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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
Application for Disposal I:r urks &instruction thrtnit
- Application is hereby made for a Permit to Construct or Repair ( 4-71; Individual Sewage Disposal
R System at:
.». e-__ 4. :�.% .! J ...Z.!fraf_»_2.d!�» ----t tor z co �'-l-6
,� Location-A rest ` »"~»•---
!_ .. AA&s .� V/ or Lot No
41
4L (eli.,/ if), ZAvk/Po/e---( co. ()7-774 Address
Installer Address efr<1.(dOr
Type of Building Size Lot S . feet
DwellingNo. of Bedrooms q
— Expansion ttic ( ) Ga bage Grinder ( )
a Other— Type of Building do- -6L No. of persons.._- . �V Showers (V — Cafeteria ( )
Other fixtures
Design Flow .l_l �� O gallons.
W �o gallons per ° e day. Total da�ly flow
• --- Li uid ca aci gallons W Septic Ta � q p ty�l �ength.._.,11�2 Width. Diameter Depth....
— No. ..__/
Disposal .
x Po Width. Total Length.__- Total leaching area.y72 O sq- ft. .
Seepage tit No Diameter Depth below inlet Total leaching q area s ft.
z Other Distribution box ( 0 Dosing tank (1/5
.
`� Percolation Test Results Performed by
0-1
Date
.._1 Test Pit No. 1 minutes per inch Depth of Test Pit Depth to ground water
174 Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water G- '
0 S
Description of Soil fr
W
567:6 -- ()/&1't ' Pe (A s-t-J -3b.chgL o ce s 4‘A17 c%
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43
U Nature of Repairs or Alterations — Answer when applicable /ci. .
i
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 further agrees not to place the system in
operation until a Certificate of Compliance has been issued by e board of health.,.__
Sig '
Application Approved By .:. `� 1 tf -,�,
Application Disapproved for the following re ns: D t`
g Date
Permit No _ ? �
. »- .
Issued_ 3. ... -•-------•---•-»
._ ......_ ___. ...... ...k_ ___
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH ,
TOWN of YARMOUTH
Qtrrtifiratr of Tuutpliunrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed
by �j Av a-- 4e ,(T' l ( ) or Repaired (c,��
at. �' So c(� �b (� �,� 1I. /
ataller
G
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Coc . as escribed in the
application for Disposal Works Construction Permit No '1' ``7‘ dated 3/3 9�
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE Inspector
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
Appliratiun fur Disposal ';r urku Cnuttstrn.rtiurt 11rrmit .
Application is hereby made for a Permit to Construct ( \° or Repair ( Individual Sewage Disposal
System at: _
.... ... � ..r."Pef�rz..-JAIA _..4_0 ..7 ecIT - '‘I/ _....�.---
�Location A res or Lot No
A 46i. .02....:64.w .e.se--:4 4
� --i2 p. AvV, .. o 00;7f y' � Ji7
i.
Installer Address
Type of Building Size Lot Sq. feet
U /Dwelling— No. of Bedrooms '. Expansion Attic ( ) Ga bage Grinder ( )
aOther— Type of Building .77%1Q� No. of persons "/ Showers (V) — Cafeteria ( )
a Other fixtures
d Design Flow 110 gallons pe ppe s�n°` day. Total daily flow �� o gallons.
WSeptic Ta - Liquid capacityi v gallons Length.-_.ID 1 Width. ' Diameter Dept...
x Disposal — No. ..._,� Width. IS Total Length_._. Total leaching area..7� sq. ft
Seepage' No Diameter Depth below inlet Total leaching area sq. ft.
z Other Distribution box ( V)/ Dosing tank (0
'-' Percolation Test Results Performed by Date
1.4
Test Pit No. 1 minutes per inch Depth of Test Pit Depth to ground water
fi, Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water C'Z-
O Description of Soil '
5t------ p nit — 2s7-e (2) s-ed '.3h,okj, Coc. s-/-u37 c2j
W /
UNature of Repairs or Alterations — Answer when applicable /✓/4.
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 further agrees not to place the system in
operation until a Certificate of Compliance has been issued by e board of health. ._,
Sig --/... .._....
Dat
—3/
Application Approved By.... ... 1.7
i Date
Application Disapproved for the following re ns:
GJ _ C/ Date
Permit No ! / Issued. �/l
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
(rrtif 1ratr of atumplinttrr
TH IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (�_
by p A r�
v_n u Installer
at IQ �+ S°``-lc — c� f- ,
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Co* as c escribed in the
application for Disposal Works Construction Permit No 9a' -`l dated .3/ Ssi 99',,,
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE Inspector