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LETTER OF WATER AVAILASITITY
OAIE OF ISSUF
INGL I DWIILIN(;4, COM M L NCIAI/INDUS I TIIAI
DUPL 6X FAM ILY DWELTING 5 OTHER (SPECIFY)3 CONDOMINIUM DWEttING
Relerence: l\,4assachuSetls Ceneral laws Chapter 40, Seclion S4
Please be advites that thc Iown of yrrrloulh publ|c wa lable tq 5ervtce address
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ler supply is dvarr
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l!5uaoce of this Letler o, nv.r,lability rs subje(t to lhe iollowing provisrons / .ertrictron5
1 The propcrty ovvncr agrecs to compry v/ith all Federarstate, and rocar talv!, Rurer and
RcgLrlations as they pertarn to the rrse oi the pUtrhc wa,o, ,rrrr,,
2. Ihc Yarnrouth Wate. Dcpartment shall have exclusive rights as to the 5r?e, number, type
a,r(l loaation of allrvarer service Ines, frre service or appurtr' .lol itenr5 (ornc(ted to the
water dtstfl bUtron system
3 The Yarmoulh Water Departrnent reserves the right to require, at the frroperty owner.s
expr:nse, thc tostallation of water mains and appurlenant it!:ms to meet w..)ter demands
.equr5ites wtthin a,ty structurc relevant to this letter of Avatlabtity.
Ihe tetter of Avatlabilrty will expire 180 day: frorr the datc of issue
I hnve read and understand the provrsjong / restrictroos Ol (his Letter of Waler Avatlabllrly
,4ctl 6tcKtl<hru Rcpresentative of Yarnrouth Depa rtmcnt
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Owncr's Srgnatrrrc
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Wdter Dept Srgnature
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\VATER DEPARTN,ITNT
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( i)llscn ittron ( r)Ilnrission
I )clsnlrlc. ( ()nlplrancc o [ \\'arcr \r ar lahr lrt r arrd or crrst rrrg locat urn
l)ctcnttirtc:. (i'rrrplrancc for Parlinr lnd l)rainalc
l)ctcnnincr (irrnpliance to \\'crlands \cr: i e ll lor(s) txrrder anl tlpc ol'
$ cllan(ls. slrr"'an$. ponds. ri\ cr5. ()ccan. trrt:i. hot s. nurshland. ET( .
l)dcnnincs (irnrpliance to Stalc and lirsn Rcgulattons. i.c.
rc!urrcnlcnt:r for Scptagc Disposal and orhcr |tuhlrc I lcahh .A,ctir itc5
I )ctcnnrncs ( brnpliance to Statc and I o$ n Rcquircmcnrs tbr personal
S lcl). Propcny Prolections. i.e.. Snxrkc l)ctruon. Sprinkler Systerns,etc
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YARMOUTH WATER DEPARTMENT
Residential Service Application
TO BE COMPLE
Application Date:
Contact Name:
! New Service
Comments:
TED BY O
Ll
ER / AGENT
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Phone / Day
Phone / Evening
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TO THE YARMOUTH WATER DEPARTMENT:
I her€by submit an applicalion tor a rosidontial water service to be locatod at:
uap*: !|- Lor*, \6 Unit #Houser: )la Sreet:6Xt\s (g l^rtSt Yar^rutL
over 125 feel in length shall be a minimum of 2 inch€s in diameter. Amvd of the Watar Sup€dntsndent.
!
I hereby agres lo pay all charges for ths 6ame and will comply with all federal, State and Locat Laws, Rubs and Regulauons as theyperlain to the use ot the Public water Supply. Should a police mad detail be required. I further agree to pay all cosls associated withpolice road detail. The Polic€ Depattm€nt has lhe solo authority rsgarding the need for such a road"deiail. ' '
Further, I will hold harmless the Town of Yarmoulh Watet oeparlment, thsir ageots and smployees against all claims. damages, lossesand exp€nses resulting from iniury lo or.dost uction of.tangible property including uut not timltei to strilus, rrees ano tencing'duing theinstallalion, relocation or rehabilitalion ot any Municipal waier service. -
Furlher, water se.vice excavations will be restored to a rough grads condition. Completo landscaping will be lhe rosponsibility of theproperly ownsr or owner's agent at the properly owne/s expensa.
Yarmouth Water Department policy requires that a water sorvice
Variance to Water Service Reguiremonts is availabls with the app
owner / Agenr name. So\r. Bt i^')f.,r-\ \
Address:
City, State & Zip
Address:
City, Street & Zrp
FOR OFFICE USE ONLY:
To Field
Service #:
Servrce lnstaller.
