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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
Appliration for Disposal Works Tontu'#ion 1rrmi#
Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal
System at:
1 _93 ... ... aQLL.d ... YaX.UQ.U.t11 ........................ .... bf ....... �3 'M �a
C ro t e au Location - Address or Lot No.
.............. __....___....... ......................................................... .... -••-•••---••-•--••••-•-----•--------•----......--••------........------........................_..
Owner Address
J. P .Macomber .. J r .:... ................................................... -------.....--------------...--------•---.._..--------•----------•-------•---.................
---------------- ----
Installer Address
Type of Building Size Lot ............................ Sq. feet
Dwelling X No. of Bedrooms .......... _3.......:......................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................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 ........................
-•-............................................................................................... .........................................................
Description of Soil.... Sand.•••_••.
.7 .......................................................................................................................................................................................................
----------------------------------------------•-•-••-------•----------------•----.........-------------------•----------•---------------...--------•-------------------•-•••-•-•••-••_--•••- `•-•-•-•-•-•
Nature of Repairs or Alterations —Answer when ap lica.ble_ _ Adding 1-1000 gallg p i t
on leaching, --to existiY� >---tank,box, leaching .it .•-- e.)I %� ....
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 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 board o� heal#.
Application Approved
Application Disapproved for
C7 –Permit No... :) .T _. �_
5/x./92
............. . .'.::......
Date
.--•-•----•---••---------------/-•---•----/-•---------...•••---••••--••••-•-
Issued..---•-•--•-- �J.... S-L.......�`.... nate ......
Date
THE, COMMONWEALTH OF' MASSACHUSETTS 1
BOARD OF HEALTH
TOWN of YARMOUTH
Tntifirate of Tontplittnre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired gX)
by. ....... J: P .Macomber Jr . .......•--• •-•-•--•••--
Installer
at....193..Setucket Road Yarm ..................
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No. ...::..�..__.. .__ ..... dated_.. ,
THE ISSUANCE OF THIS CERTIFICATE SHALL NO ECONSTRU S U RANTES THAT THE
SYSTEM' LL F NOTION SATISFACTORY.
DATE ._....
Inspector.