HomeMy WebLinkAboutApp-Permit-ComplianceNo. Fmi
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
Appliration for Disposal Works Tons=ividual
Application is hereby made for a Permit to Construct ( ) or Repair Sewage. Disposal
System a
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Installer Address?
YP of B gNo. o Size Lot ............................Sq. feet
Type of Building
Dwelling — f Bedrooms..............��..................----.....Expansion Attic ( ) Garbage Grinder ( )
'k Other —Type T e of Building No. of persons ............................ Showers — Cafeteria
a yP g P ( ) ( )
d Other fixtures
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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 ( )
Percolation Test Results Performed by.......................................................................... Date .............................. ••-------
,`'a 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 ................. _......
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ODescription of Soil.....................•--.......--•-•-•--•--.....-•----...........--------------..........................................._.............................--••--..........
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UNature of Repairs or Alter a ' — A saver hen applicable....",- .501 �Ap ....
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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 been iissu d by the board of health.,
ApplicationApproved BY ..... ... -•---- - •- ...... .....--•----..................................... ...... 14........................ .......
Date
Application Disapproved for a ollowing reason ............... ................................................. ...................................... ...._
................................................. .........
I. Date .........
THE THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
Tnrfifiratr of Tom plitnrr
THIS IS TO , 'WRTIF� That Indivi ua Sewage Disposal System constructed ( ) or Repaired
by- ......... .�&9Z ! _. .oV .. ..-- •---....,---•--••--•.................................................................•-•-------•-----
Insl
at.- ,ram . .•/ il... ................•---••-----•----•--.. •...
has been installed in accordance with the/provisio s of TITLE 5 of The State Sanitary Code as d cribed in the
application for Disposal Works Construction Permit No......9.3..-'" 4.....-- ..... dated ....... I ... ... 8..... .............
THE ISSU N E OF THIS CERTIFICATE. SHALL NOT BE CONSTRU D AS A GU RAN EE THAT THE
SYSTEM WIL FU 4CTION SATISFACTORY.lk —��
DATE.--•..................1 ..........._.................. •--........ Insp --- ............