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App-Permit-Compliance
f � , THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF YARMOUTH . ppliration for 11isposal Marks Tonsirixr#iaan rerun# Application is hereby made for a Permit to Construct ( ) or Repair () an Individual Sewage Disposal System at: ........ 4.�L_ U• L_ v ... _ .__1 ............................... t� Lipo tion -Address .............................. ............................................................ ....!"_ --- -------.......---......-. or Lot No. .................................. ........ eare Installer Type of Building .......................... . .........•------- q ... Address Size Lot ................ .. S feet Dwelling —No. of Bedrooms ---- t2 - --------------------------------- Expansion Attic ( ) Garbage Grinder ( ) Other — Type of Building ............................ No. of persons ............................ Showers ( ) — Cafeteria ( ) Otherfixtures..-•-------------------------......------.----....-•; •- ......-----........ y--.._.................� �----•---••-•------------•--------- Design Flow ............ 5 .......................gallons er, person per day. Total daily flow.......- z.-- -- y --..........gallons. ------- - 0 ........ Septic Tank — Li uid ca acct .�...-..__-_ ions Len _-g'_......... Width.Lo ... P q P Y i Diameter_ ....... Depth .... .._...... a ., Disposal Trench — No.........�_......_.. Width .... Total Length.... ...... Total leaching area -v''__..3 ........ sgr�fr. dp Seepage Pit No --------------------- Diameter .................... Depth below inlet .................... Total leaching area .................. sq. ft. Other Distribution box ( ) Dosing tank ( ) -T"w o Percolation Test Results Performed by.......................................................................... Date ........................................ i 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 .................... Descriptionof Soil ........................................................................................................................................................................ -----------------------------------------------------------•----.._..------------•-••------------•------...----------•--------•-•--•---•-------...............--•-•-------......•-•---•---------•----••- Nature of Repairs or Alterations—Answer when applicable)!vr;KTVii_!�- ...... .�U.©.. �.___Z .7271 �............... 4�0is2_Dl..Ev.4.Q2_..S----._' r... s. ! ._........ Agreement: �5N R) c;:: undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TI'I 1 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 by the board of health. Application Approved By. Application Disapproved for the following �D .,.--•-.--- ate Permit No .............. �- --- � L----�--------------------------------�•-•--------------....Issued......--- �'-...... ..._..... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH "I ! TOWN of YARMOUTH Ti nfifiratp-=aaf (faautphitnrr THIS IS TV E�TIFY hfthe djvrual Sewage Disposal System constructed ( ) or Repaired by......................... ------•-.......- : �(%-...... 1 s.----.......................-----•............---.......------......................---------- .. at-•---• ................................. ......... .. ��--....._.._ �- :..y---"--'----'•------- ......... ............................•-• ......•-•---------... has been installed in a cordance with the provisions of" `fI 5 of,T�e State -'Sanitary Cede. a lescrib, in the application for Disposal Works Construction Permit No .... . �.....;> C-- ! dated_...._:...... ----------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS G ARANTEE THAT THE SYSTEM W L FUNC 1FACTORY. DATE ............... rx_� ......... Inspector...._�.r.. ..... ....... t ... ANN,