HomeMy WebLinkAboutApp-Permit-ComplianceNo.33 Fimx, ... . . . . ..... . .....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
Appltratiun for Disposal Murks Tonstrurtion "rrutit MA P- a
Application is hereby made for a Permit to Construct ( ) or Repair ( j/<an Individual Sewage Disposal
S stun t
�... �..7�. , 1 . ..................... ... °%�..- •---� a �----.�'�
scat' Ad$ress 1-- p, `or Lo o.
n -Own Address
pq Installer Address
6 Type of Building Size Lot ............................ Sq. feet
aDwelling — No. of Bedrooms........: ............................Expansion Attic ( ) Garbage Grinder ( )
04 Other — Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
QOther fixtures..............•---•----......-•---.......--•-•-•----............... -
W Design Flow............................................gallons per person per day. Total daily flow ............................................ gallons.
WSeptic Tank — Liquid capacity ............ gallons Length ................ Width ................ Diameter ................ Depth ................
x Disposal Trench — No ..................... Width .................... Total Length .................... Total leaching area ........ ............ sq. ft.
Seepage Pit No ..................... Diameter.................... Depth below inlet..........:......... Total leaching area ....... .......... sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by ............................... ..................... Date.................
Test Pit No. 1..............'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........................
�+•--•....................................................................................................................................••--•--..........._..
0 Description of Soil...........................•-----•-•-••---............-•----•----------•---........-------------•-•--............................-•--•-----•-----------•--•------.------
W
V -•------------------------------•---••-•------•- ....----.-..--------........... - -------------
-------
...................
.----.---------------........
•----......
.••-••.......
.-------------•-
W----••----•--•--••-----•--•.............................••-•---•---•--•-•---...•--..._.............•--•--•-••••----...-•---•-•••-•--.......... ......-•-•• ..-•-•-
x > a�.
U Nature of Repairs or Alterations —Answer when ap, licable.�.......... .... ..._� ......_.._ ....�.__ :._ ........__..__.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITI.L 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 boar of heali.r
Signed... �/ % . �
Application Approved BY ••--•---.......3...
. ........ ~/Date -e
Application Disapproved for the following reasons- -------------------------------------------------------------- r
Date
No............ ...................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
(anrtifutttr of Toutplinurr
THIS I(S TO.,CERTIFY, That the Individ al Se age Disposal System constructed ( ) or Repaired (�/�
by........... ..1.... /I . ��.......�--z.. .�- -- ..... ........................... ,........................................
- .
has been installed in ar/rdance with the provisions of TITLE 5 of Tfie State Sanitary Code as
application for Disposal Works Construction Permit No ...... .2r.�.�>�p ....... dated ._.......
CERTIFICATE.
TISFACTORY.