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HomeMy WebLinkAbout0150 OLD YARMOUTH ROAD - Health 150 Old Yarmouth Road A= 344—021 Yarmouth I-� . L 0 C As ION �I E W - E PERMIT NO. ��D C/�-� `moo a� VILLA'CE INSTALLER'S NAME i ADDRESS ,. CRC MEDERM 0, 142 Corporation Street 114 - " OR OWNER lijlfiftlsr Mks. 7 Pd DATE PERMIT ISS ED DATE COMPLIANCE ISSUED �� �';,r o i � , � ----� � � �� �� � \ i - - - - � � .---© � / % -� � - - ��� �- . No. _ g®� _ Fps.. .......` .............. �\ THE COMMONWEALTH OF MASSACHUSETTS BOAR® DF HEALTH .............. ---........OF... ............ ........................................................... i Appliration for Disposal Works Tonstrurtiun rrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Indi�idual Sewage Disposal System at: R� ............................. -�--- ---- ...-•-•-------••--•---•---------•----...........------•-------------•---'--.........-------- o a_tion_ s or o w Owner �/ r s �- a _ . ... ............•---.......--.. .. ------- Installer Address; Type tof Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) U Other—Type of Building No. of persons............................ Showers Pa YP g ... P ( ) Cafeteria ) Otherfixtures ........... -••--•----••---•--••---••-•••-•-•----•----.....-•----•--•------•-------•--......_..--•-------•-.....-•-••-•-•-•----•-•-•-•••--•---•:..•-•-- W `Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 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..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-, Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •---•--------•-•• •-------••• ----•---•-•---••--•••-•-••---••--------•-------••-•••-•••••.........-•••...............•---•-...---••----•-••....:-•-..••-- O Description of Soil........................... ... ..................... .. ---•--•-----......--•-------------•-------------------......------......------......--..........•-•------- x w -•-•-• ................................ ------•--•-- - ------------- V Nature of Repairs or Alterations—Answer when applicable....... .......... ....... ........... • ---------•9toinstall --•-i��... • --------------- ----- -•-•--•-----•------------------------------------------------•------- Agree nt: The undersigned agre the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I'A LE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has een is b34he board o heal . l Sh*gne ' �.--- - -- - ---- - ----- APPlication Approved BY - •- --•--------------- ------- --- ` ate Application Disapproved for the follow g reasons------------------•--------------------------------------------•-------------•-------......--------........------ ------------------------------ --------- ------------- -............................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date No... _.... F.Hs............._............... THE COMMONWEALTH OF MASSACHUSETTS • BOARD,.PF HEALTH Z Appliratiou `far 11ispnaai Works Tonatrnr#ion Errant Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at• }. Old 174 ,t t .................sI.............................. .............. ....................................................` ---------- .........._--- " L cation Address �e + No / .................................. ` `r . ....... ............. _.J � ' ---- .� ow ."ram /" ........................................... .�a ... Installer Address - Type of Buildin Size Lot..................--- feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a'4 Other—T e of Building No. of persons............................ Showers — YP g ----•----------•------------ P ( ) Cafeteria ( ) POther fixtures -------••------------------------•---------------------•--•-•••------••---•-----•••-------••--•---•--••-•---••----•------•-......-•--------------••- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 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..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................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........................ 0 Description of Soil---------------------- . --- �! ___ x ---------------------------------------•-•-----•------ --------- - ----------•----- ---------•---------------•--•------------•-------•-----•--__------------- W Nature of Repairs or Alterations—Answer when applicable. _.__ Q •- J •"'Y..�+4M1++'t,,".••s-•..'.��,..r" � ,drrw'• tieP„w'".�•^� " u- �;"' Agreerfient: 3 The undersigned agre s�to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system i operation until a Certificate of Compliance has een is by—the board of health. f f gne t j ._.._ .. ..-•-• --------•--------•-------------• Application Approved BY _ . ....-•-----•---------- ----------•------- ............... ate-----•--------' Application Disapproved for the f ollo g reasons----------------------------•--•-----•------------------------------------------•-- ............................................................... ...............................................:................................................................................. Date `-Permit No....................................................... Issued_.................................................. Date ° THE COMMONWEALTH OF MASSACHUSETTS BOARDF HEALTH • 0r7.. -•..............OF..... y` ` .... ............................................................... 101� (9rdifiratr of T,amphanrr THIS IS CE-RTIF. That ,& Ingdividual SewageD,.isposal System constructed ( ) or Repaired ) l.r .w by ..--..�.........-.. .,j -= = � r..x - .� �......_.... at_'•----��"==-9'�-•- "`=`-� -- �} _ ,,..Rr�'............................................ ��� ------------------------- has-beenNinstalled in accordance with the provisions of TITLY, 5 of T e/ tate Sanitary (1,ode as described in the applicatioh for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST ED AS A GU ANTES THAT THE SYSTEM WILL FU6TION SATISFACTORY.DATE...................•. . .... Inspector -- . ....-•-----------•-----•- THE COMMONWEALTH OF MASSACHUSETTS ��---� BOAR,jD- F` HEALTH , .................. FEE_...........---......... Disposal rka Tv/tv#r3� ian $F. i.Permission is hereby granted-- ' --.--•=------------- ri-..� ------ -•------ ---..... --- •----•--_.... to Construcf`y/y'' +�) orilepa>r f Individua}(/ySewa Ispo Sy+te ' Street ,.. �l as s1 own on the applicatidn for Disposal.Work Construcrion Permit o... .�� Dated_._ .1_�!�_ . .......... s° ..........................•--- - ..•------•._......--- 1ATE.... oard of Health -- ---- ---------- -- -•---••,-........................................ ORM 1255 A. M. SULKIN, INC., BOSTON -