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+ C THE COMMONWEALTH OF MASSACHUSETTS 4 /UU
J / / BOARD OF HEALTH
TOWN OF YARMOUTH
Applutt#inn for Disposal 18orks TonstrM ott rami#
Application is hereby made for a Permit to Construct �k) or Repair ( ) an Individual Sewage Disposal
System at:
- aa...ir!�iTiYS .. 6i� � . /` ..:....._ 1...._. �<�/�UrlTiS' •••--.........
Locat'on.Address or Lot Nw J
..GL1ll!!9�eo :�'.: !S.k .•. - ...- - - - • - - --- %�. c!��.ecNi//D ._..�1.'!/.ls or r, ...... .......
�••�~�~- ........ Owner Address
4.
... ..):.._ . Insta .. 4. .Address........ ... - C...... ..i
.------ -- ----- --------------- .... ... .
Type of Building- ✓���f � Size Lot... "�S
............ .
U0 Dwelling —No. of Bedrooms ............................................ Expansion Attic ( ) Garbage Grinder
p, Other — Type of Building ............................ No. of persons ............................ Showers ( ) — Cafeteria ( )
Other fixtures
....................................•-•------•------•---••-•--•---•---•---.._..---------......_.........� .---� �---� ......_.........--------
W Design Flow.............�5.... :................. gallons per person per day. Total dail flow .__.._......_......:.................... gallons.
WSeptic Tank — Liquid ca.pacityZ:�2.gallons Length......... Width...6.......... Diameter ..............•. Depth..:¢..'.....
x Disposal Trench — No ..................... Width .................... Total Length .................... Total leaching area .................... sq. ft.
Seepage Pit No ....... /........... Diameter.... Z'1�......._.. Depth below inlet. L'..;5.8--. Total leaching area; 3:IL.2.sq. ft.
z Other Distribution box (X) Dosing tank ( )
0.4 Percolation Test Results Performed by.......................................................................... Date ........................................
1.4
Test Pit No. 1................minutes per inch Depth of Test Pit .................... Depth to ground water ........................
Test Pit No/x .._ .....minutes per inch Depth of Test 5.... Depth to ground water ...11,V-1 ..._..
..-•---•--•..............................•---..............................................-•--.............._......--•-•-•-••-•-•-........................•.
O Description of Soil ..... / Tv SoiG ` — Sc�/3 Tom. 4 ` - ......
U�: s . - �•3= - fir. .... i!-! f�%� ,.... Q •-•---------••---------•--....-•.......................................................
/�/0.... G !'Uriw o tZ4� 7_C,4C _ �ivC�i vii 7_r'- o�...........................................
U Nature of Repairs or Alterations — Answer when applicable................................................................................................
-------••-••-•..............•••-------•----.......-•--•--•--••-•••-•-••-•-•-•---•-•-•--••---.....------•-----..............................•-•--.............•-•-......--••••••.........................
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 syste in ,?
operation until a Certificate of Com lia een issued by a ar h alth.
(73
/ S1L' • �. Rww'w�c`.ww�..�.a...T.wa.r�/ .. .. .......... ............... /.. . �� \ .
Application Disapproved for the following
.......................................Permit No......�� �$7 ..................... /"" .�.._.�...,..�,...Issued_ ............
-------- z--------------- -- - -- --- -- -- -----
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of YARMOUTH
(Intif irau of T-im rl ttnrie
THIS IS TO CERTIFY, That the Individual *yW 4sposo S- 4tepl
Date
--
.... eu 4-
at ...... �U ..... ;Z
-at......�U....S.a........
w�vTh!-
has been installed in accordance with the provisions of TO.3LE 5 o The State Sa itary Code
application for Disposal Works Construction Permit No._.. •_2::7- ?1273ated.... Q..
_
THE ISSUANCE OF X113%.EaETIFICATE. SH L NO CONSTRUED A
SYSTEMWILL FUNC 1 N- S 1SSF W RY ,
DATE:. ........./.- .•... ..!.'�^ _;... p4 - Inspector. ---
... .. .,
esc ibed in the
47.
AT THAT THE
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