HomeMy WebLinkAboutApp-Permit-ComplianceTHE COMMONWEALTH OF MASSACHUSETTS 1500
BOARD OF HEALTH
TOWN OF Yarmouth
Apphratinn for Ui!ipwial Worbi Towitrnr#iun 1hrmit
Application is hereby made for a Permit to Construct ( ) or Repair
(XX) an Individual Sewage Disposal
System at:
16 Jac. son Ave West Yarmouth /_0T- E30
MAP *b
......................•-----•---•--•------------....------------------.............••--•-•-•-------•---•--•-•------------•••-------•--••--••..........---•••---•--••--••-•-•••-•---•---.............
Location - Address
Clarkson.
...................... --.......................................................................... ....................... ••------------------------•---•---•---........--••-•..................
or Lot No.
W
J. P.Maeomber Jr. owner
Address
Installer
Address
Type of Building
Size Lot............................Sq. feet
V
Dwelling X No. of Bedrooms ---------------- 3..........................Expansion Attic
( ) Garbage Grinder ( )
aOther
—Type of Building ............................ No. of persons ----------------------------
Showers ( ) — Cafeteria ( )
Q'
Other 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 ( )
aPercolation
Test Results Performed by ................................... ......................................
Date ........................................
a
Test Pit No. I ................ niinutes 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 ........................
t ------------------------
Sand ............................................ -----rave-1----------.. 0 ..--....... �-- v •----------- ----- t � n,► -c� S �► ,,,. � .......................
Description of Soil------•--- •-•-•-•-•••-••.....:-..&........ 5... - ;
.............•-------------.................---••---•---••---------••-------•-•---•------......--------------------------------------------•--b'-•� fi•---}'•---- - �?n. 5jo... 3 0,
...--•••••-•---------------•------•-----•-••-•--•-•-----•----••••-•--------•----------•-----•---•------------•...--------------••••-••-•--•--•-•--•••----••••---••---•-•-••--••-•-•------•---.........
Nature of Repairs or Alterations —Answer when applicable.-.-- ... in-fi1tratOrSPaCked in stone :
Pump` ...omit-existin leach•.pit................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code — The undersigned further agrees not to place the
system in operation until a Certificate of Complian e has be n 'sued by the aY of health.
6/8/93
Signed✓.. , ..�-- --- ------ ----'--. .......--------... .-----------
AApplication Approved B...................................................:.................-----.......----------.... .... - f J.....----
PP PP Y ........ q 1e
Application Disapproved for the following reaso r:....................................................................... --- ............................................
................................................................................................................................................ . .................................................. ........................................
..................
Permit No. ..-... . ..1�'�. .. ........................ Issued ........... b /.--.I . . Dace
Dace
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF Yarmouth
Gatifira a ornaly iunr e
THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired �CXX )
by J.P.Macomber J'r.
........................................................................................................... ..................................................................................
Installer
1` Jacuso6vA e West Yarmouth
at........................................... ................................................................. ............................................................ ........... .................................................... .......
has been installed in accordance with the provisions of TITLE 5 df e State Environmental de° as descrlbed in
the application for Disposal Works Construction Permit No. ....... t'.. � f . dated ..
THE ISS NCH OF THIS CERTIFICATE SHALL NOT BE CONSTRUEA AS A GUARANTEE TitIAT THE
SYSTEM ILL F�N TIQ SATISFACTORY. r 1
�� c (;�
DATE ....... tiv:......................... ................................................... Inspector .. ..... ....:.........I..........
C