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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
Apfiration for Disposal Works Tonstrurtion f ami#
Application is hereby made for a Permit to Construct
System at 8.)-
.... �'L4IL 1.. �- ..�..6.A..... Y:!►? . ........................
Location - ddress
R....-�-ts--,-Ar�---------------------------- --
Owner
:- :...j�.........................................................................
Installer
Type of Building
Dwelling — No
Other — Type
) or Repair ( v-5 an Individual Sewage Disposal
............... ....C-7. 1.. ........
m
or Lot No.
Address
.` ' _._ a_.W.. ?_..U.mR .-( A ........ =- --------------------------
Address
Size Lot ---------------------------- Sq. feet
. of Bedrooms...............3--------------------_-_---.Expansion Attic ( ) Garbage Grinder ( )
of Building ---------------------------- No. of persons ............................ Showers ( ) — Cafeteria ( )
Otherfixtures------------------------------------------------------------------------------------------------------------------------•---•------------------------
Design Flow ................. I x.47 .................. gallons per person per day. Total daily flow .............. 3_. 3 0 .................. gallons.
Septic Tank —Liquid ca.pacity.1 47P 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........................
---- -----------------------------------------------------------------------------------------------------------------------•--------------------------------
Descriptionof Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------
•-----------------------------------------------------------------------------------------------------------------------------------------------------------------•-......_..----......-------_----.....
Nature of Repairs or Alterations—Answer when applicable.._�t_AW._S��Ot��..-FrC!_.,.Jd4_�5.1-._......__..
.i5t--_ $.QX.,.. -.1. s --G � .-. cs.zyl< ' ►l7 E .._f °9s.:� +. ....--------
Agreement :
The undersigned agrees to inst ll the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT1Z 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 by the board,9f health.
Sied ........ .... ..... :.� .----------................................. -----L- - ..
Application Approved By--------------•----....---------------------........................... t..-. ............. 3 `Z --
ID
Application Disapproved for the following re ons:................................................................................................................
by
Permit No � a- ..................... .... Issued.------•--- L .- �•-a -.....
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
f�rr#ifir�t�r of (�um�littnrr
THIS IS TO CERTIFY, That gle Individual 5ew4ge Disposal System constructed ( ) or Repaired (�
--------------
at.....................................:1..._
.......................... ��..............._... tj!A/.X_!........ ................................................................
has been installed in accordance with the provisions of TIT 5 of The State Sanitary Code as described in the
OIL
application for Disposal Works Construction PerMit No..- ...-w ................. dated.... — .y'.. ...............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. �
n
DATE......-- � .r �`
----------..................... Inspector ....................................................................................