HomeMy WebLinkAboutApp-Permit-ComplianceNo....9.1—.Fss .. !.
THE COMMONWEALTH OF MASSACHUSETTS
BOA 6F HEALTH
TOWN OF YARMOUTH
Appliration for Disposal Works Tonutrurtion ' Irrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
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.-.- - ............................ V- ----- A/G. ... Z-11
Location -Address � or Lot No. if .....11
Owner
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dressQQ
.....
... .. ........................................c�._..1.1�- _.. ..
Installer Address
Type of Building Size Lot ............................Sq. feet
a Dwelling —No. of Bedrooms ....... a� -•.---•---•----_-------•----.Expansion Attic ( ) Garbage Grinder ( )
aOther —Type of Building ............................ No. of persons.-, .......................... Showers ( ) — Cafeteria ( )
d Other fixtures ..............
W Design Flow ........ 5.-5.......................... gallons per person per day. Total daily flow .......... -_fit' 0------•----------•-•--gallons.
a Septic Tank— Liquid ' ca.pacity,-�`^_4b.gallons Length -A. !. Width_ �L B. Diameter ................ Depth-_.4__ I......
Disposal Trench — No. ..... /-------------- Width ----- ? Z...--... Total Length...--. .._:-_. Total leaching
Seepage Pit No --------------------- Diameter .................... Depth below inlet .................... Total leaching area .................. sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
a Percolation Test Results , Performed by..A�4L442......!'?�f?� ... Date...`�_.�_� 7'�'
Test Pit No. l __C.Z:._..minutes per inch Depth of Test Pit ...... 7Z..`0 --- Depth to ground water ._... �i.4_.._._...
(� Test Pit No. 2-------------- --minutes per inch Depth of Test Pit .................... Depth to ground water ........................
�+--------------------•-------------------..................•....--•---........------.........-•------ .........................................................
0 Description of Soil .................... .-----............-----...._...........•-••••.._...._.............•._.............
c�------------------------------------------------------------•----------------....--....----------•---------------------------•---............--••-----------...------....--•--._.......------•----••-
..-----•---------------••--••------------------......--------------•-•-------........................................ ----------
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 system in
operation until a Certificate of Compliance has been issued by t-h�enboard of health.
G_ D
...
Application Approved By..--- ---- .._........�.�... �
Date
Application Disapproved for the following reasons:---•-----•--•-•-------•-------•--•-•----•-•----......-•...............................••--•-••--•-•---..........
.........................•-------------------•---`-•-----•-----•----....---•------•----•------•-......................-------••----------•---•---- ._...... Date
Permit No ...... - �.
- ----------------- Issued. _� l----........-----......._
D
THE COMMONWEALTH OF MASSACHUSETTS
F
BOARD OF HEALTH
TOWN of YARMOUTH
Trr#ifiratr of Toutplittnrr
THI O CERT Y, T at the I dividual Sewage Disposal System constructed ( ) or Repaired )
by .........
le .-------- .L.I. �� '���------------------------ -----.......... ---..-------------•...............
............._... -
j � Instaler
at.. - .i""`-" Z...... ........ f.���......
has been installed in accordance with the provisions of TI 5 > T State Sanitary Co e i c scried in the
application for Disposal Works Construction Permit No.... ........ ... dated i
THE ISSU NCE 9F THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUAR NTEE THAT THE
SYSTEM . WILL FUN IOOqN SATISFACTORY.
DATE..... .1 Inspec 1 _...................