HomeMy WebLinkAboutApp-Permit-ComplianceNo. ::J ...1 C._ Fas.....� .` .—
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
Appl ration for 0hipnnttl Works Tunutrnttion Vamit
Application is hereby made for a Permit to Construct ( ) or Repair
()o ) an Individual Sewage Disposal
System at:
-y�n,.�>.......�. Za1 uta
Location -Address _
1JyeLcl10 ° .......... .............. ...................................
or Lo No.
................ ........--------- _........
Owner
....................... -5'$ i?tS t 4...._
Address
........ ...........................----
Installer
Address
Type of Building
Size Lot ............................ Sq. feet
Dwelling—No. of Bedrooms... ..... ............................ ...... Expansion Attic
( ) Garbage Grinder ( )
Other — Type of Building ......................... No. of persons............................
Showers ( ) — Cafeteria ( )
Otherfixtures.....--......................................_................._.....__........
----------------------................................--------
Design Flow............................................gallons per person per day. Total daily flow ........................ .................... gallons.
Septic 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.
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........................
...---•--------------------------------------------------------•-...........................------------------.......__.............._............
Description of Soil.....C.)=A...5---..._a9S2S J..5 --•--..........sn �........ � ---------5 su-.�'............ `t,1.....Lda0
Nature of Repairs or Alterations — Apswer when
T '.Nv .a_...n I CA )c F) 1=1 lL\
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
operation until a Certificate of Compliance -h gen issued by the board of health.
Application Approved'....._
Application Disapproved for the following reasons:
_3/,i 5/Y L
Date
c` 0 .o.`
.5...4.:
Permit No............: 1.��............... Issued..----- - Z .1..�....� �........._
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH � �` V
TOWN of YARMOUTH
Tntifirttte of Tuoutplittnrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repairer))
b ktiSctr .......21M^� f�
Installer
at....... -'•......._Vrr..�'.l c-.a°rc \-\}ro l� --•-• ��-- •----------. ""::.V` 1----------------------------.......------•-----...............--•---......--------..............
........... ......... .....
has been installed in accordance with the provisions of TITLE 5 of The Mate Sanitary Code as de crib in the
application for Disposal Works Construction Permit No ..... . ..... date ... u n.........(.... ..
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS�A_GUARANTEE THAT THE
SYSTEM WILL^ FUNCTION Q%AT/IrS FACTORY. } ✓'
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