HomeMy WebLinkAboutApp-Permit-ComplianceTHE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
................ OWN.................O F....... YARMOUTH........
------------------------------------------•-----••-
Appliration for Disposal Murky Tons rurtiun Vprrutit
Application is hereby made for a Permit to Construct ( ) or Repair (XX) an Individual Sewage Disposal
System at:
... $..13a)aQQl lQa.d ...5outli. Yarmouth ...........
Location - Address
...........................................................
Owner
...A& B CANCO ------------ --•-------------------------
----------------'---'-'--'---------•--Installer
Type of Building
Dwelling — No
Other — Type
-o f - Gtl1a- MR-P- 77
---- --•- - ----------- ------ ---- - ------- --- - --------•---------
o Lot
5 Haywood Road, §Outh Yarmouth
Address
350-_Main Street,,__West _Yarmouth
-----•....................
Address
Size Lot ---------------- ------- ..... Sq. feet
. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
of Building ........................:... No. of persons ............................ Showers ( ) — Cafeteria ( )
Otherfixtures-----------------------•------•--...------------------•-------•-----------.....----••-----------------------........--•-----•---...------•-••--•......
Design Flow............................................gallons per person per day. Total daily flow ............................................ gallons.
Septic Tank — Liquid capacity ............ gallons Length ................ Width ................ Diameter................ Depth ................
Disposal Trench — No ..................... Width .................... Total Length .................... Total leaching area .................... sq. ft.
Seepage Pit No ..................... Diameter.................... Depth below inlet .................... Total leaching area .................. sq. ft.
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by----•----••---•--••••--•---------------------•--•-------•--......------.. Date ........................................
Test Pit No. I................rfiinutes 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 .................................................................................................. .........................
----------------------------------•-------------------------------------------------------------....----------------------------------•----•---------------------------------------------------•--_.....
Nature of Repairs or Alterations — Answer when applicable ----- Install --- 10A0... gallnll_ -se;Lti�c--.ta.nk,_�6flA-
aid---al<Qzto-- a..regar�a.-----•---------------- �� �cl%rt=..............................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITiZ 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 board of health.
Signed.- -'-------------•------------------------------- ----- 9 .27188
e
ApplicationApproved By-------- -- - --- - -------------•----------•----------•-•------------------------- --•- .....
D to
Application Disapproved for the f ollowi reasons------------------------------------------------------------------•-•----------------------.....----------....---
32 Date
Permit No ....... �-----------�................... Issued-----------? �. ._ ..._......
Date
THE COMMONWEALTH OF MASSACHUSETTS
ANDERSON BOARD OF HEALTH
..................TOWN.............. OF.................: YARMOUTH .........................
Trrfifirate, of Toutpliaurr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired XX)0
by.........14 .. .---•---------•-----------------•----------------------------------------•-•--•----------•--•------.....-----._...---..................------------
Installer
at........ ------- = =-� ---- S -/1
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Cocle as d scribed in the
application for Disposal Works Construction Permit No ------ ----------- dated .__._._j- _- __----- -.•--•-•--..
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE.�GONSTRUED AS A GUARANT,E'THAT THE
SYSTEM WILL FUNCTION S 5CTORY.
spec
�'
DATE...... -------------------------------------------- In
t . - y ' �, �',,! /