HomeMy WebLinkAboutApp-Permit-ComplianceNo. .ac�.s Fss.... �_
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
Appliration for 11tsposal Works Tonirnlr#tun rrruti#
Application is hereby made for a Permit to Construcl
System at:
............:......,�,.� ee .\&---'...................
ocation - Address
....•........_ .a.ice...: a.�-�.1;t_y..................................•----.
Installer
) or Repair (x) an Individual Sewage Disposal
or Lot
—+No.
Nt✓!!e.y✓. 1.1Qlr.i.........••••-'•-•'•'••"........................
_ .Addre js
........................ .�- -ram ......••.......
Address
Type of Building Size Lot ............................Sq. feet
Dwelling —No. of Bedrooms.-.-Z..................................Expansion Attic ( ) Garbage Grinder (kp
Other — Type of Building ............................ No. of persons ............................ Showers ( ) — Cafeteria ( )
Otherfixtures...........................................•----------.-----...._..•---•------•--------..................-•----...-•----...._.................._..._..
Design Flow.........................gallons per person per day. Total dam fiow__.__? ._3.C?..................._.._._..gallons.
Septic Tank -3- Liquid ca.paciPY-/ �- .gallons Length .... I....... Width.-. ......... Diameter ................ Depth ................
Disposal Trench — No ..................... Width ..... ............... Total Length ........... .-------- Total leaching area .................... sq. ft.
Seepage Pit No ...... L............ Diameter...1a.`....... Depth below inlet ..... 41.`_..._..... Total leaching area..................sq. ft.
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by ............... .......................................................... Date ........................................
Test Pit No. 1................minutes 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..... .....�iW.6.P1•T. ...... ..
.czuL lb-A.bt.....e�{A�. ....-
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 be ssue e oard of health.
Si... _.......................6�
ApplicationApproved By-- • ---------•-------------- ---- ------------------- --------------•-•-•--•------• 3.- � -� j---•--..•.
Date
Application Disapproved for the following reasons:----------•-------------------------------•----••--•--------••-----------------•------------•------..__.......
------•----.•----•--•-•------...•--•-•..................••.........•----•------------..........• -------- --•-•------------------•---•------•------•---•---•-----•--.....................................
` e7, e
Permit No..._!7 _!r_ ..1 �J-(. .-------•--------------- Issued ................................... l
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
Trrfifiratr of (guntpliaurr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (1()
by---------------------------------------------------- ...---------••-.._...-•-•--'--••----------••----•-.._..--•'-•-•...-•---•-----.---•-
Installer
has been installed in accordance with the provisions of TILE 5 of The State Sanitary ode as described in the
application -for Disposal Works Construction Permit No..- __� a '.S _.__-._._-_ dated_ _...... J
THE ISSUANCE OF THIS CERTIFICATE SHALL,NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FPNCTIPN SATISFACTORY.
DATE .................. )'-'•. Inspector