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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Disposal Warks Toustrnr#iun Prrutit
Application is her made for a Permit to Construct ( ) or Repair �XX) an Individual Sewage Disposal
System at:
�3 Colburne W.Y. �lQ
..... .......................................- - -• - - - - ----•-----....---
Location - Address or Lot No.
Harold Leaner
J . P .Macomber Jr. Owner Address
-----------------------•--•--...--------------------------.......----------------------•--------- ....------•---------------......------------•-----....--•------------•-------...._..........------
Installer Address
Type of Building Size Lot ............................ Sq. feet
Dwelling x- No. of Bedrooms.............a---------------------------- 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 ca.pacity........_...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. 1................minutes per inch Depth of Test Pit .................... Depth to ground water ........................
Test Pit No. 2 ----------------minutes per inch Depth of Test Pit -------------------- Depth to ground water ____-_-_----_---.____.
------------------------------------•--•--...------.......-•-•------------------------------- ..................
Descriptionof Soil ......---San--d-•. --------------------------------------------------------------------------•--•------
�-C -- gavel
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Nature of Re r Alt ions — A sw r h �licabl ___
1- �J� al�on tan's C `� �*� caonIeachIn� pit:
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 beep is
ed�ythe board/f heal!p.
Signed
Application Approved By ............. .. .. ....U.
Application Disapproved for the following rea.
Permit No . .............7 ...r.2
9/... g/90. ---------------
pate
-----------------
Dare
Issued.........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Cer#t#tra e of Complinure
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (XXXX
byJ,P.Macomber Jr.
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Installer
at ......43-.--Colburne Street West Yarmouth
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has been installed in accordance with the provisions of TITLE 5 of�T�e $r�t, vironmental Code s desc ib in
the application for Disposal Works Construction Permit No. .......................................... dated................../J... .....`..........J....
THE ISSUANCE O THIS CERTIFICATE SHALL NOT BECONSTRUED AS A RAN EE T AT THE
SYSTEM WILL FUNCTI N SAT FACTORY. \
DATE------------------------- ��....... �' b.........t �------------------------------ Inspector ........................................... -1 ..... ......