HomeMy WebLinkAboutApp-Permit-ComplianceIdo._...... ...� Fss....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
Appliration for Disposal Works Tonstrurtion rrrmtt
Application is hereby made for a Permit to Construct ( ) or Repair (C�4) an Individual Sewage. Disposal
System at:
cS v .......
.............. ...rra¢.` a
a
Location - Address or Lot No.
...�J.�.V. ►'.►.!t..._..` ...4�.�....41 ................. �----........ �i !LS.� :-.�•��.^..^. y... ..................
.................... . ......
owner Address
............. ....:...----
•........... ---••-.................T-drs-----
Installer Ades
Type of Building Size .....Sq. feet
Garbage Grinder t -)-
1�Dwelling — No. of Bedrooms .................... .....................Ex Expansion Attic ( )
Other—Type of Building ............................ No. of persons.._......................._. Showers ( ) — Cafeteria ( )
Otherfixtures.••-•-•-•....................................•---.......----........................•------•-•-••---•-•-•-•------•-•----••-•--•--••---------..........
Design Flow ................. ..................gallons per person per day. Total daily flow ............. ...................gallons.
Septic Tank— Liquid' capacit ..f.G-U.V..gallons Length ................ Width ................ Diameter................ Depth ................
Disposal Trench — No......./....... Width ...... 1 .......... Total Length ....... t?/...... Total leaching area ...................sq. ft.
Seepage Pit No ..................... Diameter .................... Depth below inlet.................... Total leaching area .................. sq. ft.
Other Distribution box ( D) 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........................
Description of Soil..........................................
-------------------••••-••---..................................----••-•--.
.............................•---•---------•---•---.._.......------•----------------...•-'--•-----.........-------•-•--...............................•�... ....---•------••---....
Nature of Re irs or Alterations — Answer when applicable .. Z N SD_-' . ........
_Dln �•�..�..... r. . `.1--...--. ....... ln/� c. —�✓2� c.�� � ��' ........ �l s^.........-•-• .........................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of T I'LIS 5 of the State Sanitary Code — The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been isd by the bo4,WIealth.
Signed. .
Application Approved By...
Application Disapproved for the following reasons:.
Permit No.....L....C'— ... t.3
.0 .........................
s
--------------
...........................
---•................... ......:)*. �.......
.......................................................Date-------- .....
Issued........./.. D��..L .��..A .—nate.......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
(Irrftf irate of Tuutppaha
THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired (0<)
by................•---..................•-•--....�.•�..�1.1: r7v. ........... vu.s��!t�_ ?u......-----•-•....................................................._
Installer
at......................................... . 2 ...... Z��.----............................
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._4.�_.`.__l.3a............... dated....).; -!5/..C/1 ................
THE ISSUANCE OF THIS CERTIFICATE. SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
....---••-........... J ..... .DATE ............. ...................... ;z:..l ....... ---