HomeMy WebLinkAboutApp-Permit-ComplianceTHE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.............. .. Town..............OF........ Yarmouth
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Appliratiott for Uiiposal Works Tunotrurtion 1hrmit
Application is hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal
System at:
D �rmoo' -th Lot #67 (aP
Grove S t yi , ` j'y'3
P4?
Location - Address or Lo No. T
...................... -_L!�[l1L.0 fZ..---Sr!_lkl !le4ek).-----•---•.......... ....................
..............l Z -•--- .................................
Owner Address
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Installer Address 4867
Type of Building Size Lot ............................ Sq. feet
Dwelling —No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (nd
Other — Type of Building ............................ No. of persons ............................ Showers ( ) — Cafeteria ( )
Otherfixtures-------------------------------•----•--•--------•-----.-----------------••----•---•-•-----•-•--•----------._...---•---------•--........_..._......----
Design Flow......................55_______________-gallons per person per day. Total daily flow.... ............ 20
Septic Tank — Liquid' capacityl0 0 0_gallons Length-$ .6_....._ Width: 4_'_ 1 O ". Diameter ................ Depth.5 '_4_"____
Disposal Trench — No . .................... Width .................... Total Length .................... Total leaching area .................... sq. ft.
Seepage Pit No ...... ............. Diameterl0............... Depth below inlet_3. g.....__.... Total leaching area.l94........ sq. ft.
Other Distribution box (X ) Dosing tank
Percolation Test Results Performed by ...... od_ SurveX Cnslts. Date._2-23-83
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Test Pit No. I................minutes per inch Depth of Test Pit_ 10_.5'.._..._ Depth to ground water ----- Q_`.............
Test Pit No. 2--.-! -------- minutesper inch Depth of Test Pit..10._5_'___--__ Depth to ground water ..... 0._5_'_._.__..
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Description of Soil.._._TP�E1 – 0.0'-1.0' wood loamy 1.0'-2_.5' subsoil, 2.5'-6.0' coarse white
sand 6 0'-9.0' fine white sand, 9 0'__ 10 5' med. , white sand__ TP�2 - 0__0' •_0 _5' wood lQam,
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0.5'-2.5' subsoil, 2 5'-4.0' coarse yellow sand, 4 0'-5.0' med white sand, 5},0' 6 5`
Nature of Repairs or Alterations—Answer when applicable -fine
;Lt _�ltP- sand'
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d Y' _
Agreement: 2°
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in acc6fda_nce, w:
therovisions of TI TLE, ,;:.`
p 5 of the State Sanitary Code —The undersigned further agrees not to place thd'
operation until a Certificate of Compliance has be i sued by the board of h It
Signe---------- .. __._..
to
Application Approved By -------•-- ...•---.._....
Date
Application Disapproved for the following reasons:--•-----••--------------_-------_•__----••----------------------------•---------------------
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Date
PermitNo.---- ... 5..:..�--------------------------- Issued ------------- �� fly- ................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
....................... F.....I%r< r<'......s::fi.........................................
Trrtifirate of Tootpliatta
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (_,,Y�r Repaired ( )
by-••-•--•-= ..1.3 _Z ...•..............................................•---•-------•-----------------------•-•---•----•-•--------......---._.._....•------•......._....--•------•..._------
Installer
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has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.___S..' .................. dated ___.____,.-z---- ................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE AT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE. � �� . Ins -
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