HomeMy WebLinkAboutApp-Permit-Compliance VOIDEDv • t 6- L_.26..i
No..`��...............� ��
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
FRS..... ...._
Appliration for Disposal Works Tonstrurtiun rrutit s3o�?� ��
Application is hereby made for a Permit to Construct ( ) or Repair (b< an Individual Sewage Disposal
System at • /-D( P S
fQ� NP/C. XY1.4in1c577 'SQ.
............. ......................... • .....__..._...._......__.... - .... -------...-•---
_: on - dress
Own r
Installer
Type of Building
Dwelling —No. of Bedrooms.................�..... -.......
Other — Type of Building ............................ No. f
Other fixtures - --------------------------------------------
Design Flow _---------------- ..gallons per person
Septic Tank — Liquid capacity/f ...gallons Length_._.
Disposal Trench — No. ----------_------- Width..__...._ To
Seepage Pit No --------- f -------- Diameter ...... D th
Other Distribution box ( ) Dos'tank ( )
Percolation Test Results Performed by- ----------------- ----
Test Pit No. l................minutes per inc Depth f
Test Pit No. 2................minutes per i'c Depth f
Description of
-------------
Nature of Repairs o Alterations — Answe when
Agreement:
The undersigned agrees to inst 1 the fore
the provisions of TIT11�� 5 of the Stat Sanit ry
operation until a Certificate of Complianc has e
Application Approved By
q V10
No.
Size Lot ............................ Sq. feet
/ti
Garbage Grinder..__.. Showers ( ) — Cafeteria ( )
.......... --------------- ........... .............................................................
er da Tota dailyflow ----------------�.✓�-��............... gallons.
----•------ Vidt .-----•---.--... Diameter---------------- Depth ................
to eV
__. Total leaching area....................sq. ft.
bel w inle ................ Total leaching area .................. sq. ft.
------------------------- Date ........................................
Test Pit .................... Depth to ground water ........................
Test Pit .................... Depth to ground water ........................
licable... .: .4-1.�t .----'4"� ...............
Y�®..
-------------- ..................
.................
....... - ...../.�� _:T7 '.....•-•...........................
described Individual Sewage Disposal System in accordance with
Code — The undersigned further agrees not to place the system in
en sued the bo •d ot,)fealth.
3; /
Date
Application Disapproved for the following reasons:..
---------•-•-•..............•---•--....--------------------------•------•--•------------•--••-•-----------------------cl -•---...•.....
Ye
Permit No ........ !____S-•--�•� - �................... Issued ........ ---�---- ? ................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
Tntifiratr of Toutpliaurr
THIS IS TO CERTIFKahat the Ind'vidual Sewage Disposal System constructed ( ) or Repaired
by -------------------------------------------1.24 n L,-7 0�l
�✓ ���� In tall r
has been installed in accordance with the provisions of TITLE Jof The State Sanitary Code as described in the
application for Disposal Works Construction Permit iv'o.._R:C._. .--s..cr/ ................. dated ................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.............................................•--•--...........•---••--..._--•--- Inspector