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No..... ........... _....... r' Fxs.......� .S_....._.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
Appliration for Disposal Works Toustrur#ion Hemi#
Application is hereby made for a Permit to Construcl
System at:
..............41 North. St. •. So. .Yarmouth,._Ma.
_
...... ..... ........ ..
Location . Address
J. Davidson
....................-----........................-------•---•----------------------....--•-•---
Geo. Watson, Basso Iver Car Wash Inc.
...........................................•---•------....----•----•--•-•-•-••--
Installer
Type of Building
Dwelling —No. of Bedrooms ...........................
Other — Type of Building ........................... No.
Other fixtures ............................... ...
( ) or Repair (XX4 an Individual Sewage Disposal
...........��'� �3...C"T "S i..a................................
35 MA�RJLQaLD RD. W.Or�.4 MUTH, MA.
----••--- ---.................................. .....................
t�
Main t. Bass Riveddresrs, Ma.
......Expansion
Design Flow............................................gallons per person p day. T
Septic Tank —Liquid capacity......_.....gallons L ngth___________ ___ Wi t
Disposal Trench — No . .................... Width.................. Total L th ...
Seepage Pit No ..................... Diameter.................... epth below i
Other Distribution box ( ) Dosing tank )
Percolation Test Results Performed by ..........................................
Test Pit No. 1................minutes per rch
epth of est Pit ......
Test'Pit No. 2................minutes per D th of Test Pi .......
Description of Soil .................................
Nature of Repairs or Alterations
Agreement:
The undersigned agrees to install t
the provisions of TITLL 5 of the State S
operation until a Certificate of Compliance
Application Approved By
Application Disapproved for the
Address
Size Lot ............................ Sq. feet
( ) Garbage Grinder (h'
....... Showers ( ) — Cafeteria ( )
daily flow ............................................ Mons.
............. Diameter ................ Depth ................
........... Total leaching area ...................sq. ft.
............ Total leaching area..................sq. ft.
..................... Date ........................................
...... Depth to ground water ........................
------ Depth to ground water ........................
......)na ..•--------•----•-•-----------••••---- .... ......._.......... --•- -- ------ ----•- ---- ..........
wheplacable___--------------------Septic-TANK to repalcecesspool
C .._...ne.. to__be. rep l_aced, ...w.......................S i..... -.C'
aforedescribed Ind' 'dual Sewage Disposal System in accordance with
tary Code — Th"rsigned further agrees not to place the system in
.s been issued b board of lxok.ti
2 -1?Date
—`?
..... ................. •..... .......... ..................... ........
Date
zsons.---•--•--••----------------------------------------------•----•--------•----................--------•••----
I'-- .......... ..............-------------------------------------------------------•----•---------------•-------
Permit No.-----�Z-----------------
Issued............................................. .....
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
(9 riifirate of Tontphaur�e
THIS C�/�I That a Individual Sewage Disposal System constructed ( ) or Repaired
by........ ......`�-_-------------- .. _ ......-------------•------ ....----------------------------.................------------------------.....................
at......... ......................... --•-------------............
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No-------- -1. cr..a'.............. dated....? ...... ............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
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