HomeMy WebLinkAboutApp-Permit-Compliance4 YARMOUT.H H,EAU H U& I .
Town Office Building
No. .._. � ...... South Yarmouth, MA 026,64 ..... 2�
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
o 1./h/...............OF.....�,,>/.!`f'2w-rca 1-74
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Appliration for Disposal Works Tonstrnrtion Vrrmit
Application is hereby made for a Permit to Construct (v7 or Repair ( ) an Individual Sewage Disposal
System at: p L) I
p` 'a SE:...L:q:'.`.�G:r I/✓G3T-!?i2-/ io t ;7ti...................... --------•---- �7- —.�¢ �..._.. - --rn �y-•-- —••F-{
Location - Address or Lot No.
ST�2/C /��WCs
Owner
Address
T/
S•- ----------------
p� Installer Address
U Type of Building Size Lot..Z-t..e� .. Sq. feet
Dwelling —No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other — T e of Building ............... No. of ersons...._._._._.._............_. Showers
a YP g------•------ P ( ) —Cafeteria ( )
Otherfixtures-------------------------------------------•-------•......----•-------------.....------.-....---..•.....----------------•-•-••-----•---------•-.......
W Design Flow..............5 ----------------W Septic Tank — Liquid' ca.pacity.!��_gallons Length. A.G. Width.:¢Diameter ................ Depth..:s '8.".
x Disposal Trench — No ..................... Width .................... Total Length .................... Total leaching area .................... sq. ft.
Seepage Pit No ........ /.......... Diameter ...... / . ,----- Depth below inlet ...... 6........... Total leaching area..?s z__sq. ft.
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by ....... !^!�.�... L^ ��cG ... Date......_ .. __.
1.4 Test Pit No. 1._L_. Z---minutes per inch Depth of Test Pit... ��'.�..- Depth to ground water .... __-- :.............
1= Test Pit.No. 2................minutesper inch Depth of Test Pit .................... Depth to ground water ........................
a+"--------------------------------------------------••---•--��.._......_..._..-•----•-••- --••-......................................................... s�O Description of Soil----- -:56-7L-
..---.--..
x .. 2>/3ljot> o% / �' O Z- 'fZ '—/.594 " W/7NDf Co/S �'¢r✓D -----------------------------•------------------•------------------------------• --------------------.---- ------ ------------•-------- ------••-----
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U 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 TITLZ 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 boaro, of health.
Signed.../ - 1
Application Approved BY - 1.1.4:�8 ....----•-.
Date
Application Disapproved for the following easons----------------------------•-----•••---------•-•-...-------•--•---------•-----------------......------.........
Permit No .... ..._..._.
-------•---------.---.......-
Date
Issued. ----- 1--4'5S .............................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
_7*9W. f ..... O F... .......... ......... i-!'e'.�'.......
10
Tntifilratr of Toutplinurr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (ml or Repaired ( )
by.... -K ----------------------- •--•-•---•--------------.----•---------------------•-•-•---------•------
t Installer
at--•--S.DIL -2.. els: rc ,# - E(?.........
K------------------- -
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 -----.-I ............. dated... tl.]4. .�b 5......:_...._..___....
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE �i ..............................................Inspector..., �' �c'c (rf -s''