HomeMy WebLinkAboutApp-Permit-ComplianceG`' r
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH >i a
TOWN OF YARMOUTH MAR 3 01995
,
3
ppliratinn for Disposal Works Tonstrurtiun r6tti
Application is hereby made for a Permit to Construct ( ) or Repair (✓) an Individual Sewage Disposal
System at
............ 5... •-................................ `.`% . z `.' ....
-Location, or Lot o.
........---
A.d ess 4 A . • ....................••--__-- •..............................................
OvJner Address
Installer Address
Type of Building Size Lot ............................ Sq. feet
Dwelling—No. of Bedrooms....... V..............................Expansion Attic ( ) Garbage Grinder
Other — Type of Building .......... No. of persons___ Showers ( ) — Cafeteria ( )
Other fixtures ................ /------------ \----------------•-.------------
Design Flow ......................................... .. Is pe person per -clay oto
Septic Tank —Liquid capacity......_ I
Disposal Trench — No ....................
Seepage Pit No ..................... Dia e.
Other Distribution box ( )
Percolation Test Results P rfo
Test Pit No. I................mi uteTest Pit No. 2................min a
-----------------------------------------------------------------------------
Descriptionof Soil------------------------------------------------------------------•..... .............
Ions ength................ W th
th.. ............... Total Le th__ ._.
. ............ Depth below I let..
Do 'ng tank ( )
by------------•-----------6st ----------.
inch eptl} of St
it .........
inch epth of it .........
of Repairs or Alterations —Answer wh n a
-------•-----------------------•----....---•�
Agreement:
The undersigned agrees to install the aforedt
the provisions of TITLE 5 of the State Sanitary G
operation until a Certificate of Compliance has been
Application Approved By
W
flow ............................................ gallons.
--- Diameter ................ Depth--• .............
Total leaching area....................sq. ft.
Total leaching area..................sq. ft.
.............. Date ........................................
Depth to ground water ........................
Depth to ground water ........................
able — ::::%✓ ..... /-,v/ �% s ':.c a ::.
-- --c --------------------------------------------------•---•--•-•--•---
d Individual Sewage Disposal System in accordance with
— The undersigned further agrees not to place the system in
e
the bo A of health.
aa�5
,1�.5.........
........ . ....... ..................... ate
Application Disapproved for the following reasons: ...........
-•---••---•-•-------••........................-•-••-•-•••----••----•-•-••------•••-•--------•--•----•----- -•-•-•--........-••--••----••••-•-••----••-•-•--------•----••-•--•-•••••---•-•-•-•----.......--
,Da
Permit No..- ------...--•••--_--• Issued ---- ...... �/:�� -�ie
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
(9trtifiratr of Tout plianrr
THIS IS TO IFYyy�T�hat e Ip4ividual Se,%vage Disposal System constructed ( ) or Repaired (�
by----------------------- ...--- . --------- ------------------------------------------.........----------------------..--.....-----------------------------------
Installer 4
--------l-------......--------------------.......
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No... S_=_. ............ dated__..--� o� __�.............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE�THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector .................................................