HomeMy WebLinkAboutApp-Permit-ComplianceNo. �.� :� _.1...... Fas......._....._ ..._
THE COMMOAWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
Appl ration for Disposal Works Tonstrurttun Ver M' d
Application is hereby made for a Permit to Construct ( ) or Repair �X) an Individual Sewage Disposal
System at:
... 3.7..:-R�ilro?�d..Ayenues...Yarmouth�ort�• l�i�.....................................__.....
Location - Address or Lot No.
...Donald Carl s on ............................................... .._....--••-•••---•--•-----•••-••••----.....-----..........----------.............................
Owner Address
--•Crash'-s Truck ing-,-_•Inc.
................................... ..-•---......_.....-•--•--•-----••-----•-•--•---••-
Installer Address
Type of Building Size Lot ............................ Sq. feet
Dwelling — No. of Bedrooms ............................................ 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 .................... 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 ........................
Test Pit No. 2................minutes per inch Depth of Test Pit .................... Depth to ground water ........................
Description of Soil ............................................................................................................................................................... ......
:�
--•..............................................................................................•....----...----•-------------•-------•-----------....-------•-------••---------...---••........_...:.
.............•--------•----•--•-•---------------•-••---•---•--------•---•----•----••............-•------...-----•-------••--••-----•--•--••--------.....------....---------••••-••---••---••---.•--• ..
Nature of Repairs or Alterations — Answer when applicable .... install ... a-..1., .0..0. Q... j, aa.a.on..hQ3.d1ap .2..
Ctwo_)_._flow__diffusors,...... 2fo_ot stone __
packedx__ __________ ___
Agreement: (AS PER PLANS -CALL FOR ABOVE TO BE INSTALLED)
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITA 12 5 of the State Sanitary Code — The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has beemiss§ued by the board/pf health. /f
Application Disapproved for the following reasons: ..................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
Tntiftratae of T ampItanu
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( X)
by--•.Caah..'._s...... .,.....--•-•-------•.............................................................•-•--......-----......................------......
. ---. -Installer
at ....... #.3._7. ... Rlroad_:Ayenue___(Donald Carlson_)____Yarmout_hport...__Na_________________________________
has been installed in accordance with the provisions of TIT�� 5 fgThe State Sanitary CO(Le. as describe in the
application for Disposal Works Construction Permit iv'o..-._.: �!-..:.--.!................ dated ........
_'..�1 _._......._....
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE........ : :j�.� .. L ......................................•.
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