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HomeMy WebLinkAbout0893 YARMOUTH ROAD - Health 893 �axr� �Q.aa�, Ini� No......_...� Fmc.............................. THE COMMONWEALTH OF MASSAC•HUSETTS BOARD OF HEALTH .C?.. /...l�l---.....OF.....'[ Pry, ..t - .� .. � �_ra Appliration for Disposal Works Tonitrnrtion Prrutit Application is hereby made for a Permit to Construct ( V) or Repair ( ) an Individual Sewage Disposal System at: ..9Y^x 0. r..M.. x�...... Yr� . 1�. L.Q_r.9c._._:P gip_ ... .K: ®` -�P- :-- Location-Address or Lot No. -6i�tAbt F--MC---_/-�.1iQ_� .... ... �r..to...PiAY L... in, L i. Owner Address ......VET c rZ t.rat.Q--------------------------------------------- ---13R&,&65-.......LA.ur.....BAR'N a Installer Address Type of Building Size Lot------------------_-------Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ). Pk Other—Type of Building _5..HJ2.P......... No. of persons.........Z-............. Showers (W) — Cafeteria (0d) wOther fixtures ... ...........Z.... _l..hl.t4 -------•------•------ --------•--- -- -----•-•-•-••-----------. . --- w Design Flow................JI&I.....................gallons per person per day. Total daily flow-------_L.QA..........................gallons. WSeptic Tank—Liquid capacity!®-?©...gallons Length...._.I........ Width..... .......... Diameter---------------- Depth..._............ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------i------------- Diameter.........1hP't_Z Depth below in jet ______ Total leaching area... !P...sq. ft. Z Other Distribution box (i/ ) Dosing tank (A)o) A� �0W" �� ` !� 7� '—' Percolation Test Results Performed by............ Axraa...e...Nye.................... Date.../b/Z ./7 7.__..... aTest Pit No. 1......?---------minutes per inch Depth of Test Pit.....L.Z ----- Depth to ground water........7------------- G%, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -------•---------------------•---•••-----•-•----•...---------•----------.................-----------......................................................... 0 Description of Soil--------. .......45- - , T.......... .. z x w U Nature of Repairs or Alterations—Answer when applicable...._........................................................................................... -•-------------------------•--••--------------------------•---•--••--------------------......-•------------------------.....---------•-------••------------•---------------------------••--•...-------- Agreement: The undersigned agrees to install the aforedescribed.Individual Sewage Disposal System in accordance with the provisions of TI'L 1E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by he board of health. Sig ed : . �./-1-.�°��'� (c � -Date ApplicationApproved By---••-... .' --. •--- ............1...-- ------ f------------•-•----------------- .../1..........�7.............. Date Application Disapproved for the following reasons---------------•-----------------•---------------------•--------------------------------------- •--------------------•--------------.......----•...---•------•••••---.........•-----.........--------•-•-------------------------------------•------------•-•--•-•-•-----------------------------.._.... Date Permit No......................................................... Issued---------........... � ------------------------------- Date , No... .� Fzs....A .--.--. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �.W..... ...............OF....... ..................... Appliration for Disposal Works Tontratrtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual"Sewage Disposal System at ...._ [z.:._.� Y ..N ............. s3.a R -t�- :.._53..._. Location-Address or Lot:N 411. ..7..NE.Y... ..���A.�i.1�1E.._I`�]ccaA�?--•-- - 3. .,7... A�(--1-fA. .E .1 �.(�.��lClL4,E._. Owner. Address .......................... +!? :::_I� .5..... fi2l►!�_, Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building _SAa. ..... No. of persons...... ............... Showers (tea) — Cafeteria a d Other fixtur s ..:[ T� .................. : S I . ................... . gallons per person per day. Total daily flow..............t.p./......................gallons. � etic T nk Liquid ca•ac Design P q p >tyr�PsP---•gallons Length------9!