HomeMy WebLinkAboutDisposal Works Construction Permit 94-232 No. �? FEE_..1J: L'
THE COMMONWEALTH OF MASSACHUSETTS j/ 4
BOARD OF HEALTHral
TOWN OF YARMOUTH
A14ttiratinn for Disposal c n,irks CIunstrurfin }rrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at:
Z Z 4.rc-,0 c..,ct.,<2 /297'1 ---r.44 33 (ZL Cc t /o 4
Loca ion.Addre or Lot No.
C Address
w Own 'r -1..1 .L.. — 5'.tar"1- 4 ,4? - ,, Pod- - (-. .
cq Installer Address
Type of Building Size Lot Z..(f�--feet
V Dwelling—No. of Bedrooms Expansion Attic ( ) Garbage Grinder ( )
p`�,, Other—Type of Building No. of persons Showers ( ) — Cafeteria ( )
dOther fixtures
W Design Flow gallons per person per day. Total daily flow gallons.
W
Septic Tank—Liquid capacity gallons Length Width Diameter Depth
x Disposal Trench—No. Width Total Length Total leaching area. sq. ft.
Seepage Pit No Diameter Depth below inlet Total leaching area sq ft.
z Other Distribution box ( ) Dosing tank ( )
''" Percolation Test Results Performed by Date
,,`'.a Test Pit No. 1 minutes per inch Depth of Test Pit Depth to ground water
ir4 Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water
ODescription of Soil...X"&"-•-`Z a (-de-(.„)��..XIS.[..___...._.t -c—a '-s.! ai7-7-/-=v-S 0--t.,5 "—
W > . _. vf' Cr t---/ c, . -----t-- ?Z c` /•v S:'�¢c L
x C.<,. •_J -e,-s.? e----
U Nature of Repairs or Alterations—Answer when applicable
Agreement:
The undersigned agrees to install the aforedescr' Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary ode—Th undersigned f ler ees t to place the system in
operation until a Certificate of Compliance has bee 'ssued by he board o 1 th.
igned 3/ �/
Application Approved By - . '�r�
Date
Application Disapproved fo he following reasons:
9� 23Date
Permit No .... Issued. �`��'
Date
N0.!/ )-. - --' FEZ ! ." (I Z 5'
THE COMMONWEALTH OF MASSACHUSETTS Jr/
>
BOARD OF HEALTH !!!� '�
TOWN OF YARMOUTH
Auulirtttion for fliq rnotti El larks (nunntrurtiu f rrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System Z Z. 4. I L� c,cz.,<J /2.A 7'/ -r.4/3 3 3 r /Z cc . /b
Location-Addr ___,I. or Lot No. v
.....:.P.Le ?V`..�..... C 4 ..».................»... ' •„L f C ��/ (.✓, >..-...:..
�.n C /C -C�. /, 1-c
-•--, �1 ►. ..a. �9 -4 .:.�.1 1. S.1° r� .,
Installer Address
Type of Building Size Lot.<r.. .(.7 cfst•#eet-
,..,, Dwelling—No. of Bedrooms Expansion Attic ( ) Garbage Grinder ( )
pay, Other—Type of Building No. of persons Showers ( ) — Cafeteria ( )
a Other fixtures
WW Design Flow gallons per person per day. Total daily flow gallons.
w Septic Tank—Liquid capacity.., gallons Length Width Diameter Depth
x Disposal Trench—No. Width Total Length Total leaching area. .sq. ft.
Seepage Pit No Diameter Depth below inlet Total leaching area. sq. ft.
z Other Distribution box ( ) Dosing tank ( )
" Percolation Test Results Performed by Date.
as Test Pit No. 1 minutes per inch Depth of Test Pit Depth to ground water
ill Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water
O Description of Soil.....,--,. '-? Q_sv c.''- .eW.5.r ec-L o cs.,?— �,7/.' � c S O—c„ —W '1‘..,.,4 1. .) 42.ez) C..=Z4:. .!-/-"\.?c- ..e41--L-.c -_ /- c, ' /--I 5;---1-e C=,.
UNature of Repairs or Alterations—Answer when applicable
Agreement:
The undersigned agrees to install the aforedescr..... Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary '••e—T . undersigned f er ees not to place the system in
operation until a Certificate of Compliance has • - 'ssued by e board o th.
Signed C ? Ste( C/
.,/ -_ 7/, tom
Application Approved By .. .. . .
Date
Application Disapproved for he following reasons:
Permit No !1-Z5 .._.............. Issued.... 7" / : .....
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
(trrtiftrtttr of flmnplittnrr
THIS IS TO CERTIFY, That the_Individual Sewage Disposal System constructed ( ) or Repaired ( `'r'----
by...»---s -4N+ A • ...... ..d.,cv..�• . .r e qi -J
has been installed in accordance with the provisions of TIT 5 o The State Sanitary Code as descri m the
application for Disposal Works Construction Permit No 71..2 .2'- dated 2:/5
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. %/
DATE 7: ...» Inspector _ ,�J A.4.1t/.'!/I.7
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