HomeMy WebLinkAboutApp-Permit-Compliance Na...j�.` , F'sa�5• Oc,
7HE GOMMONWEALTti OF MASSAGHUSETCS
BOARD OF HEALTH
TOWN OF YARMOIITH
.�0.�r}�lir�#in�s fur 3�i�}�n��t1 �mk� �.vn�lrur�iutt �ermi#
Application is hereby made for a Peru�it to Canst�-uct ( ) ox Repair (v) an Individual 5ewage Disposal
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a Iastaller � Add�°as �.
� Typt of Building Size I,o�---__._..._._..._Sg. feet
V Dwelling—Na. of Bedrooms-----...---�._....----..............Eacpansion Attic O Garbage Grinder O
p"�,, pther—TYPa of Building .------....__.....-----._ No. of persons....---_..-----...•----... Showers { ) — Ca£Meria { )
a+ Other fixtures ..............._..__...-----.._.__...----......_._...----...------••---...-----.._........----..........._._....--•.....___.......__.._
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Design Flaw_....._....»....._..---..............._.galfons per person per day. Total daily Raw---..-----___.._...----....-,---...---.gattoas.
� Septic Tank—Liquid capacity---...-----�°]tons Length---------------- Width.----...._.._.. Diametez.----....___.I?epth_.....___.....
x Dispasal Trench—No...----..._..._..... Width._.---...----..... Total Length----..,--------- Total leaching area.,....._..._-----sq. it.
2� SeeFaBe Pit No_-------....----. Diameter.------._----..__ Dcpth laelow inlet__....__...._-- Totai learhiag area._---._._.....sq. ft.
� � Other Distribudon box ( ) Dasing tank ( )
'" Percotatiors Test Resulu Performed by.---....---.............--....-----......_....-----._......----.... Date.-----•---..____......._----.....
,a Test Pit No. 1_----..._---...minntes per inch Depth of Test Pit................... Depih Lo groun water___----_...._..._.
�"z, ! Test Pit No. 2......-•----_.,nunutes pu inch Depth of Test Pit.--___-_--__-- Depth to ground water.._....--_...._.._.,..
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� Description of Soil..._.._.._----....__... ...., ....-..._...»...
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VNa e of R ' s or terati ns—A when ap ' ble ._ .L.Y..[V...___c!,Cf.�!i7__._��.�.,�. ,�..._..�-��-. ...r���
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ngreement:
The undersigned agrces to instalt the aforedescribed Individuai Sewage Disposal Systesn ia accardancc with
the prorozsions of iI:':.B 5 of the State Sanitary Code—The undersigned further agrees not to pLace the system in
operadon until a Certi6cate of Campliance has bcen issu e boa d of health. /
Sign ..... _... _ ._ � ... _�_.G�,�.,l:s�.................•---� � -�'-'�f�",��
Iuation A aved B ' 3 �l�=��-
�PP� PPr Y---..._ .._� --.._..----- -_. _.__. .._._._.._.------._._._.._ _..-----_._.-�----.»...__..._
Ilate
Appiica.tion L?isapproved for #hr fntdmuettg seasonc: .----_--- -------------___..-r----•--_...---_.._.._..__-_...____..__._.___..._._.._..
..................._...,..........__....._........----........_.._.....-----.._..._...._.__----•----»._-•...._---.....---...-----�-----..........-_-........---.....---.»..__....
(�; -ry �f `-7 ``� �
Permit Na......_.1_C.�:_._L�.,___......_..._._. Issae�L._�,_l..C...:�5..�.........._
a,ct
THE COMMONWEALTH OF MA�SACHU�ETT$ �
BOARD OF HEALTIi
TOWN of YAAMOUTH
f�er#ifiat�e n�f tamtt�l��ttc�
T ►���'O C IFY, th T iv' Sen:sge Disposal System constructed ( } or Repaired (�
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a�.._.....��.'..-�t.'��kk�...�.:_f��"�.....���`�..r�., .�..�....__��:......-----....................--.._........---_....
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has been inst:e2led in accordance with the provisians of TI 5 o e State Sanitary C!u7e as dexri in the
application for Disposa! ��/orks Canstruction Permit h'o....�'�.:.L��.__...___. datecl...'.'.��. .-r..��t,.''.....�,."��;;._......
7HE ISSUANCE OF THIS CERTIFtCATE SHALI. NQT BE CONSTRLE 5 A G RANTEE TMAT THE
SYSTEM W!lsl,. F11N SIO �SATiSPAGTORX. S �
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DATE.............�__...��..�.___....__._.__......_......_•._ Tnspector�._...._..._....... _ ...--•_.•_- .. ._._._..__._..............