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No. .3`. / (2 �� —l� Fns..l.... j.5...00..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Yarmouth
Appliration for Ili-npwial Wnrka Tomitrnrtiun Prrmit
Application is hereby made for a Permit to Construct
System at:
23 Old Salt .Lane Yarmouthport
................•-•----------• -----
Location - Address
Drewes S )- LV..---
---- •--------------------••--•---------•-•---------- •-•--
Owner
J.P.Macomber Jr.
installer
Type of Building
Dwelling -Y, No. of Bedrooms -------- ________________
Other — Type of Building ................. ..........-
Other fixtures -------------------------------------------
Design Flow............................................gallons per rs
Septic Tank — Liquid capacity ------------ gall( Len
Disposal Trench — No ..................... Width ....... -_-___-__-
Seepage Pit No ---------------------- Diameter ---------- --------- el
Other Distribution box ( ) os g tank
Percolation Test Results Performe by__ ______________
Test Pit No. I ________________minutes pe inch Depth
Test Pit No. 2................minutes per inch epth
or Repair )(X4 an Individual Sewage Disposal
-! or -Lot-
Address
.................................................... -.................................
Address
Size Lot ............................ Sq. feed,
ision Attic ( ) Garbage Grinder ((�
_____2___________________ Showers ( ) — Cafeteria ( )
-------------------------------------------------------------------------------------- * -------
In lay. Total daily flow............................................gallons.
---------- Width --------•---- Diameter---------------- Depth ----------------
tal en h____________________ Total leaching area .................... sq. ft.
lz cw inlet .................... Total leaching area .................. sq. ft.
-------- Date ........................................
pf Tel Pit______•-- Depth to ground water ........................
�f Test Pit .................... Depth to ground water ........................
•--•----------•----------------------•----
Description of Soil ........................................ •-•----•----........
-----•----------------...--------------------------------------------------------------•--------------
Sand
----- - -- -- -- -- -------------
Om i t existin leach field
Nature of Repairs or Alterations Answer en applicable------------------------ ............g_____._.._____._....--...................._ ---
Install 4 infiltrators. acked in stone. t 1-
Agreement:
The undersigned agrees to install th forede ribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Envi nmen al Code — The undersigned further agrees not to place the
system in operation until a Certificate of Complia as b e/n. issued by the aro of health.
Signed ._ /-- /�1/ ----3-P.8195 -------
. .. ...---------��'T - --- ------ ---------'-"---........................ -Date
ApplicationApproved By ---------------- ..................................... ................. '- ................. -- ................. ..7....
to
Application Disapproved for the following reasons: .............................. . ......'-------......... '-"-' -- ......-- ------.........................
Permit No.-----
------- .... ...... ........
.
.................... -'---
--------------
3 / Dare
�7 Q
Issued ....... .1
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OFXYarmouth
Ger#iftrate ot axnyrrittnre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or RepairecVXXX )
by--- J-.--P-,Macomber----Jr--:------------------------- ----------------------------- -Inst - allrr ---------------------------------------------------------------------------- ---------------------------------------------
at... 2.3 ---- Old .... Salt ----Lan.e---- Yarmou-thpor.t------------------------------------------------------------------------------------------------------------------------------------------
has been installed in accordance with the provisions of TITLE`q�The t Environmental C e asdescribed in
the application for Disposal Works Construction Permit No. .-
.s...3. ............. datedI...........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE T THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE------------------------------------------------------------ ----------------- -------------------------- Inspector ....... .......--.......... .--------------------------------