HomeMy WebLinkAboutApp-Permit-Compliane .� a --, \Jo D- 1-1 M exe( 12.-ED i /29 )q 6
1 cT
NDAs - gutUMt.� � rll
1 No...t-C.7 .1/ 7-4-1-14„ PO r).-At Petro.il 6S cla E--------F-g30- _
3 THE COMMONWEALTH O MASSACHUSETTS a1 ' ` - '_)
,moi R`
71t. _ - '''''1' BOARD OF HEALTH MAR 2 3 1995
TOWN OF YARMOUTHLI: ' )1..
Appliration fur Disposal lir;arks Tonstrnctiuu thrutit.._..: ....,w,__
Application is hereby made for a Permit to Construct ( )or Repair ( ) an Individual Sewage Disposal
AISYsizteZ7,11•5"117 Ade-AA-1 ci- e.‹..Y (p(0.6 It 4 ' - c>
.! 4.C1.. L ...11 ` (.ad or Lot No. �^_ ....~.:
r 6-k ..)"I l�.C1tci 4 I V (/-'.0 • `ddresyi ,,�5 I//
Installer Address -� " Ilii /`
Type of Building Size Lot �G Sq. feet
a Dwelling-No. of Bedrooms ;pansion Attic ( ) Garbage Grinder ("'f C)
aOther-Type of Building No. of .: .ns .. Showers ( ) - Cafeteria ( )
d Other fixtures j
W Design Flow I" gallons per - .- .qr. Total d�il,y 'ow 7 7�
W Septic Tank-Liquid capacity./e gallons Lengt ' --- 'dth Y /---- Diameter Depth� �
x Disposal Trench-No. Width otal L. gth__ _ Total leaching area- sq. ft.
Seepage Pit No I Diameter /6 Dep 1 below 'nlet_... ..6 ._. Total leaching area. 24 7 sq. ft.
z Other Distribution box ('-1 Dosing ?
2C3' e
a Percolation Test Results Z_ Performed by `"tel 4- "X - , Date �(21
a Test Pit No. 1 `r minutes per inch De r th f Test Pit... -t . Depth to ground water 745-Cf..
per ►-pth to ground water.._7 X32
f=. Test Pit No. 2 � minutes inch D �th o Test Pitt ... .
ir
0 Descri tion of Soil �'f-)` 7 P )'' Z r`-_l-a /^/ate f/ ✓� D„Z YL P4
W _fid f0/4-v zs�T-'./3 2/, e, '-Jai
W f
UNature of Repairs or Alterations-Answ,r when a•plicab
Agreement:
The undersigned agrees to install the aforedescri.-d Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State San, ary Co. - -The undersigned further agrees not to place the syste in
operation until a Certificate of Compliance ha . ued by the bo d . •4 •
Si: ed.. a�s;' 1 �..1
Application Approved By :.1. ' ...r`''W /// -/ /
711_.
w Application Disapproved for t e fol . ng reaso •
Date
A
Date
Permit No C�"�- �,/
! -‘-=`�{ Issued. /7/1/
-
•
THE COMMON A TH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
fgrrtifutttr of Tnmplinnrr
TH IS)O RTF ividual *wine D's sal System constructed (V or Repaired ( )
by .. ..._.. .._t.. .._. T th. 1 NA-1W-hl E!s
at ao a mor9d 4 l.-.�5 ti + Slot
has been installed in accordance 6vith the provisions of TITLE 5 of dThe State Sanitary Code as esc ' ed the
f?a? 60
application for Disposal Works Construction Permit No - 7-, dated , ..17
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUA N EE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE Inspector