HomeMy WebLinkAboutApp-Permit-Compliance E ,� r 7
79 $15.00
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
7o,wN OF Y,Clre. .C7C/T/.7
Apptirattnn fur Disposal rr;.arks CIIunstrnrttun iltrinit
Application is hereby made for a Permit to Construct (X) or Repair ( )..an Individual Sewage Disposal
System at: � W T T 4 k1 PO
/ ,',z igsoivs' D,e,viz - 12T. '41 8
Location-Address or Lot No.
f� ner. Address
41
t .nstaller Address _
Type of Building 6 Size Lot / x.-0..9 0 Sq. feet
Dwelling—No. of Bedrooms 3 Expansion Attic ( ) Garbage Grinder ( )
a, Other—Type of Building No. of persons Showers ( ) — Cafeteria ( )
a' Other fixtures
136-D,e.Qoiti
Design Flow �/a gallons per-per-sea-per day. Totaldaily flow -3- U gallons.
W Depth Septic Tank—Liquid capacity/Q_ .gallons Length8=a` Width_4'/e'-Diameter l5"�"
M Disposal Trench—No. Width Total Length Totaleaching area sq. ft.
Seepage Pit No / Diameter._/Q A'T Depth below inlet__..la__ET___. Total leaching area Z67 sq. ft.
z
Other Distribution box (k') Dosing tank ( )
Percolation Test Results Performed by.._..12-K 1 Z2- K Date /V.Z4/7 4/7 7
a Test Pit No. 1 L Z minutes per inch Depth of Test Pit.../ds'' Depth to ground water
ElTest
Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water
Phi
O Description of Soil...G- a " jeS/QQ.Z7 4.-‘2,1A1 v ,tea 211'' .. ...e/.13 of c-
u
O 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
r operation until a Certificate of Compliance has beeniti.0edlaw b.- ._h- . .
'; ed..46,,... �!►•t i
% oes.„ei ,L.T I q
Application Approved B 0•;... -.-_.-iffej.4 .0 ' j _-t... 1 ., . A- n
Application Disapproved for the following reasons:
Date
Permit No Issued.
Date
^"
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF VARMOUTH
firr ifirate of t umpttanrt
THIS IS TO CERTIFY hat a Individual Sewage Disposal System constructed (X ) or Repaired ( )
by .1 J 4./yPede.fir
Installer
at LOT 8 - FOUR SMA.Q.NS_.DRA...Y_A,R.
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit'No.....7_9: _�!L dated_._. 42-79
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE Inspector
......
* .
..1--.. ....._,.,
i*
THE COMMONWEALTH OF MASSACHUSETTS
•
A‘')/ BOARD OF HEALTH
A\'D
No 79li
TOWN OF YARMOUTH
-41nFEE.$1 5-00
Eliglingal gi Orkg Tintotrurthan Irrmit
Permission is hereby granted .4i. 4eir-7"."...,____
to Construct (` ) or Repair ( ) an Individual Sewage Disposal System
at No LOT 8 - FOUR SEASONS DR.i YAR.
Street
as shown on the application for Disposal Works Construction.Per it o. - bate.
WO I
or" •
FORM 1255 H BS
:oard o •eatth )
DATE 111,5kil
WARREN. INC.. PUBLISHERS
)S: * \°\ THE COMMONWEALTH OF MASSACHUSETTS
k A\ i
BOARDt 9F HEALTH
O\V ---------.
16'44/11-1 OF 47,10 4CTW
‘N N),7,C57.
FEE/(5.—*' a 0
Eitspianat oenritn (gottotrartion Frrizit
Permission is hereby granted / ../(4./Zee:--4-# V
to Constr9ct_,...Cd(*I c7Rei*(—#40-1-nxiividuajCSewag System 40.....c.
at No.. - -- ..eg- exi...s. #0--- •
Street ___,
as shown on the application for Disposal Works Construction P "mit fifit& areil-
.,,
DATE
- e'''.-PSI '•
....„ ,. (ii4,.....e
cz3/./.77 B.a d of Healtb
FORM 1255 HOBS & WARREN. INC., PUBLISHERS
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