HomeMy WebLinkAboutApp-Permit-ComplianceNo._.9.._ �G'.'. Fz$...1.5_.._
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
Appliration for Disposal Works Tonstrixrtion rrrutit
Application is hereby made for a Permit to Construct
System at:
........ _. ! A,,!7.' ..................................
% r p Location -Address
Owner
je.mc 4 .......................... -----------------------------------------
Installer
Type of Building
Dwelling — No
Other Type
) or Repair ( /%�an Individual Sewage Disposal
/ or Lot No. ss
... ...........................
Address
zv�'_%......................
Address
Size Lot ............................ Sq. feet
of Bedrooms ................. .-----...........--Expansion Attic ( ) Garbage Grinder kVci)
of Building ------- Wwdf-------- No. of persons ............................ Showers ( ) — Cafeteria ( )
Otherfixtures------------------------•-----------........--------...----........--------•-••----•-•------------•-------�--y-----------------••---•-•--•-----•-•......
Design Flow ........... Z.1q ........................gallons per person per day. Total daily flow ------------ IX.YP ....................gallons.
Septic Tank Liquid capacity../-A5v .gallons Length ................ Width ................ Diameter................ Depth ................
Disposal Trench — No ..................... Width .................... Total Length .................... Total leaching area .................... sq. ft.
Seepage Pit No ..................... Diameter.................... Depth below inlet.................... Total leaching area .................. sq. ft.
Other Distribution box ( ) Dosing tank ( ) -
Percolation Test Results Performed by.......................................................................... Date ........................................
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water ........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Descriptionof Soil ......................................................................................................................................
.-----------------------------•-----------------•--------------.............------•----------••--------------•-------------------------•---------•--------------------.
----------------------------------•-------......--------------------------------------------•--------------------------------------------------------...---------------------------------------.........
Nature of Repairs or terations — Answer when applicab ......... AU.CW ... ... __S .ST t.... f. 5'trQ.. K. ...
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLL 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 by the board of health.
Application Approved
Application Disapproved for the following reasons:.
_//G E�
Permit No... 5..... `---•-•--•-•---•--....
e
Ate
................................... * --------
Dau
Issued ...... (. S� .-------•--.------
Date
------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
Trrf ifirtttr of (I%ut-plittorr
THIS IS TO CERTIFY, That the Individualewage
by-------------------------------------------•----•--•-----•--.---------- .......P,Ct7s�'
I Installer
System constructed ( ) or Repaired (t�
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code s described in the
01�.
application for Disposal Works Construction Permit No.__b��................... dated..... �`1 _-------------- ------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEMA WILL FU CTION SATISFACTORY.
��/I
------._ Inspector----- '�, �-��.�.�,�.- /-----'�=����,�:...._
DATE.....J �.._..