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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
Application for Disposal Works Tonstrurtion 11rrmit
Application is hereby made for a Permit to Construct
l i Sat:
Heather .. Ln.. Y a r- =- •-•--...........................
Arthur Donley ocation-Address
......................__........................................................................
Arch Constructio°n`r
Installer
) or Repair ( X) an Individual Sewage Disposal
mnp
or Lot No.
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48 Rosary Ln Hyannis
Type of Building
Dwelling —No. of Bedrooms..........................................Expansion Attic
Other — Type of Building ............................ No. of persons ............................
Otherfixtures..-•----•..............................•----•--•----.........•----•-----•............--....
Address
Size Lot ............................Sq. feet
Garbage Grinder ( )
Showers ( ) — Cafeteria ( )
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. I...............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........................
.................................................................................
Description of Soil.........;�?nd...................•-••-------•--•-.................--•........-•--•----
- .....-•---••---•.............•-• --•--•--•••......................................---.........---•---••-•--•••.s:Ea. -- .........-• --.. -----..... ..._..---•--••- .6ffi 1. ' - •- Install a sep is
N ture of Re it o Alteratio s —Answer when a 1'cable..................•----••-r--.•••-�--..-..................................................
atank ar'c �-�ox into precast ex..psing pig . 1 S •� .
- .. .................... ... -• -- -- -- . .......•. --- ...._........... .., .......:...... ........ _.............
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITL%, 5 of the State Sanitary Code — The undersigned further agrees t to place th system in
operation until a Certificate of Compliance has bee ' ed the boa of heal
/1 Siane . - ................. /. . ...�
Application Approved By.(...,e!..:."Tgr
Application Disapproved for the followso :..........
.---.....Lf7 ..
Date
.......................................1 j: .� Date .....,
Permit No. .........1. ... �I---•---•---•....... Issued ............... .............
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
(Entifirate of Tomplinurr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by ..... Arch- Construction
..--.-..-•--•......................................................................••------.........-•---............._....._........- -.............................-------
52 Heather Ln Yar. Installer
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 .... ..._...I ... dated....:..�.7.: �f1c.....................
THE ISSUANCE OF THIS CERTIFICATE. SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..............7..... ...:':`........................... ......... Inspector... ...
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