HomeMy WebLinkAboutApp-Permit-ComplianceNo. R. ... y 8 F$z-15..............
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
Appliration for Disposal Works TonstrurtJ !.t rrrutit
Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal
System at:
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Loc tion - Address .•. or Lot No.
�� /✓.9 �ov T / 2 ............. ............................................................................ _........
/ Owner Address
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..............................................................................•-........
Installer
Type of Building
Dwelling — No. of Bedrooms....��
Other — Type of Building ............
..Expansion Attic
No. of persons ............................
Address
Size Lot ............................ Sq. feet
Garbage Grinder ( )
Showers ( ) — Cafeteria ( )
Other fixtures ...........---.------..-------------------------
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. 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....--..................
Descriptionof Soil ..................................................................................................................................
----....--•------------------•-----------•----•-••-•--------.......---.......--•-•-•--.............---.....................--••-----...----......- T-- ........... .........................
Nature of Repairs or Alterations — Answer,Nben appl;cable Ujr?. G p1 �£ ? �'E'
7 is
....... ....... .... ..................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITLL 5 of the State Sanitary Code — The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bei issue4jby-the bq;x.&of health.
Application Approved By
Application Disapproved for the following
Permit No ....... -.y ......................
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)__(date/ 2
.... ......... ........................................
Date
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.----•..................•-•---........................_.........---..--•-•-
Date
Issued.......................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
Trrtifiratr of Toutplittnrr
THIS IS TO CERTIFY, Thathe Individual Sewage Disposal System constructed ( ) or Repaired
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Installer
at............................... ,F -= - �' ..7 �... / /�d �. ?........................................................
....---••--•-•-------------•-•-•-•--•- --._ ...---------------•-- -
has been 'installed in accordance with the provisions of TITLE y5(pf The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.. R.a.........8................. dated ..... . ...............
THE ISSUANCq OF THIS CERTIFICATE. SHALL NOT BE CONSTR S A GUARANTEE THAT THE
SYSTEM Wlkt�r �IQN SATISFACTORY. ``��
DATE............. �....j.l..l1............ ......................... Inspector.. .4. --•••...................................
V.