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THE COMMONWEALTH OF MASSACHUSETTS -t� pzj r
BOARD OF HEALTH
TOWN OF YARMOUTH
Application for Disposal Works Tonstrurtinn Frrnti#
Application is hereby made for a Permit to Construct
System at:
6S �ig 5T/,�lC� 4V6-.
................_........----------------...............--••---......-----.--------
tion -Add ess �
. n C Owner
-------------------------
Installer
) or Repair ( ) an Individual Sewage Disposal
Lo7 S7
or Lot No.
............................................... ....... .........................................
Address
Address
Type of Building Size Lot .... f+aoQ.._...Sq. feet &.
Dwelling —No. of Bedrooms ................ ____________________________Expansion Attic ( ) Garbage Grinder ( )
Other — Type of Building ............................ No. of persons ............................ Showers ( ) — Cafeteria ( )
Otherfixtures------------------------------------------------------.............--------...----------......---------......--------------...-•----.._........._.....
Design Flow......... 5.5 ..........................gallons per person per day. Total daily flow ........ 4.4.0 ...................... gallons.
Septic Tank — Liquid capacity/4 ..gallons Lengthkg� t"... Width.A.�'.. Diameter ................ Depth -5 -fl'....
Disposal Trench — No ..................... Width. ......._..._... Total Length .................... Total leaching area .................... sq. ft.
Seepage Pit No ....... I............ Diameter..1.............. Depth below inlet --...4t >.......... Total leaching area._Z67....... sq. ft.
Other Distribution box ( I--)– 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 ........................
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/ ....... _...................... ------•---------.---------------
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!�/LE FACi-?Description of Soil------ .__. SEPTi