Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
App-Permit-Compliance
M: %o -a'l No._. . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF YARMOUTH Appliratinn for 11ispaou1 18orks Tondrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: �a r S f =- A 4 5� 33/d/dYr1// int...... ----------------- ....!,L..Q:.yl. ._.� Loca on..l..t/S124 ... ........................_13..�-•F.Fir.'.��:�:��.1....... .... a ........ _..... Owner /< I Address�y .. Fr�/zt t.T. --.......... - f ......-------- a p� Installer Address 6 Type of Building Size Lot ............................ Sq. feet I Dwelling — No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No, of persons ........ ..... __..... ...... Showers ( ) — Cafeteria ( ) 04 Other fixtures ............ ......• ....................................................... w Design Flow............................................gallons per person per day. Total daily flow ... ............................. ............ gallons. WSeptic Tank — Liquid capacity... ......... gallons Length ................ Width ................ Diameter................ Depth ................ p. Disposal Trench — No. ._ ................ 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 .................................. `Ij Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ N............................................... ....... .............................................. ......................................................... 0 Description of Soil........................----------.....--------------...................................-----------------------------------------................................... W V ................ ------------------------------ ----........................... ------------------------------------------ -......................... ..................... ................ U Nature of Repairs or Alteratio(ts:—Answer when applicable.......�i�C�G?..... _..1....._.v��/� ../�...C� Agreement: — 7 S ©z�j V v The undersigned agrees to inl the aforedescribed ndividual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code — The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b issued r the board 41_,_eall .......Sig --------------- ---..../-APPlication Approved BY ..... ....�Dat.e.....G.......... Application Disapproved for the followi reaso s:..................................•--------------------•---------------------............................ .............•---------.....--------........---------------------------.................................-----------.......---------------..........----.............................................. Permit No.....6 U.._d'_1....�......................... Issued_..... -7 ,...... Dam...... Date THE COMMONWEALTH OF MASSACHUSETTS A BOARD OF HEALTH G�®J'✓ TOWN of YARMOUTH \ (grrtifirate of Toutphaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired O by............. l''a.!.J...j�. �t/G..l........................................................................................................................................................... Installer has been installed in accordance with the provisions of TITLE 5 of The State Sanitary C. dgg as described in the application for Disposal Works Construction Permit No ..... ............ dated....... ................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION. SATISFACTORY. 112 DATE ............................. . ....../......!... . ..................... ..................... p...........