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HomeMy WebLinkAboutApp-Permit-ComplianceNo......4... — � . Fxs.._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF YARMOUTH Appli ration for Disposal Works Tonstrurtion jrrutit Application is hereby made for a Permit to Construct System ovation -Ad re owner .._......5..l.5.�............ ,................................................. Installer Type of Building Dwelling —No. of Bedrooms. --.-3. Other — Type of Building ------------- Other fixtures .................. DesignFlow ........................................... Septic Tank — Liquid ' capacity...........ga: Disposal Trench — No ..................... id Seepage Pit No ..................... Diame r.... Other Distribution box ( ) Percolation Test Results Perf rmed Test Pit No. I................minut s p t Test Pit No. 2................minutes per ) or Repair (�an Individual Sewage. Disposal ..............:: - �a �............. 1 4 :...- ...� Fif ! - -•---*---................ .J„ ,� `L -.-...Address ........_ �/�/ ..........•---•--•.....•-••--••-•--•.......................... Address Size Lot ............................ Sq. feet ..Expansion Attic ( ) Garbage Grinder ( ) No) of persons ............................ Showers ( ) — Cafeteria ( ) eKperson per day. Total daily flow............................................gallons. Length ................ Width ................ Diameter................ Depth ................ ........... Total Length .................... Total leaching area ...................sq. ft. Depth below inlet .................... Total leaching area .................. sq. ft. tank ( ) fbY.......................................................................... Date .................. inch Depth of Test Pit .................... Depth to ground water.. inch Depth of Test Pit .................... Depth to ground water.. Descriptionof Soil ............................................................................................ -•-•-•-----------------------••---.......-•----....-•--•-•-•------•----•...... Nature of Repairs or Alterations — Al4swgr 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 system in operation until a Certificate of Compliance has been issued by b d of health. Sign,1_.. .....................••..... ��� Date Application Approved By..4ef - --- -----------•-....................•----............•..................................................... Date Application Disapproved f oing r ons:--•--•---•--•-••---•..............•---....-•--•.............•••... ......... ...............................9 2-3-3c No ........... -------------- Issued.---- ............ D... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH, TOWN of YARMOUTH 01rrtiftratr of Toutpiittnrr e" THIS IS TO CERTIF t-t-•evidu� Sewage Disposal System constructed ( ) or Repaired by............................................ . .�...................................... .. .`J� ............. ............. at. l f ......2. .N..11...,j�. -L-n............................................... ............. has been installed in accordance with the provisioifs of TITLE 5 of The State Sanitary Code d r*bed in the application for Disposal Works Construction Permit No......_..r'�.^�– ` ed ......... •;-• 2 -•-tip* •• THE ISSUANCE OF THIS CERTIFICATE. SHALL NOT BE CONSTRUE S A GUA AN E THAT THE SYSTEM WILL FU CTIO,N SATISFACTORY. DATE.......... ....... 111. '........................................... Inspector... ... ---•..........................................