HomeMy WebLinkAboutApp-Permit-ComplianceTHE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
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Appliration for 13ispouttl Marks Tonstrnrtion Frrmit
Application is hereby made for a Permit to Construct ( ) or Repair ('✓) an Individual Sewage Disposal
System at:
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�q Installer Address
6 Type of Building Size Lot ............................ Sq. feet
Dwelling — No. of Bedrooms....................:.................Expansion Attic ( ) Garbage Grinder ( )
Prw Other — Type of Building .......... No, of persons ............................ Showers — Cafeteria
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?' Other fixtures.......................................................
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
.................................................... ...................................•-----.....----------------..................................._ ..............................................
Nature of Repairs or Alterati jts—Answer w en applicable / .4.4 .... L::..�:?�... �T�........................�
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Agreement: r
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITL% 5 of the State Sanitary Code — The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of h alth.
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Application Approved By...../. 2 ?
Application Disapproved for the fovllowing
PermitNo.........................................................
......... ..... DatS
Date
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
faertifirab of Tomplinnre
THIS IS TO CERTIFY,- That fe Individual Sewage Disposal System constructed ( ) or Repaired (lr
has been installed in accordance with the provisions of TIVI 5 of The State Sanitary Code, ad ribed in the N
application for Disposal Works Construction Permit No....... ..��?� .. dated............. * iE" ............THEE
...
THE ISSUANCE OF THIS CERTIFICATE SHALL E CONSTRUED THAT
SYSTEM W4I 1 F3 1 1?SATISFACTORY.
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