HomeMy WebLinkAbout0303 WHITE OAK TRAIL - Health 303 White Oak Trail
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH/. /
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Almliration for Disposal Works onstrnrtiun Vamit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System Pt
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......
ion-Address ) or It I }
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Owner
-Ad._e s
L_.....--!:.................•-- -...---...............--•-............................... ..........................• - ............................................
Installer Address //
Type of Building Size Lot./ ....Sq./�feet
Dwelling—No. of Bedrooms............�.......................Expansion Attic�r Garbage Grinder X VV
aOther—Type
of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
A4Other fixtures .....---------------------------------------------------------------------------
W Design Flow...............�..%,4_____...........gallons per person per dly. Total daily oflow.............�j� _..............gallons.
WSeptic Tank—Liquid capacity/®®ggallons Length.Z.%r... Width............. Diameter................ Depth.... ........
Disposal Trench—No. .................... Width ....... Total Length........._.............Total leaching area.:....; ..........sq. ft.
Seepage Pit No........./......... Diameter.... ... .... Depth b low inlet.....��__......... Total leaching area....�...r.01...sq. ft.
Z Other Distribution box Dosing tank O
Percolation Test Results Performed by.._.._, 0.0!i.e_.Y.........
_..... L ........... Date....Z . � __ �
,.a Test Pit No. 1......W_._..minutes per inch Depth of Test Pit .f......... Depth to ground water.../ ... _
fi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Q+' •----------------------------------------------------------------------------------------- :._-------------
o Description of Soil-----..... ni ................
V �V�- r .d -------- L ; !�i
_..---•-------_ -----_...- .
W
---- -------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------.------
V --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'L I TL U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance h+ben'issued teboa lth.i ne ...... Date
Application Approved By----•-------- ------- -- •. ---- ............................ ----- Z 1: /.........
Date
Application Disapproved for the following reasons:-----•-------------------------------------------------------------------------••------------------------•----•-
--•---•-•---------------------------------------------------------------------------------------------------•--------
Date
PermitNo..............................................•----..... Issued.......................
Date
s--y 1-16-�-- .fO-3 �►
L O,C AT I O N SEWAGE PERMIT NO.
l4a--7-70t 0 L L
Yll A E
Rff O
INSTA LLER'S NAME i ADDRESS
CA L
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0 U I L 0 E R OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED ��2-/fY
V4�
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No.... ,l.K. ,�,+t Fps.......
THE COMMONWEALTH OF MASSACHUSETTS 1
BOARD OF !-TEAL H
�0 _77......OF.........., CY..L.7...- ................................
, pphrFation for UhipmFa1 Works unstrurtion rrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Sysi e_ R.K /��i G� _�G 1r t�i Ile- � a � .. �.�........
__.. .... ........ ..........•. --•. ..... ---. ..------------. ..
/Ty�yyion-Address A' �/[� /�J or Lot I
.C .... ..!..C. ....�..... -!_..I..:----- -- J
E' b�
....mot . . -
......
Owner .Ad••e s..
� Installer Address / A /
Type of Building Size Lot./........................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder /VV
'4 Other—Type T e of Building No. of persons............................ Showers
0.� YP g --------•------------•------ P ( ) — Cafeteria ( )
d . Other fixtures�.•-•••------•-•-----------••-•------••---•------•----------------' '----------------- .....-- ..................................
W Design Flow...............S..u�'.____/..._._.._...gallons per person per day. Total daily/flow._._.........�,t�. ................gallo�s.
WSeptic Tank—Liquid capacity/P-Pgallons Length.ft.�.... Width__.....--... Diameter................ Depth.....4...1...
W 0 Disposal Trench—No. .................... Width_ ..__�...._.._... Total Length.__..........-.f..... Total leaching area....... ...........sq. ft.
Seepage Pit No.........�......... Diameter.... ..._..... Depth elow inlet..... ....:.::... Total leaching area... ...sq. ft.
Z Other Distribution box Dying t v Y a o2 �
''" Percolation Test Results Performed b ...... _ 0'1" e Y y 1 .
... Date... ... . ...
Test Pit No. I....... ......minutes per inch Depth of Test Pit....... ......... Depth to ground water...6D........
V-4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 .....•--•--•----•............•••••---•-•-----•-•-•---........-•------•.......................................................................................
0 Description of Soil............ ..-. ........
........----
.----•----------------------------------••-•----------------------------------•--------------•--------------_-_-----------------•----•-------•-------------... ------------
--•------------
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 TIT-TE 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 y the ebboa;d ealth.
Sign
---.......--• _.._.
�c Date
Application Approved �!'......._. !/ a
Application Disapproved for the following reasons:....... �........................................................................................................
.....................•--•--•-•-----•------..........---------------------•--------------•.....---------..._...-•--•------------------------------------•--------•-•••-•---•...---...----•••--.--•••.-•---
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.............OF....... ......................................
Trrtifiratp of Tomliliaanrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed �) or Repaired ( )
by d� y----------------------------------------------------------I------nstaller--------•---------.......... -•-----
•-_._..__..._
at........
C f >- - -•--
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.... �. . --------------- dated------------------------------------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.............................................,/l,`4 ' Inspector.............. �................----••••----••-•••••••--
tT�
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...................OF......... gyp` ._....................................
,;;- FEE_ . '.
,.s• ...
Mapimtt1 Works %'-paindrudilitt ttirrutit
Permission is hereby granted----•-•• ��
to Construct or Repair ( ) an Individual�$ewage sposa� System
at No....... '.....9.1VI.••---•-� }�, �'� `f� treet...... � ���,��'v....•-----•---
as shown the p lication for Disposal Works Construction Permit No..................... Dated..........................................
�.- ---•--•--------------------------------
DATE--------=--------------------------------------••----...............--..........
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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} FRANK
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OWNIM By
CERTIFY THAT THIS FLAN S H®WS 0 � �.e��� �?• ,�� - `
THE ACTUAL LOCATION OF THE
STRUCTURE CAN THE LAN® AND FRANK CJNERY 5 TRENTON ST.
THAT IT- CONFORMS WITH THE HYANNIS. MASS. 02501
BY-LAWS OF THE TO\yV REGIStEREID-ETiOWMA & LANDSURVEYOR