HomeMy WebLinkAboutApp-Permit-ComplianceTHE COMMONWEALTH OF MASSACHUSETTS Fmc ... tf
BOARD OF HEALTH
TOWN OF YARMOUTH
Appliration for 11iopoottl Works Tonstrnr#ion jhrmi#
Application is hereby made for a Permit to Construct ( ) or Repair (k) an Individual Sewage Disposal
Installer Address
Type of Building Size Lot ............................Sq. feet
Dwelling —No. of Bedrooms ................. . ........._..._......Expansion Attic Garbage Grinder ( )
Other — Type of Building 1914-F-..... No. of persons. :-C.0hewers ( ) — Cafeteria ( )
Otherfixtures---------------•--.......--••-•----•---•--------------.--••-••----............................----•-.
Design Flow.._. .��..........................gallons p e .day. Total d_,a'I flow. �v..•....--....•.................... gallons.
Septic Tank — Liquid ' ca.pacity� a.gallons Len ___..__. Width...._.. Diameter ................ �,Dff th...s;.-I..._-.
Disposal Trench — No ..................... Width .................... Total Length .................... Total leaching area._`�!.�,T_.
Seepage Pit No.•--••-----.-._--_- Diameter ..................... Depth below inlet .................... Total leachinj area .................. sq. ft.
Other Distribution box (0(,) Dosing tank ( ) VSo? 'a C__*W1l4ry_1S e1'Zt_;' 57AZ
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 ........................
� -
Description of Soil ........ ....----------- W �2. -----•• `,7I......
...e ;/ �.....__.
..--------•---•.........................................•------•----------•----------•---------------•-•-•---•-----------•------------------------------•---•----.....--......_----------••--•--•----•-.
---------------------•----------------------------------------•---...------------------------.........-----------------------•-----------------•-----.....---.....--•-•---•--•--
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 TITLE 5 of the State Sanitary Code — The undersigned further agrees not to place the sys em i
operation until a Certificate of Compliance has bessued by !�5 board of health.
Application Approved
Application Disapproved for the following reasons:
Permit No...........1
-------------------------------------- -----------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
Tntif irate of Tomptiattrr
THIS IS TO CENT- FY, That -the Individual Sewage,Disposa Sits cp�istrucye�d ( ) or Repaired (V )
by----------------- -----
has been installed in accordance with the provisions of TITLE
application for Disposal Works Construction Permit No......4
THE ISSUANCE OF THIS CERTIFICATE SHALL NO
SYSTEM WILL UNCTI N ATISFACTORY.
DATE......... ............................................... Inspi
of The State Sanitary Code as descri ed i the
CO.. Rdated ............ e>- ,?. .. .......
NSTRUEA AS A GUARA TEE HA THE