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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
Appliratinn for 13ispusal Works Tonutrnrtiun Permit
Application is hereby made for a Permit to Construct (4 or Repair ( ) an Individual Sewage Disposal
System at:
-48 Ni;Z.4L G'"P-GAie�3 F�b OSSs550n-5 chow 59 A-Aal-ek &-z.6
ocati A dry s^dor t...:
Lot No.
.:.................................. C�............) G�`z
_.
Address � t
:......_ ................:
......................
Installer 1. :.. naarys:
Type of Building Size Lot..
Dwelling
feet
Dwelling — No. of Bedrooms........... 3.............................Expansion Attic ( ) Garbage Grinder ( )
Other — Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Otherfixtures--------------------------•---....---------.............------............--................ ......................................................
Design Flow..............-�..................--..gallons per personler day. Total daily flow .......... !3o ......................... gallons.
Septic Tank—Liquid capacity.M.88..gallons Length:.�y? .... Width....t�3=.. Diameter ................ Depth....+.'. C�
Disposal Trench— No. .... ei:!�.,.... Width ......$Ii........... Total Length .... ZIF.......... Total leaching area ..... 3.9.4 ....... sq/ft.&/O
Seepage Pit No ..................... Diameter.................... Depth below inlet.................... Total leaching area .................. sq. ft.
Other Distribution box ( ) Dosing tank ( ) Gam( �� �
Percolation Test Results Performed by.. 7 fi d/ IA d,•,_%Yl _ �,• Date... �.` .....:..3 ..............
Test Pit No. I .... ±.Z ..... minutes per inch Depth of Test Pit....�.1 ........ Depth to ground water..I `:4 .............
Test Pit No. 2....4` 7 .....minutes per inch Depth of Test Pit .... 11<7........ Depth to ground water..P M.!t ........
Description of Soil.... �....Q.-Z.rj:...
`Y
p .s
Nature of Repairs or Alterations — Answer when applicable...............................................................................................
Agreement:
The undersigned agrees to install the afore escribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitar -_ 7e — TheKe
der'siesned further agrees not to place the system in
operation until a Certificate of Compliance has b en�ssved by boar ofSigned,• ^ ------..!
...._ .. .. .. ............................ . ate
Application
Application Approved By.................................................................................................. ..................... .......
............
Date
Application Disapproved for the following reasons: .......................................................................................................... . . .
.................................................................................................................................... ................. ............... .............................
IL
Permit No ..... .G-.��.3-....... ......J .
................._.... Issued .............. .... `�.J..b...... ............
Date
`1r THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
x4 ` TOWN of YARMOUTH
�� ���`� . (�ertifirttte of (�nmplittnre �'
w Sewage Disposal System constructed (B.' or Repaired ( )
THIS CERTIFY, That the In .. id
Installer
at............ YY.... tro 1� O.�s)p= �......................................._............_
3 .. .. •....... ,
has been Installed in accordance with the provisions of TITF 5 of The tate Sanitary C e s de scr bed in the
application for Disposal Works Construction Permit No.........:� i.*---��..... dated......t....��.. �.........
THE ISSUANCE OF THIS CERTIFICATE SHALLNOT-BE_CONSTRUED AS -A GUA NTTHAT THE
SYSTEM W L FIJ, ICY'JON SATISFACTORY. j( �' y
M A T V ." C 1
3 '• I' 1 _ T«� —1-'-L 1 4 'I r�...d=.l-.._._..