HomeMy WebLinkAboutApp-Permit-ComplianceNo................ . .... FEB----
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
Appliratiun for Disposal Works Tanstrurtiun trrutit
Application is hereby made for a Permit to Construct ( ) or Repair Individual Sewage Disposal
System at: .................� �... --�! -- ,
......_........... ............................... Lzr-::�4X2 .......... y_la
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Location ((dressor Lot
............... • ............ ......... ...................... .
Address
.............................
%..----... Installer Address
Type of Building Size Lot ............................Sq. feet
Dwelling — No. of Bedrooms......91 ......................................Expansion Attic ( ) Garbage Grinder ( )
Other — Type 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 ..... jx';' .-...... Depth below inlet..... .......... 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 ........... 0............
Test Pit No. 2................minutes per inch Depth of Test Pit .................... Depth to ground water ........................
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............ ..... ...... 0..........
Descriptionof Soil ............ ..........•----•--•--...-•----------------------.................---•--------..........................•..................--•---........--•.................
.................•----------............------.......-----•--••----•-----•-----.......--•---...-•-•---••---•-•-•-----•--•-------....---------•-•--.--•-•- ......-••--•--
Nature of Repairs or Alterations — Answ r when applicable . _.� .. -1- ' :!�?� __..... .?. ....................
.... .... �..... .. _ .... _ . `'_ !`...)�....�?.......`.!.---- .. ^........
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITIE 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 tale board of health. , ,
Application Approved
Application Disapproved for the following reasons
by
PermitNo ............................... --------------••------
................... tc ` . 5�......
—I
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
(arrtifirate of fauutp1tattrr
THIS IS TO CERTIFY, That the Individual) wage Disposal System constructed ( ) or Repaired
------------------------------ /--x--1'-"-0- Z - -=-- ------ ' ° -----------------------------------------------------------------•---------------
Installer
at- ..... ... 4-' ...
has been installed in accordance with the provisions of TIT of The State Sa.nitar Code s d/El
ed in the
application for Disposal Works Constructin Permit 1�'0....... .? :. ...__...... dated•... V- --�---------------THE ISSUANCE OF THIS CERTIFICATE. SHALL NOT BE CONSTRUED AS A GU RANTHAT THE
SYSTEM WILL FUN TION SATISFACTORY.
DATE._.....:.. ................ .... Inspector-.--.. ..._
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