HomeMy WebLinkAboutApp-Permit-ComplianceFas......
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No. . _. .._....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
Appliratiun for Disposal Works Tons#rurtiun f rrmi#
Application is hereby made for a Permit to Construcl
System at:
7 Sullivan Road West Yarrnouth,Mass.
Close Location - Address -
................_..____......._.......................---.•.....----•---------..............
J.P.Macomber Jr. owner
-
................. --• - ---...................................................
Installer
TvDe of Building
) or Repair (X ) an Individual Sewage Disposal
................. -L-=°r:. K Lam... ..- ..........._._..
------------
or Lot No.
..............................................................................
Address
------•--------•--------------•----••----------...--------.....---------------•--.................
Address
Size Lot ............................ Sq. feet
Dwelling x- No. of Bedrooms ............. 3 ............................. Expansion Attic ( ) Garbage Grinder
Other — Type of Building ............................ No. of persons ............................. Showers ( ) — Cafeteria ( )
Otherfixtures......................................................................................................................................................
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 Soil ............ .. .
S a n d '--77"ra:ve' ---------- ----
•-------------------------------------------•-•-•-••----------------------------•----------------------------------------------------.................------------............--------•-------------•---
Nature of Repairs or Alterations - Answer when a licab e....1 -.1g �gQ.._ga llo n tank. 000 gallon
11
leaching pit packed in stone. Omitting two cesspools.::_.:._.:
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT1Z 5 of the State Sanitary Code — The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has begn issued by thA board of health/ �%
Application Approved By
Application Disapproved for
Permit No .........
.. 2/12/92
1A
Date
Date
Issne(..."'.�... Z ......... ..
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
Trr#ifiratr of TOUtpliaurr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by ................. J. PsMacq );Lgr..Jr.........•----
7 Sullivan Road West Yarmcktbhr
at...............•....................................................................................................... -----•-- •-----•--------•--.....-----------•--.......----
has been installed in accordance with the provisions of TIT of �S ate Sanitary Code as escr n the
application for Disposal Works Construction Permit No..__.._��. �.-'. -_-- .-_-- dated_ Z.":'. ��--�e .......
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED A ARANTEE THAT THE
SYSTEM WILLFUNCTION,$ATISFACTORY.
DATE....... L
..............................In to ....--•---- .. ......