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Home My WebLink About0741 YARMOUTH ROAD UNIT #A - Health 741. YARMOUTH ROAD 1 345-008 HYAl®NIS i i � I 1 ' 1 f a li i No ..��..�� Fis...,��...'........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................OF............................................----.........._...._....._....---------------• Appliration for Diipo,ial Works Tonstrnr#'ion 1hrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ! ��- ............................ 1...,l Q..�f/. ............................ --..........._..-•---•-....._..--••--•---•- --........_............_................. — Location- ess or ;,ot No. ..46..w.-1-1 . .. .. C• V-I-•-•--•-^-•-----•-•--..... a.�t.a�..!--f•-•---....----•-------•....................... Owner' ...............•.Address W Installer Address dType of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other 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 ( ) ►-' Percolation Test Results Performed by.......................................................................... Date........................................ 1-4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �+ ..---------••......................................................... .•-•-•--------...------•............•----•------.....-------•---.._..•----- ODescription of Soil..................................................................................... .....................................................=............................ x c., ----------------------•------------------- W •-•------------- ---------------•---••---------.....:-----------•---•-•--•---------...•-••.._.--------•---...-•--�av-- - -- UNature of Repairs or Alterations—Answer when applicable...._..... __4.1�..J'�..___*_.._......,...--__________________ Agreement: The undersigned agrees to install the aforedescribed. Individual Sewage Disposal System in accordance with the provisions of LITLL 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issued by the board of health. Sign .._ . .......................................................... GJ�. ApplicationApproved By............... -- ------------------------------•--•-----•.................. ...... Date Application Disapproved for the to g reasons:•-•--•-•----•-•-•••--.....-••-•-..........-•-----------•--•-.....-•--•-----.....•............................... Date PermitNo......................................................... Issued........................................................ Date H3 No ... FEB./ ............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................OF.......................................... ... ....... Applirttiiun for Bi_qpu,ittl Workii Ton,sirnriiun rantit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: �,,,, ................... �'.r.. �,.. 1 �--7---- ...................... •---...-•--••----...-----..........._....... .._•------•-••-----•-----••-•--•-••----•-- Location- less or ;rot No. 3 L.. _ (I -•----------------- . .z .. Owner Address W - j a ................... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures --------------------------------------------•---------............................................. 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........................................ a 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........................ 174 ...•-•••-•••-----------•--.....•.................••-•••---..........•-•-............._......._....--•----•-••------•--------..................••-•---........ 0 Description of Soil........................................................................................................................................................................ U W Ot x --- ••----••----------------••-- ---------------------------------------------------------------------------------------------- ................................... U Nature of Repairs or Alterations—Answer when applicable........ _. .►t___ 't...+........17.. -----•-••----••-•. ----------------------------•••••---•--••••-•••--••••-•--•••-••••••••••-••••••-••-••.......•--•--........_....•-••••••--•••••---••••••...-••----••••................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI is 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be n issued by the board of health. Sign _ ................................................. ..p...._ - a Application Approved By............... -•--•-- --.......'G---�-•-----•--- . .3 Date Application Disapproved for the o g reasons:-----------•---•------------•----------------------•--•-------------------------•---•...._......•----.....------ ---••-•-••--•••••••••-••••----•-•---•••-•-••-•••••••••••-•--••--•-•••-•-•--••.._..•-•........................._•-••--•-------••••....•--•-••-•-••-----•••-•••--•-•------•------•--•.......................... Date PermitNo......................................................... Issued........... .......................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... ` (9rdifiratr of Tomptianrr TH ,S 1-�I CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (k#) bY--'-'--. -------- - •-•------ ..................................... -•-------------•--......•..........-•-•--........-------•.....-------•-------•-••----••-----. Installer at.................... •••• ••-••------....._...•-•-••----••......•-••._.. . ...... •.......... has been installed in accordance with the provisions of TIrI,1 j,gf� he State Sanitary CPcie d s in the application for Disposal Works Construction Permit No.. _..� dated..../_1-1 THEJSSUA'NCE F THIS CERTIFICATE SHALL NOT BE CONSTRUE® A GUARANTEE THAT THE SYSTEM WILL U TION SATISFACTORY. L pp�� DATE..../.D V........-•............................ Inspector .--....... -•-••----.......••....................................... THE COMMONWEALTH OF M ACHUSETTS BOARD OF HEALTH Q ..........................................OF..........---••••••••••..........................•••••-•••._....................... D No.. FEE... ............. �iu�rou u �onu�r�rtion rrnti� Permissioni her b granted------......• --•••••...• •......•-••••-•••••-••••-•••••••-•••••-••••••--•-••••-•••••••-••-••••••........••--••............................ to Construct or pair an idu Sewage Disposal System atNo..._.. ... .......................................... ---------------- Street - as shown on/thhealicatio for Disposal Works Construction Permit N .._. ....._._.. Dated..........................................-•-•- ... -- -••...•----...••-•••--•••-••••--•..............•---••---••---.... �/ Board of Health DATE-•-••• ._O FORM 1255 A. M. SULKIN, INC., BOSTON LOCATION SEWAGE PERMIT NO. VILLAGE w'( /auJ 5 7-' INSTA LLER'SAA NAME 6 ADDRESS a V I L D E R OR OWNER _ 5% Ta -nZ-,e f 7ec DATE PERMIT ISSUED ^ � -- DATE COMPLIANCE ISSUED t i O �. N W __� t --