HomeMy WebLinkAboutApp-Permit-ComplianceNoffi11^ ]�ir •= 2
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Disposal sal Warks Toustrnr#ion rami#
Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal
System at: L vT' v (O
50 Reid Ave. West Yarmouth k_
........... - . ............•-- - ------.....----------------------•-----------••-
•-
Surette or Lot No.
Location - Address
...................... ......•---....-------••--------...----------------•------•-•--------------•------••-------------•-....---•-----•------------•••----•-•-----•--------......---.._......-----•-
Owner Address
J.P.Macomber Jr.
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Installer Address
Type of Building �'� Size Lot............................Sq. feet
X dd
Dwelling — No. of Bedrooms-------.--T_,� ______ � _ xpansion 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. 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 ........................
--------------------------------------------------------------•----------.......--•-------......... .........................................................
Description of Soil ........... Sand
-•----------------------------------------------•----------------------------------.--------------------•---......-------------------------- ------------....----•--------•---•-••--------------------
Omit Existing cesspools.
N tore of Repairs or Alterations ns r when applicable .._______________________________ ____________ __
-1000 gallon tank 4- i
.................................................. ------ .
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 bSenjissued by the ,�oar� of health.
Application Approved By ... .............
Application Disapproved for the foll
12/16/91
� Date
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q� Dare
Permit No. 1- ................. Issued . ... �-�------------
Date
THE COMMONWEALTH OF MASSACHUSETTS
I BOARD OF HEALTH
F
. TOWN OF BARNSTABLE
C6ertifi ate of Compliance
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (XX )
by-------- J...P_..IVIa.nor?mbe.r... -Jr -•......................................................................... -------------------------------------------------......................... ...................
- Installer
at........ 5.0 .... Raid ... A-ve_...... Wes.t....Ya_rmout.h.,Ma.s-S-•----------------------------------------------------------------------------------------------------------------
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as describ ed in
the application for Disposal Works Construction Permit No. .... ... `.... .,R'._5. ....... ._ dated ..../, ...✓l ...... . ........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE ............1, ", --------------
Inspector }��y/ --