HomeMy WebLinkAbout0176 BAY LANE - Health ` "tl
176 Bay Lane
Centerville
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SEWAGE PERMIT NO.
VIL
INSTALLER'S NAME & ADDRESS
B U1'L0E R OR OWNER
DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED
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77 0 6?
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......
No.................. .............................
THE COMMONWEALTH OF MASSACHUSETTS
BOAR OF H IL
.....OF.. .... ... I
... . .........................
Appliration -for Digpaiial Workii Towitrurtion Vrrmit
Application is hereby'made for a Permit to Construct or Repair ( 4^afi�TtNvidual Sewage Disposal
System at,
... .......05_� --------- -----------------------------------------------------------------------
-
Loca*on - ------ or Lot N
...................................................
..................... . ..... Owne 7 Address
..................................................................................................
----------------------------
e; Address
Type of Building Size Lot............................Sq. feet
U
Dwelling—No. of Bedrooms___________________________________________Expansion Attic Garbage Grinder ( )
-1
a4 Other—Type of Building ____________________________ No. of persons.-_______________________.._ Showers Cafeteria ( )
Other fixtures ..... ---------------------------------------- -----------------------------------------------------------------------
---------------- ----------------
Design Flow...........................................gallons per person per day. Total daily flow----------------------------------- ........gallons.
P4 Septic Tank—Liquid capacity------------gallons Length________________ Width-____:.-_....... Diameter___-_--_-__-__ Depth-------------_
Disposal Trench-- No. ..................... Width_________..____-____ Total Length___________________- Total leaching area--------------------sq. f t.
Seepage Pit No_____________________ Diameter_____.__.______.___. Depth below inlet____________________ Total leaching area------------------sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date--------------_------------------_-----.
Test Pit No. I_-------------minutes per inch Depth of Test Pit..-________________- Depth to ground water-___-____.___-__-__--_--
�_4
44 Test Pit No. 2................minutes per inch Depth of Test Pit-___________________ Depth to ground water-..--------- -----------
P4 ------------------------------------------------------------------------4W.................................................................................
0 Description of Soil-------------- --------------------------------------------------------- -----------------------
U�4 I-------------------- ---------------------- ........7--------------------------;�--------------------------------------------------------------------------------
-- -------7_'
W --------------------------------------------------------------- --------------------------------------
U NAat ,e of Repairs or Alterations—,AAs-wer when applicable._411-��F." ----------------------
0 �0
------------------------------------------------------------ ----------------------------------------------------
g V t
reeme
The undersigned agrees to install, the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to placert6e system in
operation until a Certificate of Compliance haskeeln issued Iff the boar
------- -----------
.. . . .. ... ... ...... ..... 71/0,-7.14
e -------------- Date :77-7
7
Application Approved By__';4�..Q..15..W, ---------
Date
Application Disapproved for the following reasons:------------------------------------------ ---------------------------------------------------------------------
.........................................................................................................................................................................................................
Date
PermitNo........................................................ Issued........................................................
Date
- - - --- ------ ------------------------------------------------------------------------------------------
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No.------•7��:- Faic. ......
THE COMMONWEALTH OF MASSACHUSETTS
BOARQ OF H LT
.To"6"t ' .....OF.. ... .... .�. J -.
t 0
Appliratiutt -fur Rupuuttl Works Tows rurtiutt Prrutil
Application is hereby`made for a Permit to Construct ( ) or Repair ( krMFI-n-clividual Sewage Disposal
System at
'mot-: .,..-- •�'T ................................
Location-Address g or I of N
-t! _.t .�.... .. =' 9- Address•• Owne
--. -• -----------------------•-•--- -•---------•-------••---••-----•---------•----•-•-----•-----...• .............................
er Address
d 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 ( )
a' Other fixtures ---------------------------------
W Design Flow............................................gallons per pet-son 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. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water..-.-------.--.---.-_-
G14 Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water-_---.-----.---.--._.__.
a+' ----------------------------••-•--•-- ....................................................................................... -------_---------------------
0 Description of Soil-----------------------------------------------------------------------------------------------------------------------------------------------------------------------
x
--•----•----------------------------•---.---------•---•------------
--------------------------------------------------------------------------•--•------------------------------ ---- (QG
U Nattlye of Repairs or Alterations— wer when applicable.-._ .. _ _..
--------------------------------
--------------------------------
Ft reemen
g
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has en 'ssued b the boar f
ed. . l --•----•-- -2---•---•----•-•---
Date
Application Approved By---- •v 'la ----- - -------------------------------- -.3 �2 - 7 7
7 ----
Date
Application Disapproved for the following reasons-----------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------•----------------------------------------------------------------------------------------------------------------
Date
PermitNo......................................................... Issued...................... .................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..............O F......../�.�.. . .... .. .. .... ...'.......
(9rdifiratr of Tomplitturr
THI S C TIFY I fl, That e ividual Sewage Disposal System constructed ( ) or Repaired (�
by.... 9� ------ ----- ..........C
- - ---- ---- - ----...
Inst r
-- - -------
at ..�J •--• -•-- . . ------'---------------------------------------------
has been installed in accbrd< ce th the provisio s 0 A�t XI The State Sanitary Code as describe in the
application for Disposal Works Construction Permit No..............�/.................. dated__.-; .'z__ ..._ ._......._....._....
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE. ...................... Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD... .. O HEALT '
7
....... . ......
No......... ---•---- FEE----
DisputittT
ur mtror i t rrvai#
Permission is her by granted_-."_-_- ` .. G� _
•------------- --------------- .......................................---------
to Construct pair ( Aividual wage D s al Syste
at No j,�(
------- _ •.... ,
Street —� � `
as shown on the application for isposal Works Construction Per _--- -- ---- -- - .....
------------- ----- - --------------------- ---Glitil -
t1 Board of Health
DATE...�...../-----•-------------------------•-------------------------•------•
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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`rTH E TOWN OF BARNSTABLE
�pF Taw
OFFICE OF
s BARNSTABLE, i
9 MAO& BOARD OF, HEALTH
�p 1639. 0Q�
a NAY a� 397 MAIN STREET
HYANNIS, MASS. 02601