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No... . .......... .....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH L
TOWN OF YARMOUTH HAR 3 Q 1995
Appliration for Disposal Works Tonstrurtiou 'rrutit
Application is hereby made for a Permit to Construct ( ) or Repair (.,�an Individual Sewage Disposal
System at:
G •-----/-3 - - A
�) ton: Address
._...�...... ave ^' ........................... ........ � Y�:.Owk.4!�L�Mo*
-_.---------_._..._......................--
e Owner Address
--- "1 .. �1..�.�.. ..............------------------------------------- ------•---... �4.0 /11 ?�! ___...___---•-•-------__
Installer Address
Type of Building Size Lot ............................ Sq. feet
1_4 Dwelling —No. of Bedrooms............................................EVd.
sion Attic ( ) Garbage Grinder ( )
04 Other — Type of Building ____________________________ No. of p_._________ ............. Showers ( ) — Cafeteria ( )
P4
Other fixtures ___________________ __
W Design Flow ............................................ allo er s pe to daily flow_.____........._.._..._______.._............gallons.
Septic Tank — Liquid'capacity_.___._..___ all ength__ _____i t________________ Diameter.________.__.__. Depth_..._..___..___.
Disposal Trench — No_ ____________________ Wi h__ __.____.________ T talh__________.......... Total leaching area .......... _......... sq. ft.
Seepage Pit No_____________________ Diamet r. -__...__..._..._. Dept9 below inlet .................... Total leaching area .................. sq. ft.
z Other Distribution box ( ) Dosing tank ( )
~' Percolation Test Results Performed by .......................................................................... Date ........................................
Test Pit No. I ................ >`ninutes 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 ........................................................................................................................................................................
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73
if
Nature of Repairs or Alterations — Answer when applicable_______ V, --------------------- *------ _................................. ]rzn... ..___.
................................................... r
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 the boar of health. r�
Signed..- L� -• - 3 ..Oc
ate
Application Approved By- -------------------•- ------
Date
Application Disapproved fo the following reasons:..••-----•-•----•-------------•--------------------••---------•--•-•-----------•---------------•------•--...•---
--•------••••-------------------•....._ _..._..--------------_...__-_ __•----•--•------•--•--------------...---------------•---•----....•------------•------•----•------------------•. _.. _._ _...-----------
Date
Permit No ....... �`�-J-`-�_�._._._`�..�-.................. Issued ............... 1��--Z'•---• /J'_- -•----
Date
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THE COMMONWEALTH OF MASSACHUSETTS
Y BOARD OF HEALTH
TOWN of YARMOUTH
Tntifirat a of Tomptlaurr,
THIS IS TOTIFY, That rr the ndividual Sewage Disposal System constructed ( ) or Repaired (_''J
�---
I sta11 r
l_.
has been installed in accordance with the provisions 6f TITLE 1 of The State Sanitary Code s described in the
l appkication.for I ispo„sal Works Construction Permit No-________�'�__-_�-l,1_�"_ dated__....-.__-�-._7.-_�'�
��..>�-17THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE"S A GUARANTEE AT THE
SYSTEM WILL F N TION SATISFACTORY.
DATE ��121!-7-------------------------------------------- Inspector ------- --- •