HomeMy WebLinkAboutApp-Permit-ComplianceV,
No.��.:. ...... 7.
THE COMMONWEALTH OF M SSACHUSE17S
BOARD OF H LTH
TOWN OF YARMOUTH
Appliration for Disposal Varks Tonstrudion Orrmit
Application is hereby made for a Permit to Construct ()() or Repair ( ) an Individual Sewage Disposal
System at:
........22 e11"Cx_ 9v L: L -a7: nle.�,4........1�/-1.a:p.....5...5�....... _.............
/ / ,/ •L ati•.••••Address a ••.• •••�••••�•••••••• .• •• . • or No
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z�lr'�Lf�l�i i/L� �----=s s1/D�Y//ZfjZ........
Ownerr .. p T //
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Installer Address
Type of Building Size Lot.... g' S: Sq. feet
..... ........
Dwelling —No. of Bedrooms.....: --- �1511&6)------Expansion Attic ( ) Garbage Grinder ( )
Other — Type of Building ............................ No. of persons ............................ Showers ( ) — Cafeteria ( )
Otherfixtures------------------------------------------------------------------------------------------------------------------------------------------------------
Design Flow.11K. .,P1.�P-. X01............gallons per person per day. Total daily flow........3. ........................gallons.
Septic Tank — Liquid' capacitylgN?....gallons Length ..._..t�...:. Width. -f!&."'.. Diameter ................ Depth. . '.7 "...
/ rr
Disposal Trench — No ..................... Width .................... Total Length .................... Total leaching area ................... sq. ft.
Seepage Pit No... 4� ..... Diameter...../..2........ Depth below inlet....4............ Total leaching area ..2.la..3... sq. ft.
Other Distribution box Dosing tank ( )
Percolation Test Results Performed. b .............A.�.���.._. sdC....._......_ ........_.... Date....../�'.- 7.� 9z ...........
y ..
Test Pit No. 1 �.. Z ...... minutes per inch Depth of Test Pit..l4.4i ....... Depth to ground waterAQT._c!✓4r.
Test Pit No. 2 �. 2._..._minutes per inch Depth of Test Pit -A144 ......... Depth to ground water&07.A' 15✓ ..
Description of Soil .... Zn/ ...... 41
.. .._.. ..'s :'_.7a.. XM6..........................
........................................................................... ...........................................................................................................
Nature of Repairs or Alterations — Answer when applicable...............................................................................
........---•......................................................................................••--••-•---......--•--:.............:,.•---•.......................................••--••...........
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 syste in
operation until a Certificate of Compliance has been issued by�iea =rz
Application Approved B .. ........................�Z,-- ........\,. /
Application Disapproved for the following reasons: ....................
Permit No..........^.��^_.:�.............................--•------•----.....
.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD 6F' HEALTH
TOWN of YARMOUTH
f�rxtifuttt�e oaf fauut�rli�tnr�e ;
Date
�®
THIS IS TO CERTIFY, That ,the Individual Sewa a Disposal System constructed (X) or Repaired ( )
by........................!�&..... '.�yG.: ....L.:B?7.Slid!C. t:P./!1 �...-•••......................... ............................ .......................
at . �........ 4 . iLGatiG1 ........ Installer .. ............ .............. .........••- .... .......
•- ' ..
has been installed in accordance with tithe'provisions of T TLE 5 of The State Sanitary. Code as described in the
application for Disposal Works Construction Permit No...... ....... _ dated ....... /..0._...��._.._`�/-----------
THE ISSUANCE OF Tk11S',,'CERTIFICATE."SHAL,,L NOT BE CONSTRUED AS A GUARANTEE THAT THE
YSTEM WILL FUNCTION. SATISFACTORY. /