HomeMy WebLinkAboutApp-Permit-ComplianceNo ..... Fps..:.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
Appliration for Disposal Works Tonsirnrtiun f umi#
Application is hereby made for a Permit to Construct ()0) or Repair ( ) an Individual Sewage Disposal
System at:
....16 C 145En-VA116ry SILIVIZ Pbn-Y 'QS SQA.? -M �Z�....»RAYZA:,E:t— N 33
Location - ddress . or t No.
»... •---- ._ =- =i--.------' --------•----- = ...
....
Ad r
Ow���/� �ail�/�LS�{rt
Ins alter Address
Type of Building Size Lot...21�. % � ..---......Sq. feet
Dwelling —No. of Bedrooms ..................................... .......Expansion Attic ( ) Garbage Grinder ( )
Other — Type of Building ............................ No. of persons ............................ Showers ( ) — Cafeteria ( )
Otherfixtures------------------------------------------------------.----....---------------•--------------•---------...........------...............---••------•---
Design Flow ................. 5.5............._......gallons per person -per day. Total daily flow ......... 3.36 ........................ gallons.
Septic Tank— Liquid capacity.14. A..gallons Length_.X� ..... Width..5 ......... Diameter ................ Depth_._"f' £F!C
Disposal Trench — No . .................... Width .................... Total Length .................... Total leaching area .................... sq. ft.
Seepage Pit No..._ONE....... Diameter ..... )-Z_ .......... . Depth below inlet ...... 1.......... Total leaching area 7A.&#.set:-ft.
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed b .--- n'jj° ... !'J.. PE .. Date-.! Z5."9.5. ................
Test Pit No. 1.... !�.....minutes per inch Depth of Test Pit .... 1. 9.n ------ Depth to ground water.. N���?........
Test Pit No. 2 ....... ----minutes per inch Depth of Test Pit--__l.�i ....... Depth to ground water._JVA/. VW......
Description of
------------------------------------------------------------------------------------------------------------------------------
Nature of Repairs or Alterations — Answer when applicable....... ....................
Agreement:
The undersigned agrees to install the of a ibe
the provisions of II A. - 5 of the State Sani ry Cod —
operation until a Certificate of Compliance h bee hued
Application Approved B
PP PP Y ........... ... - - - - • Application tion Disapproved for t e following reasons :.................
Permit No....� _.?e4
Permit
Goc!LSA..sSA'^'...............................
Sewage Disposal System in accordance with
ned further a ees not to place the system in
of health
------- -------------- - f ---
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
Trrtifirate of Toutplittnrr
x
/ Date
THIS IS TO CERTIFY, That. the Individual Sewage isposal System constructed (S,_) or Repaired ( )
bY................................................... J.` ...: E`er:',1.....------............-----------. •.......--.....»----»
nst er 7
at... .... ----•---•• .............•----•--
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code crime in the
application for Disposal Works Construction Permit No.__ _
.`:��._q ........... dated ------=... .--=�...................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON TRUED A VTHAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
%e
DATE.................... f-�__.��"......--------•-----....•...... Inspector .... .. a_....................--.
4