HomeMy WebLinkAbout0095 BERNARD CIRCLE - Health 95 BERNARD CIRCLE
A = 171 — 083
Centerville
5 M EAD®
N�2R
smucLeom 9 Mado In USA
No.... �..... F��.......4...:... ........�
THE COMMONWEALTH OF MASSACHUSETTS
�t� 3 BOARD OF HEALTH
g
I oF............... ��dJrtis t .
. pphration -for Rsvaoa1 Workii C owitrurtion Prruift
Application is hereby-made for a Permit to Construct ( or Repair ( } an Individual Sewage Disposal
System at
L cation-Address or Lot No.
- ---------------------------------------------------
Owner Address
Do/lo�rt /
Installer Address
d Type of Building Size Lot.... a` ---___Sq. feet
U Dwelling—No. of Bedrooms-------2---------------------------------Expansion Attic �(/(a Garbage Grinder (NO
Other—Type of Building -_---A . ---------- No. of persons--.--_-�--------------- Showers (Z� — Cafeteria ( )
Q' Other fixtures ..._.....g------------------------------- --
Design Flow.. Qallons per person per day. Total daily flow..... ` --�-6--__---------- ---------
W gallons.
WSeptic Tank—Liquid capacity4440-_gallons Length--- --_- Width..... _._.. Diameter------P..... Depth----i-a ......
x Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area---doloo-----sq. ft.
Seepage Pit ____________________ Depth below inlet-------------------- Total leaching area------------------sq. ft.
Z Other Distribution box/( ) Dosing tank ( )
aPercolation Test Results Performed by._.o - ___ !1.; !!1 l/Z.!_1'l ate....................................
a Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------
rZ4 Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
W ---•----------- ------------•--- ------------------------------------------------------
----------
---------------.....
.-------------------------------------
O Description of Soil------- !>/ __._...._.
x
_ : ---------------------------------------------------
x ------------- ----------'°- �----�r---- �--`- '�
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 Article XI.of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be en is ued by the board h$al
Signed...... -'--------------------------------------•--------------------------------- •- --------- ---------
/ Date
Application Approved By.......... _../L
Date
Application Disapproved for t ze following reasons-----------------------------------------•--•----------------------------------------------.....---•-••--••------
...........................•-•......--------•-----------------•--•--•.....•--•-----•••-•-•-••••-•----••....•-•••---.....--••----••---------•------.._.....-•----------------••----------------------•••.
//---•- ----�---- -------
Date
Permit No------��//........................................... Issued.....7 �
Date
---—----------------------------------- ----------- _ -------------------------------
J
ell
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
_....... -- .OF......................................................................................
Appliration -for Dhipwial Works Tonitrnrtion Permit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
---•--•-••-•--------------------•--•---..........--•--.......-----...-•-••---•••••••---........... ••-••••'•--••-----•••••----'-'•'------••......-••••-•----•••••-•--•-••............•--'••......---
Location•Address or Lot No.
.........-••••------------•-•---........ -- ......................
Owner Address
W
Installer Address
Q Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
per, Othet—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
Test Pit No. L---------------minutes per inch Depth of "Pest Pit.................... Depth to ground water___._._.-___.-.-.-_._.
�14 Test Pit No. 2................minutes per inch Depth of Test Pit.................--. Depth to ground water-..-------.-------......
------------•---------------------------•-------------------•------------------••--•"'-•---------'--""-•---•-•••---•--•-•-------------------------------
ODescription of Soil--------------------- --------------------------------------------------------------------------------------------------------------------------------------------------
x
r"---------------- -----r r------------------------ ----"............7---:---------------------------------------------------------------------------------------------------..-..------------
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 Article XI 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.
Signed-------------------------------------------------------------------------------------- -----•------_----------------
Date
ApplicationApproved BY--------- . /L--- '------•---•--------------------------------------------------------•--
Date
Application Disapproved for the following reasons--------------•...----------------------------------.......--------------.-.......-----------•-------------------
•...........-'---'----...-••-•--------------------------------••-----------•-•--'--'-•-••••-•'---------'•..----"-'---------------•'--•--••••-------'----------------'---- -----------------------------
Date
PermitNo------ly-1.------••'----""'--•--•--•-•-•-'-........ Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Jai Ii.Gcd9f 7l�G�C G
...........................................OF........ ..........................................................................
C.ertifirate of f'omViianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
bY---•---•----•---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Installer
at---------------------------------------------------------------------------------------------------------
has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No ---�'-/----------------------- dated_----
----.-......------------..-.--.---.__.-.--.
THE ISSUANCE OF THIS CERTIRCATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE............................................----•---------.................... Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
No......!°//........... FEE_. U
Dinpoiittl Morkii Cnooitrnrtion Permit
Permission is hereby granted.--.---;��`yC.s------__ ('IY. r:�*
to Construct (x) or Repair ( ) an Individual Sewage Disposal System
at No. 7 kI Z._3 f��' i h/ �� f--. - --rf-T r
Street
as shown on the application for Disposal Works Construction Permit No----Z!!!6........ Dated----------.._: _. . � ........
-•-•--•--------•-.......--•--'---------------------------------------------------------'---•------_...._
Board of Health
DATE_'----•........................•-•-•-----------•----........................•.
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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` I HEREBY CERTIFY THAT THE PLAN OF LAND a STRUCTURE
r "STRUCT'URE SHOWN HEREON WAS LOCATED
BY AN. ACTUAL FIELD SURVEY ON ON
APRI L 1'1.;,197 Co •AND CONFORMS TO THE
ZONING BYrLAW OF THE TOWN OF i3� �IJ A I� 1� 12C L 0Vw
'
,-MASSACHUSETTS.
MASS.
hn ,. REGISTERED LAN URVEY R
r
SCALE I"= yd . 1197
'.DATE ,��,�v.r1 OF MqS C_ 4 / S 'fJ
EDWIN A. ` CAPE COD SURVEY CONSULTANTS
YOUNG A DIVISION OF BOSTON SURVEY CONSULTANTS,INC.
9096
r �. • r + �v. �4 ROUTE 132
HYANNIS, MASS.
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