HomeMy WebLinkAboutApp-Permit-Compliance - Revised 2019 (2)No. 9;-32
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
Fos _......1.�._..._�
Applirtttion for Miposttl Warks Tonstrurtion Frrmit
Application is hereby made for a Permit to Construct
System at:
.•.27 Blue Rock Road, ,South ,Yarmou, h,t,_Ma :-,-, -,,,,
______.......... .
Location - Address
_Pamela. PhiPAS..................................................
Cash's Trucking Owner
.................................................................................................. .....
) or Repair (X ) an Individual Sewage Disposal
or
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 arm ................... 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........................
Descriptionof Soil .... ............................................................................. .................... ................................... ................................
................................................................................................... ----------------------------------•--......................................................... 'L�
............-- -
................................---............------........................•••------.....................---.................................................................. 4
Nature of Repairs or Alterations—Answer when applicable ... I?stall__1,-000-_-gallon,.holding.........................
tank. Install 1,000 gallon leachl.ng �rt/3' stone Backing
... ................ nk.....Insta .. .... ........ .
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 1 �
operation until a Certificate of Compliance has been issued by the boa:dgf healtjl. �A
//tel Signed -----Z, � /r��' `:.--1X--A/ _ 02-05-93
a((e
Date
Application Approved By....
Application Disapproved for the following
...............Permit No...........--•-- --- ...
•-^-.---`.......................--------------...................Issued.....-..... �..�.....
..... .................... D
ate
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
(In ifirtttr of Tomplittnrr
Date
THIS IS TO CERTIFY t;s
That the Individual Sewage Disposal System constructed ).Ior Repaired («)
by........S:.Sx h°.':..:i.bt��l.Lll:�:_�Lnxyn S. Cayn) PO 50 /t Ya,:muuthpor , Ila 2 h
........ ......... ..............................
Instal er
27 Flue: Rock Road, South Yarmouth, 11ao (SwnL-C
r 'aa,ela Phipps)
at------ ----*--- •-------------------------- ......••...*.............. .........
has been installed in accordance with the provisions of TITLE S of The State Sanitary Code as Iescribed in the
application for Disposal Works Construction Permit No......... �.- ✓ �......... dated .......... 2... ...� ...I �a.��.........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARA T6 THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. � f