HomeMy WebLinkAboutApp-Permit-ComplianceNo --,---1 j ,,--•-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
Fica...
, pplirtttion for Disposal Murks Tunstrurtiun 1hruti#
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
............... ..... kJ1 ........... ... ......
Location - Address --;-i
.....-----•-----------------------------_.._
.............. _..____. - ..--•__---_.-----........_.
Owner _ _ �dEess 1 �.
`uvA `i I- VA.
Installer Address
Type of Building Size Lot ............................ Sq. feet
Dwelling —No. of Bedrooms............................................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 _Q...gallons Length ---------------- Width ................ Diameter................ Depth ................
Disposal Trench — No ..................... Width _//.� _.____.__.__... Total Length .................... Total leaching area .................... sq. ft.
Seepage Pit No -----i_ ............ Diameter.......1Q ......... Depth below inlet--- ._............ Total leaching area .................. sq. ft.
Other Distribution box ( tj- Dosing tank ( )
Percolation Test Results Performed by .......................................................................... Date ........................................
Test Pit No. 1 ----------------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 ........................
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Description of Soil ....... k.".e_
(ti
--------------------------------------------------------------------------------------------------------•.... ----------------_- �} i ------------......--•I ---.--
Nature of Re airs or Alt ations — nswer when a licable.... ��!� .�._-
t7
j
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT 1Z- 5 of the State Sanitary Cole — The under-s�i ned furt ler agrees not to place the system in
operation until a Certificate of Compliance has beer}Xsued by the �oau of hey�t i. J
Signed_._ .. ./.j,
Application Approved By ......:.. ....... -- --•-•- .......................
Application Disapproved for the f ollo ' reasons :....................
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Permit No. ._.•------.--_ 1.I.
THIS IS
by
Dau
Date 0
THE COMMONWEALTH OF MASSACHUSETTS
�WX�5
BOARD OF HEALTH `
TOWN of YARMOUTH
Trr#ifiratr of ffaautphaurr
IFFY, a f ual Sewage Disposal System constructed ( ) or Repaired (,
_ ....-------------•---•--------•---•------•-______•--•----•-•-•-----------------....._-------....._
ler
at..................!'= ....... �v�.-- - ..---.... ................ .....-------••-•-----•-••-•------•-•• --•--•----•-••---....
has been installed in accordance with the provisions of TITLE of hie tate Sanitary C s rib j�} in the
application for Disposal Works Construction Permit No .............. . .. ......... ....... dated...... ... ��....�..............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT B CONSTRUED AS AR NTE THAT THE
SYSTEM WILL Z � N�.,S�TISFACTORY
DATE.:.. `��
........... ... ......... - ..................... Inspector_............--------•-- ..... -•----• \•---•- - ..... ........_.. ...