HomeMy WebLinkAboutApp-Permit-ComplianceTa
No..:_ �------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Town. ---..... •---.OF...........Yarmo.•uth..
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FEB.... 1....15 11-.12
Appliration for Disposal Works Tonotrur#ion Pgruti#
Application is hereby made for a Permit to Construct ( ) or Repair XX3 an Individual Sewage Disposal
System at:
309 Route 6a YarInouthport �p*-lJty h�F�h D
--.......- - u.t.e ... . ----- -• -----•--. ---...-- •-•-•- ••--•-
Location - Address or Lot No.
Liimatainen
Owner Address
J.P.Macomber
----------------------------------••-------------------.....-------•--•-----------•---•---•---•--------•------------------•-•-•--•---•-•-••-•---------•----------------•------•---.....---•---•---
Installer Address
Type of Building Size Lot ............................ Sq. feet
Dwellings No. of Bedrooms...............3------..............___.__.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 .................................... Sand ... &... gravel.
•• ••-----• • ••--------------•------------------•------------------------------------•--•....-•----------....----•-------------••------•--------•-----••--•----------••----------••--------•-•----•-••-•--
-----------------------------------------------------------------------------------------------•••-- ---------------------------•----•------------•---•--•----------•---------------•------------•-----•-
Nature of Repairs or Alterations — Answer when applicable ------ ______________________ _ _ _-______--_. _
1-1000 gallon leaching pit.
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Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of mT tm x �.,
:. 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 e bo rd of hea
Signed ,(/✓ 1/24/89
a D
Application Approved BY ti --•------- ----7
- ------------
ate
Application Disapproved for the f ollowi reasons----------------------•-----•--------------------------•---------------------------............................
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Permit No.. 0101IssueIi�' t..
� 1,,,,
Date
.......... --•_.. --------------------
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............�_.Own................ OF ............... Yanrian. t"a .................................
Qxr#ifirttft, of Tompliatta
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired kxk
by----- J-_-P-_mac*4b.&----------------------------------------------------------------------------•-------------------------------------------------------------------------------
Installer
at------ -------------------------------------------------------------------------------------- --------------------------------
has been installed in accordance with the provisions of i of The State Sanitar ) Code as d ijib d - the
application for Disposal Works Construction Permit No `P ....................da .____._ ___._:: %f.j _._._.._
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT ONSTRIIE S GUAR EE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. �
DATE. f , �� ........ Ins 1