HomeMy WebLinkAboutApp-Permit-ComplianceTHE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
Appliratiun for Dispooal Work Tonstrurivan jrrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
•�,--..... �...._. - -. .... ........................ ......------........... -• ----..........---
ocat'on •Address or Lot No. j
.............................. ........ -- CA�vI�. 1..: U�;i i..IQ-)- ••--• � -------m.mua tt
Oq�tgr Address
`6.....::33..:_.... - .. ... ......-- -
Installer Address
Type of Building Size d ------- feet
Dwelling —No. of Bedrooms..........................................Expansion Attic ( ) Garbage Grinder ( �S
Other — Type of Building No. of persons ............................ Showers — Cafeteria
Otherfixture----•----------•---•------------ .....----------------------------------------
Design
5 ... ......
Design Flow ................ gallons per psi per dart',. Total da�ly�(iow gall�n�st,
Septic Tank — Liquid' capacity�l� 'gallons Length._/L.4>t--. Width._G..4.._._. Diameter ................ Depth.ZL1.....
Disposal Trench — No . .................... Width .................... Total Length .................... Total leaching area .................... sq. ft.
Seepage Pit No.---- ......-Oiameter......... 1 U.... Depth below inlet ....... G ........ Total leaching area.-.l`r. Sq. ft.
• Other Distribution box ( ) Dosing t �)
a
Percolation Test Results Ij Performed by LC r+ Date; — �---rf
Test Pit No. 1 _._ 4__. ---minutes per inch Depth of Test Pit... �._ _ r._ Depth to ground water .... ?'..ZZYTI
Test Pit No. 2 ......... __._._nunutes per inch Depth of Test Pit ... �1��.._.__. Depth to ground water ... 7. ZS_...
Description of
........................
Nature of Rel
........................
Agreement:
The undersigned agrees to install the afor,
the provisions of TITLi; 5 of the State Sanitary
operation until a Certificate of Compliance,has be
Application Approved
Application Disapproved f oe'the following reasons:....
Permit No ...... :.. l ................. _....
lividual Sewage Disposal System in accordance with
undersigned further agrees not to place the system in
the
.......... __:h .............
Date
Dau
Issued...........
- - ... ......
Date
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
Trrtifirate of TOMptiattre
THIS IS TO CERTIFY, That the I dividual Sewage Disposal System constructed (X or Repaired ( )
�by.................................................'�%:�..:.... ..s ...... .......................................................................................................... _
.,
ler
at............................ ..f ..._l ......... . J`i'b ` ---4.00 ✓.....--•--
has been installed in accordance with the provisions of TITHE 5 of The State Sanitary Code as describedin the
application for Disposal Works Construction Permit No.___. :::.41 ---------- -... dated ._...._-.4 ......... ----------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. '
DATE..•-•------.•-� = E-�- �� - ._ Inspector Z/ .. ........... ---.
�4