HomeMy WebLinkAboutApp-Permit-Compliancer YAR;M O U i H t-U_.AL 1 i -I a' -.r i -
Town office Building
Nofa: South Yarmouth, MA 0.26,6/ Fizz_
THE COMMONWEALTH OF MASSACHUSETTS,
BOARD OF HEALTH MAP (09
LOT;Q � �
Apel ration for Disposal Works Toustrnr#uan Errant
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
Sys" ft
........ ..............................................._--.. -- -b �
Loca •Address or t No-.
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---- -------------------------- ----••---------.....-•--•..:�5.......f_ ............................ --.....
Addres
Installer Address
Type of Building Size Lot ................ q,
,.� Dwelling —No. of Bedrooms_________ ___ ______________________________Expansion Attic ( ) Garbage Grinder(p
Other — T e of Building No. of persons ............................ Showers — Cafeteria
Other fixtures --------•--•----_---- -
W Design Flow............................................gallons per person per day. Total daily flow ............................................ gallons.
WSeptic Tank —Liquid capacity ............ gallons Length ................ Width ................ Diameter ................ Depth ................
x Disposal Trench — No . .................... Width .................... Total Length .................... Total leaching area .................... sq. ft.
Seepage Pit No ..................... Diameter .................... Depth below inlet .................... Total leaching area .................. sq. ft.
ZOther Distribution box ( ) Dosing tank ( )
•-' Percolation Test Results Performed by .......................................................................... Date ........................................
,a•1 Test Pit No. I................minutes per inch Depth of Test Pit .................... Depth to ground water ....................
Test Pit.No. 2................minutesper inch Depth of Test Pit .................... Depth to ground water ........................
..........I .......... - - -•
::.._.... - _
�'-.�i�l!' �. -•--• tij�
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.p Description of Soil •----------t-----------------------.
-L--- --- -•--- .... -
Nature of Repair or Alteration Answer when applicable__ __________a?:'�_E�
c�
.....................
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Agreement:
'�j, S 5�...!>x...—_.0..`-- -- •-yam
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TLITA L 5 of the State Sanitary Code — The undersigned further agrees not to place the system in
operation until a Certificate of Compliance h n issued by the board of health.
Wj
Application Approved B . a ..
Date
Application Disapproved for the following reasons: ...................................................................................... ........_.._
Permit No.:M:Q!-------------------------------
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Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
y! .............................. O F.......... ........'1`r.. >:. ...............................
Titr#ifuttte ifnf Tompltnnrr
THIS.IS70- CERT Y, That
by ------------ �= =:h . . �'....1 '.
Disposal System constructed
has been installed in accordance with the provisions of• �LEE-'"_M.a�5 o The State Sanitary
application for Disposal Works Construction Permit No._ _.....•••••••-•.• dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS, l
SYSTEMA WILL FUNCTION SATISFACTORY.
DATT_ C 1 _____ Inspect�e'P,1in
/
or Repaired (V )
as
T THE