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NoJ� _ 32 ... (_��Fps_ ``�.�.15.,
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
Appliration for Dispas l Warks Tonstrur#inn ramit
Application is hereby made for a Permit to Construct
System at:
-•Location - Address
............. .'S.: :.r: .�, ki...la � - `-M=�-!2------•--
V� Own
Installer
) or Repair ( '-an Individual Sewage Disposal
................. ]._....;.f_ c- �. vv o-, -L, -.)-,D-6 .) "3S
or
S Lot ... 1 ...L .
Addres
----....-••-..... . - -� k ......6h -i =!� - -
Address
Type of Building Size Lot ............................ Sq. feet
Dwelling —No. of Bedrooms ..... 3 .................................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 ------ 1............ Diameter------` ____ Depth below inlet ........ 'L{....... 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 ........................
Description of
-•------------------------------------------------------------------•-----------------------------------------....----•-------------
Natu�of Repairs or Alterations — Answer when applicable ...... A. -Y0 +a ..... Q
Cid_ '-)G rG -P_ I,.CS,STVLA 1 VI -t_ a--.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITI.% 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 t( b rd -
Sign�3 > �
/ D t ,}
Application Approved BY ••-• . -- .•--------............................................................... -•--1 �jl�� V
Date -------------
Application Disapproved for the f owing easons----------------------------•---------------------------•---------•----•-----------------........................
.....................•----------•----•--------------.....------.....-•---••--•--.......------------...----•-•----••••------..............••-•---•-•-------...........•-•-•--•••--------•-•--••••----•---
Permit No. v�-- -3 �� --•------- . Issued.......- - � '� --�d
' )Date ..........Date ......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
Tatifiratr of fanutphanrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( )' or `Repaired
1by......................... ........L�......................................................... •---.......................................
Installer
at..................................... 7 ....... `i - ._- � '..:------...---- { m eef'� 4djescribed
--------.
has been installed in accordance with the provisions of TITLE 5 o The State Sanitary Coo e n t
application for Disposal Works construction Permit Iv'o._%Q..�.g................. dated...lt-. aL_.
THE ISSU NCE F TH15 CERTIFICATE SHALL NO NSTRUED AS RSYSTEM WILL FDNC ON SATISFACTORY.
DATE.. :._. ,._..11.... b ........ ................• ...... Inspector-- ,