HomeMy WebLinkAboutApp-Permit-Compliance �.., _ Town Office Building
ire•....5.. ).O c� South Yarmouth, MA 02664 F::_..--r-
• THE COMMONWEALTH OF MASSACHUSETTS
# BOARD OF HEALTH
To w,v OF /41 'r o' 771
Appliratiun fur Disposal 'l r;urlui Qlunutrurtiun ilprnmit
p Application is hereby made fora Permit to Construct (a.j or Repair ( ) an Individual Sewage Disposal
tan
��" SC at:
577e&-z T _,.,.., �........ v 1.7?71 _».. 3
I •
X' Location•Address � � or Lot p_..._... ••
Go.k.ad.. .._._.f/..f5t 2 '............. ce -.1 ._ rr 2 .,Po/2
Owner Address
Inataller Addreu - .._
8 Type of Building Size Lot./4.7 75 ..Sq. feet d
a Dwelling—No. of Bedrooms .» 2-....» Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No. of persons .. Showers ( ) Cafeteria ( )
Other fixtures
... .... ........................
Design Flow..»......... — .., gallons per person per day. Total daily flow 2Rn .... gallons.
M Septic Tank—Liquid capacity /cs. v gallons Length P'4" Width '4'' Diameter Depth m'6'"
1 Disposal Trench—No. l Width.-.L Z' `zTotal Length Zc 'N Total leaching area...3°1- ....sq. ft.
Seepage Pit No Diameter Depth below inlet ...- Total leaching area... ......sq. ft.
z Other Distribution box ( ) Dosing tank ( ) /yB
Percolation Test Results Performed by mow'' +a E »'amu eY ._..._..». Date24c......:......,,. it
•...1j Test Pit No. 1 .4 7- minutes per inch Depth of Test Pit. /2-•"' ... Depth to ground water 7z"
Test Pit No. 2. G z .minutes per inch Depth of Test Pit.-./!4" Depth to ground water....«".....
O Description of Soil d'"—46' Ce 7. hv,p . stA8--sod 4..--01"-'-.P c4-497 ...... -/i:`f......_...._...
M Ivey. s.4-iva T_.
U 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 Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been la.ued tly the board of th.
• /' r
gn
Application Approved By ... 1.... . i...._.._......_.........................._ .........._.. Z
v.
*Date
Application Disapproved for the following r' . ons . .....-._.....
Permit No.... v`�...._._.._._.—.... __ .... ...._.._ Issued.... ...... a.... Due
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
To twA/ OF )4iyu e-'77"
tarrtif irntr of ftumplinnrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (v) or Repaired ( )
by......................._ .._....._.......... ..... ..... ........ _....._....__.._.._...... ...
~Installer
at... ....._.» _. ...
has been installed in accordance with the provisions of T3TLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No dated.....
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE,.»»».911L&5...................._ Inspector—. ..._ .-
THE COMMONWEALTH OF MASSACHUSETTS