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App-Permit-Compliance
Nog5..: Flcs. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF YARMOUTH Appl ration for Disposal Works Tonstrar#ion rrrutit Application is hereby made for a Permit to Construct System at: pEsEr� s us L/l-i,i� ...... Location -A dress -- M Installer UP4 a a a WQ W x G4 a O U W x U Type of Building Dwelling — No. Other —Type c (v*') or Repair ( ) an Individual Sewage Disposal .. .. or Lo f �! ' ddress yam•-----•__. - Address Size Lot. 3.Sq. feet of Bedrooms ........... . 4 ........................:Expansion Attic ( ) Garbage Grinder ( ) Building ............................ No. of persons ............................ Showers ( ) — Cafeteria ( ) Otherfixtures--------•-------...-•-------•----------------------------------------------------------.............................................................. Design Flow ............ `�------------------------- gallons per person per day. Total daily flow..... ---... ....................gallons. Septic Tank— Liquid capacity.1 !?.-gallons Length._6_ _'.�_-. Width. ¢ .K'-�... Diameter ................ Depth:: -'8" Disposal Trench — No ..................... Width .................... Total Length .................... Total leaching area ................... sq. ft. Seepage Pit No.-------/....._.... Diameter.......14-....-_ Depth below inlet_.. 3 ........... Total leaching area..ZB-rc S.sq. ft. Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by..A�R ...... .- -- -- -. Date..Ie! S _ /tel F Z Test Pit No. 1-.G ... _._..minutes per inch Depth of Test Pit ----1 ____.. Depth to ground water ........................ Test Pit No. 2.. . .. Z____minutes per inch Depth of Test Pit..... SZ....... Depth to ground water ......— ............. Description of I, ge,,, , v.-7 -5,4-1 S®e e- 4& ':-1.44 a .................•-----------•---•--•-•-----....---•------------------------•---•--...............-----........------•----------.......................--•---.........---- 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 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 bo rd of health.� / Sig L'+y 4......................... s.c°1.... �.y....I..z-:-- a Application Approved By.. . .... ... .. ...•--•-•.....----•-•. � 6(D e Application Disapproved for the following reasons:---•---••--•---•-----------•--------•---......---•-•-------------------•----------...--•••--•-•-----............ ....................•---------.....------•-------------...........---•---•--....--•--------•------•--•---.-••-----••-•----•••-•----•--•-••--------..------ .......... ................................. '0 - Date Permit No.........— �. {�.3 ............. Issued.......© Z................. Date THE `COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN of YARMOUTH Trrtifutt#r of Toutplittnrr THIS L TO CERTIF, Yt That tl IndividMal_Sewagq DiRgsal System constructed (t/jor Repaired ( ) by a ................ .............. ............. —----- — F---------- %Z;6.--^--------------------------------------------------------------- ................... has been installed in accordance. with the provisions of TITIE 5 of The State Sanitary Code a des ed in the application for Disposal Works Construction Permit N( ...... ...... dated ....... /.�..�% .. z......_._... THE ISS ANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUA ANT E THAT THE �-- ... .....-•-- + ... ..SYSTEM WIL FUNCTION SATISFACTORY. DATE...... Ins ector j.);�kg . ...