----- Width;,-4,-------- Diameter---------------- Depth................ W Disposal Trench—No..................... Width.................... Total Length .. Total leaching area....................sq. ft. Seepage"Pit No......l.__.---------- Diameter._G*..z..... Depth below i et .� L. Total leaching area.-e.O....sq. ft. Z Other Distribution box (V Dosing tank (No) C� /0 ` I �► T .. ~" Percolation Test Results Performed by....... .A.X_T.a.l-... ....................... Date...1.0_1Z l__..:rT__..._..... Test Pit No. 1......I.........minutes per inch Depth of Test Pit......1_Z.`__::: Degth.tground water....______________" (s, Test.Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R4 ---•-----•--------•------------------------------- ------------------------------------------- ------------ Q;'r. Description of Soil......... .Ll_l�l.......M-e DL V-I...-----.. N D............4-:----T Q Z .........;,I :. ------------------••------•---•-----------•-_------•- -----•••... W ....•---•-•-•----------------•----------------••------•-•-•-----•---•---•-•--------•••••••---•--•---•--•••-••-•-••••---.....-••--------•---•--•---•••---••••-•--••••-•......-•-••-•• t: U Nature of Repairs or Alterations—Answer when applicable.................................................... ............................................ ,....._.... ` = Agreement: The '6ersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the;.provisioris of TITIZ- 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. 'X Si d----•- •--••--•_• ----------------------- g , '' • _ Date Application Approved By.......... .r= �...... ,. Date Application Disapproved for the following reasons:---.n....----•----------•--•---------------------------------•----------------•-------------•------•-•......•- --••--------------------------------------------------------------------------=--------------------•-•---•-•--•-•----•--•--- --------............................................................. S Date PermitNo---------------------------------------- ,:. Issued...-----•••-•-•-----------••--•-==••----•-- ------------------ Date THE COMMONWEALTH,—OF MASSACHUSETTS N BOARD OF ' HEALTH r ..OF..... Tntifiratr of (lor4pliFanrr T I .TO CE TIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) by------- ...I �: __..04lrll"J--'..:............ ... ---------- -•--------------•-------------.....-------------......-- ,j/� f /il'nst .a£._. .1Jt -- <`1 EA ! / -�21 y �.taa-tR; 4- ------------------------------------------•- has been installed in accordance with the ro sions l ofi�The State Sanitar Code as described in the P > Yapplication for Disposal Works Construction Permit ...7 d-5�"-------------••- dated /,,, 7--7.......................... THE ISSUANCE OF THIS CERTIFICATE SH °tL NOT BE CONSTRUED'AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.:...... .. ............. - ... .....:................... ..Inspector. = ............................................=-........ V THE COMMONWEALTH OF MASSACHUSETTS k. BOARD F HEALTH70 s— ................OF......X04113��4.......................... ` 7 ,, FE Imo.......... _ �t� ar ork� on��r�tr#ion�� �ernti� Permissi n hereby grantea:... .Q ._... 1t '......_.....................................................................L............... to Constru ) r epa>r ) an I' * u }�evir ge Disposal Sy,ifeni atN`o�J •_ a `/1 yt-- - jj" -•--------••------•-••-•-----•............................ as shown on the application for Disposal Works Construction P it N Dated ._,.,.___ '_ '............... = � �� ---------- ------------ e _ ��.. , %/ dhr3 of Healt DATE----=-= -------�------------._.-•----------------------•---- -.-----•--•---- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS t C©M E.RC 1 Ate` 4'' fi taL L: % 3>dt t_ti( cww -- 1IC) 4 3 = "CSC? G.P-V. �ti 8� l u 4; I O CX3 IG,A L. . ,j:)ISP'oSA,L PIT - USE I000 1 y ac/ALL AEA = t50 tC_>Ca SF BVrT'TO,(A Aef=_A r r-�O Sr-. 5t TOTAL �ESIGIJ = 4'L5 ToT41-- 33o6.PD. '�' GT_=2GDt_1&T1OQ C2l_\TE Clo Smi.w' OIZ Lr--%. 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