HomeMy WebLinkAboutApp-Permit-ComplianceNo......tl r `/
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
Aurfiration for Dismal arks Tonstrurtiun
Application
iis` hereby made for a Permit to C�o�n/s�trucl
_
nstaller
f rrutit
) or Repair (4 an Individual Sewage Disposal
-•-•• --- -- L O F s y 2 �v►A P 5q --••- •---
-• xA----- P,AZVs:..... ? , :.........
Address
Type of Building Size Lot ............................ Sq. feet
Dwelling — No. of Bedrooms -_A ...................................Expansion Attic ( ) Garbage Grinder (`
Other —Type of Building ............................ No. of persons ............................ Showers ( ) — Cafeteria ( )
Otherfixtures .....................................................••----•--•-•-•-----••-............
.................. lops.
Design Flow ......... ...........................gallons per person per day. Total daily
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 ........................
Descriptionof Soil...............•-----....................-----....................--------------•••-................_--....
Agreement: yv� (��I �+� 11A--, ht5r_-e ►cJ�
The undersigned agrees to install the aforedescribed Individual Sewage
the provisions of TITIE 5 of the State Sanitary Code — The undersigned fur
operation until a Certificate of Compliance has been i_ &%mdb t e board zh
Application Approved
y4tem in accordance with
not to place the system in
Application Disapproved for the following reasons: ...................................................................................... .......°................
.......................................................••-------•-----------.....................------.................---•-------.......•-----•--......•--..-•-•......... ...........................
ate
Permit No...... ,----------------- Issued........ - . . .----
au
THE COMhdoXi I(EALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
Trx#ifiratt of Toutphattrr
THIS X T,p�CBRT�FY, what the �Indiv_idytal SUe DispQsal,stem
has been installed in accordance with the provisions of TIT 5
application for Disposal Works Construction Permit No..-_._ �,�. n
THE ISSUANCE OFT IS CERTIFICATE. SHALL
v
SYSTEMA WILL FUNFTGI.NSATISF,ICTORY.
DATE ................. � �. ®�- . L. ... .........._........... Inspector
constructed (') or Repaired
E...............
e Sanitary Code as�E%scrd in the
AS
THE