HomeMy WebLinkAboutApp-Permit-ComplianceT_-NG(NCf9'\J6 C-rP-77P/ -
THE COMMONWEALTH OF MASSACHUSETTS
,BOARD (O�F� HEALTH '
........... OF ........... 1. !u'"Jl.n..................................................
, ppliration for Disposal Warks Tonstrurtion Errant
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE. 5 of the State Sanitary Code — The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued b the board of health.
/7�_ _ 11/14/86
Application Approved
Application Disapproved for the following
Date
Permit No ..................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN YARMOUTH
.................................... OF ................................................................................
Trrfifiratr of Toutphaurr
GT rj.8Ig TO CERTIFY, That the Individual Sewage Disposal System constructed tK ) or Repaired ( )
b.................'...�'�-•-•----.•................•-----•--------.............------........-•--•-..................--••--•---..............----••......--------_...._
Lot 41 Doherty Lane - W.Y. Installer
at------------------------------- -....-------•----------------------------_....----------------------------------------•-------••----•......------....--•-----_.._.
has been installed in accordance with the provisions of TITLE of The State Sanitaryde described in the
application for Disposal Works Construction Permit No -------------- _Q_7=_/1 ............. dated/ ._�.-�....................---.....
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS� NTEE THAT THE
SYSTEILL %FUNCTION SATISFACTORY. rj
t'
DATE_ . . ��J� - --•. .............................. Inspector :; ��---- t. j� ._._...................
Application is hereby made for a Permit to Construct (X) or Repair (
) an Individual Sewage Disposal
system at: ----- �� (U._......-•--7aLz....�:....•-------------------•-----.._..........-----------------........41..
Location - Addressor Lot No.
Thomas Powers 1 Powers Lane - W.Y.
........ _-____......._----_......-- - ---- --- ------ --------------... ............._........ - -- -- --........._........_.--------...................._......__.
W
........
Gor-Dan, Inc. Owner
Address
Installer
Type of Building
Address
Size Lot .... la gan ........ Sq. feet
aDwelling
—No. of Bedrooms ............... ......................... Expansion Attic (
) Garbage Grinder ( )
p,
Other —Type of Building ............................ No. of persons ............................ Showers ( ) — Cafeteria ( )
Otherfixtures .....--••--•-•---•-------•----•-••----••-.....
Design Flow ............... S5_ .................... gallons per person per day. Total daily
e.
flow ..... =......................... gallons.
-Y
W
...
Septic Tank - Liquid' ca.pacity.JJ ..gallons Length .... ._.____ Width .............
Disposal Trench No: I.......... Width jO ......... Total Length 2�i._.......
Diameter ................ Depth --- .........
Total leaching ......... to
x
— ------- ..... .....
areas:31Sa
Seepage Pit No ..................... Diameter .................... Depth below inlet .................... Total leaching area .................. sq. ft.
Z
Other Distribution box (\A) Dosing tank ( ) /� �7
Percolation Test Results Performed by.. -1.G -OI ... W6ZL j-..�LZ .............. Date ....q.-. ..:.&------_-�_-•--..
,aa
Test Pit No. 1... jZ-...minutes per inch Depth of Test Pit ----_ r7 ._......
Depth to ground water ...._..ao...........
Test Pit No. 2................minutes per inch Depth of Test Pit....................
Depth to ground water ........................
x---
ODescription
---------------------------------------------------- ---------------------------------------
of Soil------..�_ ; PIAI........................•---------------------------..........-----•-----•--......----------------------•--•-------•--...
---------------------------------------------------------
W
U
W----•-----------------------------------------------------••--•---•----------•----------.........----------------------
----------- ---------------- --------•-----------..._..----------------------------------------------------- •----------------- •----------------•-•-------------------------.....
-------------•------....---------------......----•---•-•....._...............
..... -...... ----------------
UNature
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 Sanitary Code — The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued b the board of health.
/7�_ _ 11/14/86
Application Approved
Application Disapproved for the following
Date
Permit No ..................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN YARMOUTH
.................................... OF ................................................................................
Trrfifiratr of Toutphaurr
GT rj.8Ig TO CERTIFY, That the Individual Sewage Disposal System constructed tK ) or Repaired ( )
b.................'...�'�-•-•----.•................•-----•--------.............------........-•--•-..................--••--•---..............----••......--------_...._
Lot 41 Doherty Lane - W.Y. Installer
at------------------------------- -....-------•----------------------------_....----------------------------------------•-------••----•......------....--•-----_.._.
has been installed in accordance with the provisions of TITLE of The State Sanitaryde described in the
application for Disposal Works Construction Permit No -------------- _Q_7=_/1 ............. dated/ ._�.-�....................---.....
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS� NTEE THAT THE
SYSTEILL %FUNCTION SATISFACTORY. rj
t'
DATE_ . . ��J� - --•. .............................. Inspector :; ��---- t. j� ._._...................