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App-Permit-Compliance
Fzz............. .... .^ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF YARMOUTH Appl ration for Disposal Works Tonstrurtion jrrmit Application is hereby made for a Permit to Construct ( ) or Repair (�an Individual Sewage. Disposal System at: •••..... •t-- •-_-----Locatio •Address ......-- • •----- ^.... ....... ^�•�� .... -- or Lot �.o. ..... ..........-- i�_Y.° :..��.. G� nom..`.✓. .. 4 !.: �;. E/ CL?�rQ%S� —.�J y� W Ad �_.� ..� -.� :.T..: L�'r - �..3•l..................... .......... �.S.Z L.. �,C ...:�:...1 .1fGs ...¢.:.lG :./... 4��............ F 1 Installer Address Type of Building Size Lot ............................ Sq. feet Dwelling — No. of Bedrooms•.-.�------------------------------ Expansion Attic ( ) Garbage Grinder ( ) p, Other — Type of Building ............................ No. of persons ............................ Showers ( ) — Cafeteria ( ) a Other fixtures --------------------•--•-------• --- W Design Flow .........�.(_75 ................ gallons per personer day. Total daily flow ....... !a�,D_C.................gallons. WSeptic Tank 4- Liquid'ca _�Vgallons Length._ ,..... Widt rh__.___. Diameter ................ Depth ................ x Disposal Trench — No. 2-1.: 64L., Width ..... ........ Total Length..... ........ Total leaching area ...................sq. ft. Seepage Pit No ..................... Diameter.................... Depth below inlet .................... Total leaching area .................. sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results Performed by ........................ ....... Date ........................................ ,aa 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 ........................ ...-•--•..:...........................•-•-•--...................................._.._....._...------......................................................... Description of Soil... ••-•--.......-•-•• •-••--••-••-•-•-•-•-•----•-••-•-••••-•-•-•---••-••-•••-•-•--•---•-••-----•--.------••-•-••-••--•••-•---...-•-•- Nature of Repairs or Alterations — Answer when applicable•?t:.`�i— — n ✓o v 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 furtherrees not to place the system in operation until a Certificate of Compliance has been issued by the"oard HT&Kby� Application Approved :........ Application Disapproved for the following reasons:......... Permit No ........ S... ................... /MD.tt/ . --------•............................................................................................ ............................................... ........ ........... ................................ Issued-........ _ © _ ��Date ............. „ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN of YARMOUTH - Tntif irate of Tanutplittnrr. THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed , ( ) or Repaired by........... r�"'1.. C..1�!t1�...7.5 •........ . ................. . ......._......._.......................... ] /.y� Installer .- at..........................................................i ..4...�u....d.l =�'r.. — k ........ has been• installed in accordance with the provisions of TITLE 5 of The State Sanitary C e s des ribed in the Works Construction Permit No.. _. "'Z _ dated...�..- application for Disposal 3..: 57 `•••••••••• THE ISSUANCE OF THIS CERTIFICATE`=SHALL,NOT BE STRUED A A GUA ANTii THAT THE SYSTEM WILL FUNCTION SATISFACTORY. F QIXZf—'� DATE........ .. .....01:3 :............................... Inspector .....---- � ... � ...---............