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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
, ppliratinn for Disposal Varkii Tons#rudinn ]Jrrmi#
Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal
System at:
29
RunPond
nd Road, South Yarmouth, ..............................................
_
Evelyn Ku1CZykLocation -Address-_��--_^.----_..__---
or Lot No.
Owner Address
Cash's TruckingL Inc.
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Installer Address
Type of Building Size Lot ---------------------------- Sq. feet
Dwelling —No. of Bedrooms -------------------------------------------- Expansion Attic ( ) Garbage Grinder ( )
Other — Type of Building ............................ No. of persons ............................ Showers ( ) — Cafeteria ( )
Otherfixtures••••---•••-•--.......-••--•..............•-•---•----•-.....-•--•---•-••--••---••••--•--•-----••-•......._..._..--•--------------...._.........._---_..
Design Flow ............................................ gallons per person per day. Total daily flow ............................................ gallons.
Septic Tank — Liquid' ca.pacity..__........gallons Length ................ Width ................ Diameter ................ Depth ................
Disposal Trench — No ..................... Width ...... :............. Total Length .................... Total leaching area -................... sq. ft.
Seepage Pit No ..................... Diameter .................... Depth below inlet .................... Total leaching area .................. sq. ft.
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date ........................................
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 ........................................................................................................................................................................
-•-•---•-...---••--••••--------------•-•--------•--.._.......--••-••••--•-•---._............---....•-••-•-•-•------•---•---.._..._._...-•------•-----•••--•--•--•--------............... ......._
.........-••------------------------•--------------------------------------------------•-----------------------...------------•----------------•...•••---•-••-.._....._..__ �_� .�-.�:'�--- C
Nature of Repairs or Alterations — Answe when applicable: install a 1, 0 0 0 g a l l o n h o Yd i n g ;pit .
..-----i . ...c%v� ul... ..` __.. XE .. �.G . ......
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TAI TIL 5 of the State Sanitary Code — The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be issled by the board of health.
Application Approved By,
Application Disapproved for the following reasol}�! ....... ..........
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Permit No...........'.�� - ------
�� 09-20-91�
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i Da
............................ ......_ at
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Issued................... o•� .�.7.. D........ ..
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
(9rdifirate nrf Tomplittnrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( X) `
by........ Cash ' s Trucking , Inc . '..................................................•-•-•-•••---.......... ..._....._
29 Run Pond Road [Evelyn Kulc�21�kj'South Yarmouth, Ma.
at............................................ -......................................................................................................................................................... .
has been installed in accordance with the provisions of TIT of The State Sanitary Code as describg,,0 in the
application for Disposal Works Construction Permit No.... " "Z.50........ dated....._ -- o""` ..........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE... 1 �-...............................
. �. ---- G \ .... Inspector--- '------------ -------........ �,