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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
....................... !own: ----....OF ........ Yarmouth
Appliration for Disposal Works Tonstrurtiuu 1hrutit
Application is hereby made for a Permit to Construct ( X) or Repair ( } an Individual Sewage Disposal
System at:
13 Rhine Road
Location - Address
German Hill Estates AssociatesBarnstable
...................... .......................................................................
Owner
T.W. Nickerson
--------------------•••--•.......----------•------------•-•--_..,.
Installer
Type of Building
Dwelling- No. of Bedrooms ................. 2 .........
Other—Type of Building ,Single Familo
Other fixtures
-Lot 20 IM p P-836
-------------------•-----------...._
or Lot No.
Holding Co. 100 W. Main St: Hyannis, -MA 02601
Address
So. Chatham, MA 02659
....---•------------------•---•---....--••-------....-------------...........•-•---••-
Address
Size Lot ------ 8 28._ ±_____Sq. feet
...Expansion Attic ( ) Garbage Grinder ( )
of persons ............................ Showers ( ) — Cafeteria ( )
................................ ----•-..•••••---------•---•--------•-•-- --- •------••--•••-•-•--•--------...----------••---------••-
Design Flow .......... 110________________________•_ -_gallons per
'W ill r�day. Total daily flow____.___.___.___•220-----------------.._ 0loi��s.
Septic Tank — Liquid capacity. 1000 gallons Length 8._.__6_.___ Width_4___-10_._ Diameter________ Depth ....... -0___.
Disposal Trench — No ..................... Width .................... Total Length ..........� ........ Total leaching area .................... sq. ft.
Seepage Pit No ............ Diameter ....... Depth below inlet ...... 6_........... Total leaching area.. 267.'.1.... sq. ft.
-Other Distribution box ( X) Dosing tank ( ) D. Mason - Yarmouth B.O.H.
Percolation Test Results Performed by ...... Flaherty__Associates,... nc.______ Date --- .___2•_�l/90
Test Pit No. 1___-__3 ....... minutes per inch Depth of Test Pit _.___ 14'___... Depth to ground water... N.on.eobserved
-- ---
Test Pit No. 2................minutes per inch Depth of Test Pit .................... Depth to ground water.,...___/_
Description of Soil....T,P_.___j�l_ 0"_-31" Top __and Subsoil 30"-168" Fine to Medium Sand with !(�o
------------------------------------------------ -
ilt---_...__
-----------------------------------------------------------------------------•----------------------------------------------------------.--------------------•---••
Nature of Repairs or Alterations — Answer when applicable..........................................................
Agreement : <-^
The undersigned agrees to install the aforedescribed Individual Sewage Disposal Syst
the provisions of iITiE 5 of the State Sanitary Code — The undersigned further agrees not
operation until a Certificate of Compliance has been issued by the board of health.
.- _I
Sign '� •-- ..... �'! .. r I 5' D
Date
Application Approved By- .................. LU
�.
Date
Application Disapproved for the following reasons--------------------------------------------------------------------------------------•---•--•------•-------•-
------------------------••--••----.........--------...---------------•--------•--------------------•---......_..---------------- ---------------------------------------•-•-•--•----------------•-_-----
_Date
Permit No. -........ 1--•------------------------ Issued------�0 ...............
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.......................................... OF............). .'.....:.:.� ..'...... { ..:......:..............................
Tertifiratr of Toutpliuurr
THIS IS T9 _C.ERTIFY,. uTha the Individual Sewage Disposal System constructed (�`) or Repaired ( )
b1�1 _...:1�.. _��,�. i_...--------•------------- --- ---------------------------------------------'-----------------------------------
Y .. ..
Irotaller
............................................
------------------•--------------------------------------------------•-----••-•---------•--
has been installed in accordance with the provisions of T m TZ 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No..'..lc........... .................. dated_ .______L,�_
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCT�ON SATISFACTORY.
Inspector.
DATE .................. - - ...:. __..