HomeMy WebLinkAboutApp-Permit-ComplianceNo.•--� I�1-1...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Town Yarmouth
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Appliration for Disposal Works Tonstrnrtion Prrmit
Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal
System at
42 Rhine Road Lot 32 V --A 1, P-- 816
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Location - Address or Lot No.
._G m n..l i.U..Estates.-.Asaari a-tesfBarnztahlzilal�ing--Go......10Q..WI --- 0260. -
Owner Address
T� ... ik�?rso---------•--------•-•--------------------••------------------.. ......0iatLham..--Z---Q2.(i59.
Installer Address
Type of Building Size Lot ..... 12_,.132 --- ±.... Sq. feet
Dwelling —No. of Bedrooms.............................2..._..._......Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building .Single__FamilNo. of persons ............................ Showers ( ) — Cafeteria ( )
Other fixtures ........................................
gallons.
Design Flow ............ 110_________________________gallons per Per day. Total daily flow.._......220••_______-___-• . • __
Septic Tank —Liquid* capacity..l000gallons Length.$.....6 . Width. 4'.-10" Diameter ------- Depth ... 4'_ -Off.
Disposal Trench — No ..................... Width .................... Total Length .............. ...... Total leaching area .................... sq. ft.
Seepage Pit No ........... Diameter .......... Depth below inlet .......... _........ Total leaching area.•.._267r.1sq. ft.
Other Distribution box ( X) Dosing tank ( ) D. Mason of Yarmouth Board of Health
Percolation Test Results Performed by.._Flaherty Associatesz Inc: Date ..... 2�1�90
Test Pit No. I ......... 4._ minutes per inch Depth of Test Pit ...... 14......... Depth to ground water. None__ Observed
Test Pit No. 2................minutes per inch Depth of Test Pit .................... Depth to ground water. _......
Description of Soi1..T.... _-..1-_-_-0"-30"_ To .._....Subsoil-_-_30"-168"__Fine..to .Medium _ ��.�� -------
Sand
VY
•-••------- Sand__w/_ Some...Silt ..._Boulders------ ------- ..-•- • --•-- .....--• •......... ''MARK
- - ----RK
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✓ Nature of Repairs or Alterations —Answer when applicable__________________________________________________________ ..,�.p�9:_�n..�
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Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in S lih
the provisions of TITLE 5 of the State Environmental Code — The undersigned further agr
system in operation until a Certificate of Compliance has been issued by the board of health. �f l�o
� Dace
Application Approved By --- ------..............................................................%%q6
Date
Application Disapproved for the following reasons---------------------------------------------------------------- --------- - ---------------------------- -------------------..........
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n �^' ��^^ /�, Date
PermitNo. .................................................... Issued ------......-• - .. tJ- =l -(,1. ---------------------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF t- ... .. .
........................................... �.._...... 5..........................____.............
Gertift-ctt#e of %Q11= 11inu e
THIS�TQ CERTIFY, That the Individual �ewage Disposal System constructed ( / ) or Repaired ( )
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tI taller
lY 7 4
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Codg 4s des `ribed in
the application for Disposal Works Construction Permit No. _.`_:._!..t...�.. k i ............... dated ...... .... :: =:. --f-i .....
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED ASA GUARANTEE TAT THE
SYSTEM WILL FU14CTION SATISFACTORY.
DATE Z% C Inspector`l t ' . ..................................
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