HomeMy WebLinkAboutApp-Permit-ComplianceNo.15.._.. ..... .........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
Appliratiuu for 11isposal Works 11onstrurtiuu 11rrutit
Application is hereby made for a Permit to Construct ( ) or Repair (V-�'an Individual Sewage, Disposal
System at:
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Location - Address "
.............. ,e e..1 —�!!A.tq........------
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Owner
.................C`�_�: t1r�_..� C�' Z-.......--- ..........
Installer
..............................................t...°..........................................
.............`5 .._ i.G�.aC` ddress ...........................
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Address
Type of Building Size Lot ............................Sq. feet
Dwelling — No. of Bedrooms.............................................Expansion Attic ( ) Garbage Grinder ( )
Other — Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Otherfixtures.---•--------•...............................•--•---.............---....._.......------....------.......:.....................................
Design Flow......... 5. .....................gallons per person pgx-day. Totaj�aily flow ............................................ gallons.
Septic Tank -%- Liquid capacityl:��-gallons Length ..... 4....... Width ................ Diameter... ............. Depth ................
Disposal Trench — No . .................... Width .................... Total Length .................... Total leaching area ..-- .............sq. ft.
Seepage Pit No ....... ............. Diameter ..... A)........ Depth below inlet ... 4p!.......... Total leaching area .................. sq. ft.
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date ........................................
Test Pit No. I..............nminutes 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 ........................
Descriptionof Soil -----------------------------------------------------------------•------------------------------------------------------•-----••--------------------------•-------------
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Natur of epairs or Alterations — Answer wen ap licable._:h� --- '�,�?_�X?.��?l?.L'�t_.......
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Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of ITLE 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 health. --'7 _
Application Approve
Application Disapprc
Permit No...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
f9rrtifiratr of Tomp0aurr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by............................. :. .S' .. 2 1..(------..---..-...-------------.................--------............-............--------------------------
Installer
at................................... ! ,.52 ----....X v...-....---...--- �-=��—�., �r v�! sr ................................................
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....5................ dated ....... 5-:7/7.`.��.................
THE ISSUANCE OF THIS CERTIFICATE. SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE ............. ................. r......................................... inspector .............
....... .