HomeMy WebLinkAboutApp-Permit-ComplianceNo...FEB.$...] '�..QQ........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
................... Town. ----------..OF.............. Yarmouth..
Appliration for Disposal Works Tontrurtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal
System at:
...Chi jk4ape...LAL?.+...WQ,51 ..... 67.3 ....Lo ... Lf... ----...--"..9- --- L O.�.................................
Location - Address or Idt No.
... Robert Gong.4.13mg ........................................................ .. Lamp -+-....... 0267.3-
- Owner Address
a-A & B Cessp... T.QKM.Q.9 Hya i + - .....
Installer Address
d Type of Building Size Lot ............................ Sq. feet
Dwelling — No. of Bedrooms____________................ ............. Expansion Attic ( ) Garbage Grinder ( )
a
p, Other —Type of Building ............................ No. of persons ...... ...._...
........... .. Showers ( ) — Cafeteria ( )
a Other fixtures -------------------------------- .
W Design Flow............................................gallons per person per day. Total daily flow ............................................ gallons.
WSeptic Tank — Liquid' capacity -...........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.
Z Other Distribution box ( ) Dosing tank ( )
'-� Percolation Test Results Performed by .......................................................................... Date ........................................
aTest Pit No. 1................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 ........................
------------•----•--•------------------------------------------•••----•--•------•------...----•-•--- ..........................................................
0 Description of Soil ----...---•-----Sand...................................................................................................................................................
"4
U---------------------------------------------------------------------------------•------------------•-------------------------.
W
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U Nature of Repairs or Alterations — Answer when applicable ... .nstallation__of__a__l,_000__gallon__pre-cast,
...stone---�ked__leach__pit_ oYerflow '-•---------------------- ---------------------------------------------------.........--...---------------
Agreement :
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITL;; 5 of the State Sanitary Code — The undersi ned further agrees not to place the system in
operation until a Certificate of Compliance been issued by ;the bo d o
Sign 11 1 81
------------------- - � .. ...._.
Application Approved By ------------b_4- -k ................ --- n------------------------•-• ------------------- -•----------------- T3
Date
Application Disapproved for the following reasons- ---------------------------•-------------------------------------------------------------------------•--•--•----
........................................................... ...-----------•-----......_..-----------••••----------------•-------•---------------...------------------•--•----------------------._.......
Date
Permit No .......... 81--U 0 ............................ Issued _.11,13J81
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
......................... T awn..... O F........ Yax�outh.......................................................
(Irdifiratr of Tompliatta
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (X)
by . A & B• CesSp o01 Service , 128 Bishops Terrace,__ HY.a a .1!'fA_ -02`01----- -
Insta11
at Chickadee Lane, West Yarmouth, YA 02 7 - Robert, .Gonsalves
........................................................ --- ------------...
has been installed in accordance with the provisions of TITLE 5 of T...........
State SanitaryCo e as described in the
application for Disposal Works Construction Permit No.�------- 1'-.-7........... dated..11-- 1 ?-------------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
��4' 0/31
DATE-•--•-. ------... Inspector_-- --------------------- - --••---•-----•-------•----••-••--•-••-.