HomeMy WebLinkAboutApp-Permit-Compliance=•1
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
Appliratuan for Disposal Works Tonstrurtiun ramit
Application fis hereby de for �Permit tstruci
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�!- Location - Address
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...........................
Installer
( kAb or Repair ( ) an Individual ewaa Disposal -.
L� w 133
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or Lot No.
................•-•-•.........------...----• a�.............................................
Address
Address 2,3
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 ........... ..3.....................gallons.
Septic Tank — Liquid' capacityfO.'a (gallons Length...rF.�..-. ' Width... -.t.. 8..._'Diameter ..........•..._. Depth..5 f3.::..
Disposal Trench No ..................... Width.........: . .......... Total Length.............._...Total leaching area.........�!........,ft.
Seepage Pit No......./........... Diameter.Z . '.A! ?-Depth below inlet... : .... Total leaching area.,���A 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
•---......z..•--......-•-•-••............:.•..........•-•-......_..............
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.........--•.........................................................................•----------------•----•----••--------------....--•••• ................
Nature of Repairs or Alterations — Answer when applicable ..................................................
--•-•----.......-•------------------------•--...---•----•--..........---••-----•-•-----•-•--..............------------...---.............---.......--••-----•--.........-•••-•••-••---..............
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State SanitarXbn
Code — The undersigned further agrees not to place the. system in
operation until a Certificate of Compliance ed by, the boar of li lth.
%ateApplication Approved .......... .... -------•-..... ac ..... L
Application Disapproved for the following reasons:..........................•---....---------•----•...............•-•--------...............--------.........
..........................................C...�....q... . ....
Permit No....... ......... Issued ............... ...............
Date
_.---------------- _—. --- - ---
THE COMMONWEALTH OF MASSACHUSETTS ALois-/ A,/ &40'
BOARD OF HEALTH
TOWN of YARMOUTH
(In ifirate of Tomplittnrr
Y/That� h. Indivjtival Sewage Disposal•System constructed• (- or Repaired (-.-)
...._.In -• ll - -.. .....
Installer �. ,� - /'�
has been installed in accordance with the provisions of TITLE 5 f The State Sanitary Code a descr' ed the
application for Disposal Works Construction Permit No .............. . /--t .._ _ dated........../........aox�T
THE ISSUANCE OF THIS CERTIFICATE. SHALL NOW E CONST UED AS A GUA ANT THE
SYSTEM WILL FUNCTION SATISFACTORY. /°�
DAT ... f •7 1-¢ ..................
................... Inspector................. .. . -... ............