HomeMy WebLinkAboutApp-Permit-ComplianceNo....... 2 .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF YARMOUTH Fss.... �Sr ..�... Appliration for Disposal Works Tonstrurtion V#init Application is hereby made for a Permit to Construct System at: 6.1 QuAprefz"Mn ...Location - Address Owner - 3.- -�. ►-- --- In ------- stall---er •---- ------------ .------- --------------- --- Type of Building Dwelling — No Other — Type Other ) or Repair (w<an Individual Sewage Disposal or Lot No. --.. ......................................•----••--........-••-..............................--- p Address, �!::t�� ...... ........................... Address Size Lot ............................ Sq. feet of Bedrooms._ �....................................Expansion Attic ( ) Garbage Grinder ( ) of Building ............................ No. of persons ............................ Showers ( ) — Cafeteria ( ) fixtures--------------------------------------------•---------------•------------------------- 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........................ Descriptionof Soil---------------------------------------------------------------------------------------- 1 •---•-•------------•----•---------------------•---••------------------------------•-•----•---......------------ / --- --fit Naturg of Repairs ori1.;=erat*ns—,Answe when applicable` y 10©©. �.ral 4�--.. i A� ..>.......-8S x Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of 1ITL% 5 of the State Sanit ode — The u rsigned further agrees not to place the system in operation until a Certificate of Compliance haj be }led by thk b and of health. Application Approved By Application Disapproved f .............................................. Permit No........... the following rhlisons:.1.... ..1.'J.....! -l' ---- Date `l , Date Date Issued- ---------..................... .............. Date i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN of YARMOUTH Tntifirate of Tomplinurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (iJj by....... h'k- 3.....0 C. ----------------------------------------------------=--------------•--•----------•. - ...------------ -.................... ............----•----••- Installer at.1.1..--- U.HiL`v-L�(Z. .S ?� ....------ 64Q W..--------------------------------------------------------------------------------•-----•-------------- has been installed in accordance with the provisions of TITLE of h.�j S ate Sanitary Code s described in the application for Disposal Works Construction Permit No ............. dated ---l- �-- ............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU AS GU ANT EE.THAT THE SYSTEM W!&L NCT ON SATISFACTORY. -'..��.. DATE r Inspector.... ........................... ------------------------ -------------- ...