... J......... Diameter... ..... Depth below inlet .... 6�.__........ Total leaching area.. 5 ro2 ... sq. ft. Z Other Distribution box (X) Dosing ta / ~' Percolation Test Results Performed b -/___- ......:..........tel ra_'_e;...lti.t_�__._.._____.. Date___/_ �0 _.�'..... Test Pit No. 1 .... :54:_Z minutes per inch Depth of Test Pit ..... Depth to ground water________________________ ti Test Pit No. 2 ----------------minutes per inch Depth of Test Pit -------------------- Depth to ground water ........................ Description of Soil .... ...-/_.- ---' ---..Z-42 �'S.� `--------�..J v SG Nature of Repairs or Alterations — Answer when applicable •s?.�o j�......................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIZ 5 of the State Sanitary Code — The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b e d by/ye of —healt Signed ' CYL_... ...---• - �-__ - - - d-.........9_� Application Approved BY--/ -' °•------•---- ..•-----.......................................................j_._ �.. / te Application Disapproved for the f ollow' g reaso -------------------•-----------••---•-•------•-------------•--...-------------------•••---•--•---•------•-•---•- ----...••--------•--•-------•-------•-•-•••-----••••--------------------------•-•----------------......_......-----------••----••--••--•---------••-----------•-----......--------- •--------•---•--•----- Date PermitNo --------------------------------------------------------- Issued -------------------------------------------------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................... T01M........ OF ................ YAR11OUTH ............................................... Trrtifiratr of Toutpliatty THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( X) or Repaired ( ) bP._. -IM ERG-------------------------------•------•------ ------------...................---------•-------------•------------------------•--•------------ Installer at...................................... L0T__2a__- S17LUV1M1•R[--------------------------------------•------------------....... ............................................. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No ......................................... dated ................ ................ ____ ....------ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT STRUE GUARANTEE AT THE SYSTEM WIt�L FU CTIO ATISFACTORY. DATE... {/U. _ . .. --1------------------------------- Ins pec r