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Home My WebLink AboutApp-Permit-ComplianceJ7`Z(D Fss........ .00 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF YARMOUTH Appliration for Disposal Works Tontrur#inn jrrntit Application is hereby made for a Permit to Construct ( ) or Repair (�an Individual Sewage. Disposal Lo L4©__...Loc......e..1,. ... .��,...a ......•--..... �:.�!�� .W...t�...`�....M.1�'�........F..... � 3 1 Location ddr ss or Lot No. Description of ............................................... ---------- -• ......._....... ... Nature of Repairs or Alterations — Answer wh p ieable. _�, -•-----�•t.'•�;/-= -�--• �g��eaforidescribed _.• -...... rr• •T• --- -•-• •----cy ---------------------- AgreementThe undersigned Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sam ry ode — The undersigned further agrees not to place the system in operation until a Certificate of Compliance h s i ued ((b5_-�t h�e}} d of health. 2'TX-e Application Approved BY .. �....e --^D Application Disapproved for the following reasons:.......... Permit No ...... .` 1 �T fir. ._...... .--•------...-•-------•-•-••-------•-•---•.......................•......... -•..............................••..................................... issued. .......1 �� Dau ....--• ...,!......... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN of YARMOUTH Ta ifiratr of Tnntplianrr THIS IS ):Q j�E jZTIFY, 7Jhat4hgIndividual Sewage Disposal System .constructed by, ha eenw,�lst d in-aaccordance with the provisions of TITLE 5 of The State Sanitary Cc. application for Disposal Works Construction Permit No--------—.. .......... dated.....--. THE ISSU NCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE A A GU. SYSTEM W�L�FUNATI.OI SATISFACTORY. ) or Repaired ( t-_� in the O&ANTA THAT THE t !1. Iti..a1—T' .a...-- o�.no - Ad rc s - •............. pq 6 nstaller Type of Building dress Size Lot ............................ Sq. feet aDwelling — No. of Bedrooms............ ........ ........................Expansion Attic ( ) Garbage Grinder ( ) p, Other — Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures ............................ W Design Flow............................................gallons per person per day. Total daily flow ............................................ gallons. Length Width Diameter................ Depth WSeptic Tank —Liquid capacity............ gallons ................ ................ ................ x 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... ................................................................ o ------ Date ........................................ Test Pit No. l ................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0:4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Description of ............................................... ---------- -• ......._....... ... Nature of Repairs or Alterations — Answer wh p ieable. _�, -•-----�•t.'•�;/-= -�--• �g��eaforidescribed _.• -...... rr• •T• --- -•-• •----cy ---------------------- AgreementThe undersigned Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sam ry ode — The undersigned further agrees not to place the system in operation until a Certificate of Compliance h s i ued ((b5_-�t h�e}} d of health. 2'TX-e Application Approved BY .. �....e --^D Application Disapproved for the following reasons:.......... Permit No ...... .` 1 �T fir. ._...... .--•------...-•-------•-•-••-------•-•---•.......................•......... -•..............................••..................................... issued. .......1 �� Dau ....--• ...,!......... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN of YARMOUTH Ta ifiratr of Tnntplianrr THIS IS ):Q j�E jZTIFY, 7Jhat4hgIndividual Sewage Disposal System .constructed by, ha eenw,�lst d in-aaccordance with the provisions of TITLE 5 of The State Sanitary Cc. application for Disposal Works Construction Permit No--------—.. .......... dated.....--. THE ISSU NCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE A A GU. SYSTEM W�L�FUNATI.OI SATISFACTORY. ) or Repaired ( t-_� in the O&ANTA THAT THE