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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
Appliratinn for Disposal Warks Tonstrwtilon liermit
Application is hereby made for a Permit to Construct (�) or Repair ( ) an Individual Sewage Disposal
C' ,$ywstem at
%....Lfl _....S3 �..... .............. .�.:: G? .... .... A'le �•-• per +._. vv1 11 -E
t ----
__Location - Address or Lot No.
.....�.�e Ft..... FL Dpi ............. ....... .`. r.- �...�.0 ...........................
g
. .............
a� Installer M ddre s
--------•----•............................••----....--------•--...-•----••---...............------•--•--•----•----•........-----...........--•--.......--•--....................--•---....--•--.........
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accords ce with
the provisions of TITIE 5 of the State Sanitary Code —^e undersigned further agrees not to place he s stem in
operati un ' ertifica.te of Compl issue by e o r o�health.�� 3�
�O�1 Sin ..---............
1 t g ....
Dat
ApplicationApproved By ................................................................................................. ............ .......... ..............
Date
Application Disapproved for the following reasons: .............................................................................................................. -
....................•--...............------.................................................---•-----•-------•.....................--•--•------•••..-•-•------•....................................._
. I ��. 0.............. Date
Permit No._.... .(�7.:......... Issued......._ 2....,tWV ...............
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
Ta if tratr of faomplisurr
THIS I$ TO CERTIFY, That the Individual Sewage Disposal System constructed
_ ,.� F I �
at..............( ........••--• ..........- M................. - ...... .... - -
has been installed in accordance with the provisions of TIT of The State Sanitary Code s desc ibed in the
application for Disposal Works Construction Permit No._...-_-.... �l .0.......... dated.._....__..._-.. ��.........
THE ISSUANCE OF THIS CERTIFICATE. SHALL NO STRU D S GU A E T THE
SYSTEM WILL UN' ION SATISFACTORY.I.
DATE.................� ................................------.......... Inspector.....................•--- ...............................................
Type of Building
I .
Size Lot....�...... Sq. feet
aDwelling
—No. of Bedrooms............................................Expansion Attic (
) Garbage Grinder ( )
a,
Other — Type of Building ............................ No. of persons............................
Showers ( ) — Cafeteria ( )
Other fixtures ............................ .
r�---`7..
Design Flow..................."7
------
' '.._.._ .........gallons.
WSeptic
Tank — Liquid ca.pacity�.cx_Q.gallons Length..P.?.ka" .. Width-'..
Diameter ................ Depth .....r�.._5..
x
Disposal Trench — No ..................... Width .......... Total Length ....................
Total leaching area ...................sq. ft.
3
Seepage Pit No ........ ............ Diameter.:... q.. Depth below inlet........ ........ Total leaching area ... 2-6.-.7 .... sq. ft.
z
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by --.�---���:�r------------------
q
Date ....... I_q...�... 43
aTest
Pit No. 1 ---- GZ.... minutes per inch Depth of Test Pit ...... ��.7��
Depth to ground water ......... .�i .
Test Pit No. 2................minutes per inch Depth of Test Pit ...... (..�A........
Depth to ground water..............�t '
O ,
Description of Soil.'[ .. -� ^ 30 ..... i s�3 .- �� ' ...'`� . [ !t"t. Sa,•�.� �, .S�i....::%Z.._ .�?
wl(`4 0-%".. W.tty-SA-A:9.......................,..........................
...
•
... �, �g , ....
AL �'. wt.iL ./ 5
........................................>M-�........................................._................................................................................
UNature
of Repairs or Alterations — Answer when applicable................................................................................................
--------•----•............................••----....--------•--...-•----••---...............------•--•--•----•----•........-----...........--•--.......--•--....................--•---....--•--.........
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accords ce with
the provisions of TITIE 5 of the State Sanitary Code —^e undersigned further agrees not to place he s stem in
operati un ' ertifica.te of Compl issue by e o r o�health.�� 3�
�O�1 Sin ..---............
1 t g ....
Dat
ApplicationApproved By ................................................................................................. ............ .......... ..............
Date
Application Disapproved for the following reasons: .............................................................................................................. -
....................•--...............------.................................................---•-----•-------•.....................--•--•------•••..-•-•------•....................................._
. I ��. 0.............. Date
Permit No._.... .(�7.:......... Issued......._ 2....,tWV ...............
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
Ta if tratr of faomplisurr
THIS I$ TO CERTIFY, That the Individual Sewage Disposal System constructed
_ ,.� F I �
at..............( ........••--• ..........- M................. - ...... .... - -
has been installed in accordance with the provisions of TIT of The State Sanitary Code s desc ibed in the
application for Disposal Works Construction Permit No._...-_-.... �l .0.......... dated.._....__..._-.. ��.........
THE ISSUANCE OF THIS CERTIFICATE. SHALL NO STRU D S GU A E T THE
SYSTEM WILL UN' ION SATISFACTORY.I.
DATE.................� ................................------.......... Inspector.....................•--- ...............................................