HomeMy WebLinkAboutApp-Permit-ComplianceNo....... : ........ .......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Town ---------------OF........... Yarmouth
..------------------------------------------------------------------------•
Appliration for Uispaoal Works Corm rnrtion 1hrutit
Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal
System at:
• •-•-•--....._._.16 Rhine Road Lot 36 VoY-f-!..........--
............................................. •-•-•----•..._.....
Location - Address or Lot
German Hill Estates Associates/Barnstable Holding Co. 100 West lain St. Hyannis, MA 0260
.... -- - --•• - ....... ....----------------•-._........•••--------------------------•------------•---••--.....•------•--•----•-----_____•---•--_...--
Owner Ad ress
W T.W. Nickerson 160 Mill Hill Road o - Chatham, MA 02659
,-a ------....-•-----•----•-•-------•---------------•-•-•--••-----------•............---
dres'--....._--•-------
� Installer Address
d Type of Building Size Lot__ 12., 947 ± Sq. feet
U Dwelling —No. of Bedrooms ............................................ Expansion Attic" ( ) Garbage Grinder ( )
e of Building Single Fami
Other — T p ( ) — ( )
YP g -
Single --• m - o. of persons Showers Cafeteria
Other
W fixtures
10� N-------------•---------------------------•----•--•-------- 2--20..- ----••-----------.-_-------------
Design Flow ..................................
---gallons per�peray. Total
s6 to .
WSeptic Tank — Liquid capacity.._.....•.•.gallons Length ................ Width ................ Diameter ................ Depth ..... ...........
x Disposal Trench — No ..................... Width .......... ________. Total Length ...... 6T ------- Total leaching area ..... _ sq. ft.
l 10 657.r
Seepage Pit No ..................... Diameter.........._......... De th below inlet ---- Total lea h
p D. Mason o Yarmouth -c13.,85?rea____" "" ..... sq. ft.
Z Other Distribution box ( X) Dosing tank
�-+ Flah r y Associates, Inc. 2/1/90
a Percolation Test Results Performed by ................. T _._. Date•-•--_._____-__.__
4--------•----•-••---------i�--...--•------- -- N-oiie"CFiserved
Test Pit No. 1..............:.minutes per inch Depth of Test Pit .................... Depth to ground water ........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit ............... _---- Depth to ground water ........................
.-••-•-------•••••••--------••----••-........•••-------••--•-•-----••----------•--..._....••----•--- ...........................
O Description of Soil ......T,_g...... 1 ----- OP-3a==••3'op.--&--- S4bsail--3.0.=-'-168' _Fine ... to._Medium_Of _
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` w{ •• ..84.1-t-7 --•----••_...-•-- - ------------------------------ -------------•••---. �t . -- .
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L> Nature of Rep ter) FEAt IE�iTY ,,,
IMPO'�'
L ---- MESSAGE
Q)DIVi
Agreement: For
The unde al Syste
the provisions DaY Time P M rther agr 6Nkb
system in oper M wealth. Z N ��
Of
Application A
Application D- Phone �®
FAX Area cows Number Extension
...................... --------- MOBILE
Permi Area Code Number Extension
at ---------- i (`
has been it
the applica
THE I:
SYSTEM V
DATE
Telephoned
Returned your call
RUSH
'Came to see you
Please call
Special attention
Wants to see you
Will call again
Caller on hold
.....................I.�..� ea....�.....
etc)
1T Dale
Dare
Message c3.rhe sr L( �►�r,
01
% c :ed ) or Repaired ( )
----------------------------------------------r-----------------
onmental Co s d
r
e " nbed in
Signed dated --------- .........
�niversW'g8o23 -� A GUARA EE THAT THE
1`S LITHO IN U.S.A. L__i
%� %F? /,(------------------------------------------------------- Inspectf) � .... .
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