HomeMy WebLinkAboutApp-Permit-Compliance20
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THE COMMONWEALTH OF MASSACHUSETTS PIP.,
BOARD OF HEALTH
TOWN OF EJ
Appliration for Roposal 10orkko-ronistrurtion Prrutit
Application is hereby made for a Permit to Construct or Repair (XX) an Individual Sewage Disposal
System at:
Michelles Path West Yarmouth Lo -r—
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e
...... Murphy Location . �Tr s or Lot No.
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Owner Address
J - P . Mac oM12.Q.r.
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Installer Address
Type of Buildinf
Dwelling _ No. of Bedrooms ............................................ 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' capacity ............ gallons Length________________ Width__._____________ Diameter__..____________ Depth_._____.______._
Disposal Trench — No_ .................... Width___.________________ Total Length____________....____ Total leaching area .................... sq. ft.
Seepage Pit No_____________________ Diameter_______.___.._______ Depth below inlet___.____..__......_. Total leaching area .................. sq. ft.
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by .......................................................................... Date ........................................
Test Pit No. I ................ minutesperinch 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 Soil ------------- S-a'n-d ---- &-Gi7aTe-1 ...........................................................
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f RReair Alterations —Answer when aglicable ---- . ..........
t e 1-1 00 P:allon
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Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code — The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issued by the board of health.
Signed .................... ................
' ned --------_--------- --------
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Application Approved By .............. .. ....... ................
-re
Application Disapproved for the following re ons: ..........................
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Permit No . ....... 9Z Z �
2/6/92
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2 `<:�>
/1 Date
Issued ............... Date _
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certifirate of Toraylianre
TTS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired XX)
by...JJ.. Macomber Jr.
... -1 ...................................... ................................................................... i ........ .......... ....................... .................................. ................................ M-,`
nstaller
69 Mechelle's Path West Yarmouth
at ..... ...... 11 ------- .........
.... . ..................................................... ...... _ ............ I ........... I ............ 11- ........................... ......................... ........ ... ........... 77 ...................
has been installed in accordance with the provisions of TITLE 5..ofThe State Environmental Code -,.as described in
the application for Disposal Works Construction Permit No . ..........J .............. dated
.... .......................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GilARAN TEE,THAT THE
SYSTEM WRL FUNCTION, SATISFACTORY.
DATE ..--------
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- Inspector ... ............. .............. V
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