HomeMy WebLinkAboutApp-Permit-ComplianceNo... 20-/23q LW x•--1 • lam. • Fim..4011 L%r�
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...................... Y
.Town. -----....OF........... armouth.....
Appliration for Disposal 19arks Tnnstrnrtiun Pani#
Application is hereby made for a Permit to Construct (x ) or Repair ( ) an Individual Sewage Disposal
System at:
50 Rhine Road Lot 30 _ . q kA C, n ... (o_
................_..._....._....---• -._ ................................................... ...---•-----•-----------•----•••---•-------- -
Location - Address or Lot No.
German . .
Address
Nickerson _160 Mill_Hill Road So Chatham, MA 02659
•-. -- - -- ------ --•- • --- - ---• • ••............. -• •........
a Installer Address
Type of Building Size Lot ._ 14,683 ±
.......... feet
U Dwelling —No. of Bedrooms..........................................Expansion Attic ( ) Garbage Grinder ( )
p1 Other —Type of Building Single FamilyNo. of persons ............................ Showers ( ) — Cafeteria ( )
Otherfixtures----------------•---------------------.y.q.�p............................................................................................................
W Desi n Flow______________110 ____ _ _gallons per`er day. Total Bail flow__________._._____..220 gallons.
g 1000 8 6" 4'-y10" --- 4 -0"
WSeptic Tank — Liquid' capacity............gallons Length ................ Width................ Diameter--.-.._.__...... Depth.-------._._....
x
Disposal Trench — No ..................... Width .................... Total Length .................... Total leaching area .................... sq. ft.
Seepage Pit No ................... Diameter.......... ---.._ Depth below inlet.......... �...--.. Total leaching area ..-267........sq. ft.
Z Other Distribution box ( g) Dosin tank ( ) D. Mason of Yarmouth Board of Health
gFlahert Associates, Inc. 2/1/90
Percolation Test Results Performed b .................................................. ------....•---- Date-------•--......-••------------.........
as Test Pit No. 1___ �__ .....minutes peri ch Depth of Test 14 None �....... Depth to ground water. None Observed
Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground w `�.. _... ,y
---------------------------------------------
S--------------------------------------------- i• --- e ---•-----_---_----
O Soil.."-168"Fn-_toescrpono..._.F,' ... 1.._.0:73Q'1.....IQD..&..ub
_--.0 -.•_- -_
4----Jl4Afai< Fif
............ Medium $ani -?w/__Trace_.of-_hilt------------------••-----------•-•----------••••-------------•-----•--...-----
C-'-- ....... CIVIL
U Nature of Repairs or Alterations — Answer when applicable " No. 33863 Q
Agreement: �°fl0NAL
The undersigned agrees to install the aforedescribed Individual Sewage Disposal Syste
the provisions of TITLE 5 of the State Environmental Code — The undersigned further agr not po ce t e
system in operation until a Certificate of Compliance has been issued by the board of health. -r°
Signed .. �/��
-..... ................
Application Approved By ---- ---------------------------- ---
Application
-
Application Disapproved for the following reasons- ------------------- -------------------------- ----- _-------_--------------.................................... --------
- ------------------ --
........................................................... ........ Date
2 1 Q
Permit No. .. `.J Issued ��
............... ....Date ...........-..----.-.................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
AT
QxrtYfteate of C�uutlati ure
THIS IS TO CERTIFY, That thje I.t dMd�al Sewag� Disposal System constructed (�C) or Repaired ( )
Y w staller ---' ----------------------- --' ------------------------------
' �' �.
In�
at............ 1 i .� .................. - ....................................................................................................................
i ..
has been installed in accordance with the provisions of TITLE 5_of The StateEnvironmentalCode. as described in
the application for Disposal Works Construction Permit No. :%.::::�......... dated.......:....1..........;..:..�:-.........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANtEE THAT THE
SYSTEM WILL F NCTION SATISFACTORY.
DATE ......-
. �..............-�-------------------------- ----------------------- Inspector .r i.,� - � . �` �„=r