Owner / Agent (Iype or print)
-\?- fuu"\,.Aq\\ Qn\r,\\ L1 ov-b...r"\\ r hlh., 0L66.[
BILL COST OR WORK TO: (TYPE OR PRTNT)
Name: 5o\o.o Brr,.,\.',.^l\\a NluL..r.rrt\\_RD __
Scv\L v[.{h^r.\L' mh, o) 6(,rl
Owner / Agent Signature t
Pole #:
Cross Street
Cross Street
Digsafe #:
E Cut and Cap El Relocation D Replacement E Other (specify)
H \WatedYWO Shortcul On|y\YWD\YWD FonnsUor3 Restdsntat sc.vics 6pglicaton.doc
YARMOUTH WATER DEPARTMENT
Residential Service Application
'lndividual applications and water services are required for each unit within a dwelling / building.
I. USE
II, APPURTENANCES
Lawn Sprinkler
Fire Sprinkler
Separale Fire Services
Fire Pump
Swimming Pool
Oth€r (specify)
lll. FIXTURES (how many)
Sinks
Tollets
Bath Tub / Shower
Garbage Disposal
tv WATER CONSUMPTION
?
Number ot Units
Number of Units
Number of Units
B,
Averag€ Oaily Consumption Peak Hourly Consumption
Condo Dwelling'
Duplex Owelling
Other (specily)
3
Sinks
Toilets
Bath Tub / Shower
Garbage Disposal
ARCHITECT / ENGINEER
Architect's Name:
Address:
city, state & zip
Phone #:
Engineer's Name:
Address:
City, State & Zip
Phone #:fog -7?,t- (rctOo
H \Waler\YWO Shortcut or iYWD\YWO Forms\2o t 3 Rostdeotat s€rvics appticaton.doc
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YARMOUTH WATER DEPARTMENT
Residential Service Application
Address:
City, State & Zip
Phon€ / Day
Phone / Evening
TO THE YARMOUTH WATER DEPARTMENT:
I hereby submit an applic€tion tor a rosidenliat wate. service to be tocated at
t,tap*. I tot*, \6 f]! - su""t,C-xt\.-r R 6 urtst tlar^rufL
I hsreby agrso to pay all chaqes for the same aod will comply with all federal, State and Local Laws. Rutes and Regulations as thsypertain to ths use of the Public Water Supply. Should a police road detail b€ requirsd, I furlher agroe to pay all cogJ associated withpolice road detail. The Police oepartment has the sole authority regardirE the need for such a road detail
Further. I will hold harmless the Town of Yarmouth Waler Departm€nt. their agents and employe€s againsl all claims, damages, lossesand axpenses resulting ftom injury lo or-dosuuction of tangible proparty including Out not timtteO to strrubs, tress and fencing'during theinstallation, relocation or rehabilitation o, any Municipal waler service.
Furlhsr, water servic€ excavalions will be restorod to a rough grade condition. Complet€ landscaping will be ths rsEponsibility of thep,oporly o$,ner or owner's ag6nt al the property olimer's exp6nse.
Unrt #House #
Yarmouth Water Deparlm€nt policy requires thal a water servica ove|125 teet in length shall be a minimum of 2 inches in diamsterVariance lo Water Service Requirements is available wilh the approval of the Water Superintendent
Owner / Agent name 5o\..Rt i^,tt'.,\ \
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Su.,1r..' ;
Owne( I Agenl (Type or Print)
BILL COST OR WORK TO: (TYPE OR PRTNT)
Name:
Address:
City, Streel & Zip
Uo-$rr^t=r\J -
Owner / Agent Signature
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FOR OFFICE USE ONLY:
To Field:
Service #l
Service lnstaller.
E New Service
Commenli:
Pole #.
Cross Street
Cross Street
Digsafe #:
E Cut and Cap E Retocation E Replacement D Other (specify)
H \WatedYWO Shortcut Onty\\4r'VD\YWD Form3\2013 Rosdeotat sefvica apgticnliro.doc
TO BE COMPLETED BY OWNER / AGENT:
Apprrcarion oate: Ll lrrhir _
contactName: 5.0\' Rrr^\'*\\
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DESIGN CALCULATIONS
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oAPPROVED: BOARD OF HEALTHt\
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BUOYANCY CALCULATIONS
LEGIND:
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PROPOSED SEPTIC DESIGN
STEPHEN BICKERTON
tzz E)GTER RoAD, aor 16
1TEST YARMOUTH, MASS.
sIEEISER ENGINEER|NG20.! SEfuC(EI RO^D
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i^EFEB. 7, 2022
E.MAR, Jo, 2022 E 6 4654-00
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