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Home My WebLink AboutApp-Permit-ComplianceNo..��.. ..... ©.� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF YARMOUTH Applirtttion for Bispnsttl Works Toustrur#iun Frani# Application is hereby made for a Permit to Construct ( ) or Repair () an Individual Sewage Disposal System at: io" {asps ._.1 ............... sem-..1df---'M: ..................... .---. Location - Address or Lot No. --------------••---•------•----....._ _£Z. ----.e ..Z) ... Address _4 �L iS rs32os GenlS _4 y E /z...i2.. s .................................... Installer Address Type of Building Size Lot ...............•.•.......... Sq. feet Dwelling — 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 ...................................... -----•--------------------------•---------------------------------...•-•-•----------•-------------------•-------••--•-------•---•---------•-----•--•............--••-----------........ Nature of Repairs or Alterations —Answer when applicable_ Sa43... .... _ - ......... `.l'3 -_.......... .................................................................................. Agreement: The undersigned agrees to install the aforedescribed the provisions of TITLi:, 5 of the State Sanitary Code —' operation until a Certificate of Compliance has been i d Signed.. n----•-•-•---:- Application Approved Application Disapproved for the following reasons: 3ividual Sewage Disposal System in accordance with undersigned further agrees not to place the system in he board oW_* -----•-•....:................. .Z�e ------ . .... _-•-- Date ate Permit Permit No.....7............. Issued____.. -•-•_. ......... ..._.. .-..................... --•--� ------------- Date — — — — — -- — — — — — — — — — — THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN of YARMOUTH -. flrrx#ifutt#r oaf �%nt�rlittnrle THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (�) :�r...C.. = ...::.nl.-------•--------------------------•------------•-•-----.-.------------•--•---------.-----.-------- Installer at... 21.... %1 ......... . ......... , .......... 5 !_J, ./?Er r has been installed in accordance with the provisions of TITLE _ of The State SanitaryCod as escribed in the application for Disposal Works Construction; Permit No .... _-�`�7 --- dated .... .... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT B6�ONSTRUED(AS A GUARA TEE THAT THE SYSTEM-fW, 1LL. FU CTION SATISFACTORY.// DATE...- �� 3- 5 Inspect�:...�'Z.t�J ' ...._.,..�!l. ?