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App-Permit-Compliance
N.o. rl... _n THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF YARMOUTH Appl ration for Disposal Works Tonstrur#iun 11rruti# Application is hereby made for a Permit to Construct ( ) or Repair (,IlZan Individual Sewage Disposal System at: Loc ..........•' �.1=_I.CX.J ©, ati' ;-Cd'- 5 .................... ............. ........ . ..°. .... Owner .......... 1.._...... ...���._ ......0 ...................................... Installer Type of Building Dwelling — No. of Bedrooms Other — Type of Building ... Oth r fixtures LI �)qP- 9±............ ...� �:.. � �'........................_....... V� --.• Address Aaar�as Size Lot ............................Sq. feet .................Expansion Attic ( ) Garbage Grinder ( ) No. of persons ............................ Showers ( ) — Cafeteria ( ) e................•-------•--..._...._..............-•••-••-•---.....--•-........•---..............._..•-•-----••••----....................... 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 AA ratigns — Answe� w ............... Agreement: ►��J���Q a* ;1 j � �1..% The undersigned a es to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1.L 5 of the State Sanitary Code — The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued hy the board of health. Application Approved By Application Disapproved f Permit No....... . -----��._.`..��...... .. ..................[_D.... Date ---._....---•--...----.... ........ ...•.................................. Issued.......v ._ `._.. ......Date----- D THE COMMONWEALTH OF MASSACHUSETTS t BOARD OF HEALTH., TOWN of YARMOUTH (ardifutt#r of Toutplinurr THIS IS TO CEP�FY That In ividual Sewage Disposal System constructed ( ) or Repaired ((/K by..............................•--•.. ,..�`•.. ......................... ,..................:...........................----•-•--..................................... Installer at.............a....................... l�l� e et A ?:-..ld.Ge/1if GU'ffl� !ih'r ....................... ------ ........................ has been installed in accordance with the provisions of TI 5 of T State S itary Code de ribed in the application for Disposal Works Construction Permit No ....... ..2�.�.. ............ dated_ �.�_ .fit.._... ...... ....... THE ISSUANCE OF THIS CERTIFICATE. SHALL NOT C N UED A AR T E THAT THE SYSTEM WILL ?C ION ATISFACTORY. DATE .......................... .,........ ......... ...... .........:.... Inspec ..... -- ........ ........................