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HomeMy WebLinkAboutApp-Permit-Compliance1146 ROUTE 28. 4 -- - SO. YARMOUTH, MA 02664 Fss............ ..... THE COMMONWEALTH OF MASSACHUSETTS /jI,77 BOARD OF H LTH ...... o Appliratiun for Disposal Murk, Tonstrnrtion f rrmit m P -P- iog Application is here mad fo a Permit o Construct (Jw) or Repair ( ) an Individual Sewage Disposal system at -------- ---------------------. .:�� p,�--- Wags -- � --- - ..... a,,. �1 _. a2 P : 8 ............Y ... . --Location -AddressLot No. - II ..41 � %. _..l � v %?!!i!! N -�'? .r. 1�� �►�C! 'i tl P_ © iz�`.....__. OwnerAddress- - ------•.....--•-----••-------•-- ----------------^ .......................... ......_..__...-••----•-------------•---------•----------•--------•----•-------•-----------......-- Address �` a Type of Building Size Lot ..... ......................Sq. feet Dwelling No. of Bed s --------- 2_______________ _ _ _____Expansion Attic ( K Garbage Grinder ( ) Other — Type of Building ............................ No. of persons .......... .............. Showers (!I) — Cafeteria ( ) Otherfixtures -----------------•-----------•--------•-------•-----.......-----------------•---...------------------..._..---...__...... Design Flow ............ 5...................... gallons per person Qet� d�Y. Total day flow ---______.�-20---------------------- 10 Septic Tank —Liquid* ca.pacity_.d� .gallons ,L h._.g_3___ .Z-.. Width..] �-_ Diameter ................ De th_ e Disposal Trench — No. ....... I........... Width___ eTS-_ Total Length-�W ._ -'VA _ Total leaching area.__ ... Seepage Pit No ..................... Diameter .................... Depth below inlet .................... Total leaching area .................. sq. ft. Other Distribution box (X) Dosing tank ( ) Percolation Test Result Performed by.Jpljo.' �-�ip'.�..._...' p p .. �J_ Depth to ground water.._..._Y�____...� Test Pit i�To. 1 _....__ ...minutes er inch Depth of Test Pit_____ 1 S � _ ah fie.., Test Pit No. 2________________minutes per inch Depth of Test Pit ------ § i . Depth to ground water ........ � - -------------------•----------------------- --- -- -------..._.. Description of Soil ..................................................... ... �r►es� �` ............................................ .------------------------------------------------------------- -------------------•---•---•-••----.........--------------.-_..._..-----------•---...------•-----....----------••---•--•------••----•------ ----------------------------------•----•-----------------•-----------------------------....-------------------•-------•----•------------•--------•---------...._..---------•-•-••-•-----._....--•-_..... Nature of Repairs or Alterations — Answer when applicable............................................................................................... ..__......-•---------•---------------------------•-------------•-•------........----...._..._._..... _...._......-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in ac ordance w h the provisions of TIT11, 5 of the State Sanitary Code — The and rsigned further a s t lac he syste operation until a Certificate of Com pl s be %is/ssuued� b t e and of he th. / X Sig d. -xll 1 •-------------- - - - ate ApplicationApproved By--- ... - .-- -•--- .. •--- ---- ............................................... ... ...---�-................... Date Application Disapproved for the following reasons: .............................................................................................................. ............................ .•---------------.....------•----•------------•--------------•-----•---..._....-•--------------------------------_- ---------------------------•---------- f� � /- �Permit No .... -rSl........................ I ued_ - - "-D- r,����..d.......... / 7 THE COMMONWEALTH OF MASSACHUSETTS J BOARD OF, HEALTH by ...................OF......... ..................................... (irdifiratr of Tuntpliattrr THIS IS TO CERTIFY, That�e Individual Sewage Disposal System constructed (�) or Repaired r!i Jig' �� "".�- 6� ;Zj,p11 _ has been installed in accordance with the provisions of TIT5 of The State Sanitary Code application for Disposal Works Construction Permit No...4 �____n__? . i' ........ dated ...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS U'� SYSTE WALL FUNCTION SATISFACTORY. - -- -- - '` DATEc::_,.L_t.�.......................................... Inspector..-� %e='c'"f ........ - .................... •ibed in the r ................... THAT THE