HomeMy WebLinkAbout0009 FULLER ROAD - Health (2) q W.Pr fidj (and.
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No.f Z17... ' Fx$Jr � .................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
. ........................O F..............-.......................... .....
ApplirFation for DiopooFal Workii Towitratrtion Urrntit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
Fuller Road Lot "J" /'
................__......-----...... .. ....•---•---•--.........---•---------- .......------..... •----...._. ...--••--•. ---•---..----------•--• ---
Location-Address or Lot No.
...Vats,x1sL,.._.lac..y...11cla Ali qu patz.e_,...L)zes.•................. ...7.b a.....Weat.-I laim-_.St......Hyann.is.,...MA.....Q2 fzQ1....
Owner Address
a ..Axch..QQas.tru Coas.tructimi....................................................... --Hyjann-is.,..MA....................................................................
Installer Address
Type of Building Size Lot2Q-,.03_5.............Sq. feet
U Dwelling—No. of Bedrooms............ ..............................Expansion Attic ( ) Garbage Grinder ( —)
aOther
—Type of Building tWoOd...Fr-a[aP.___ No. of persons......6.................... Showers (2 ) — Cafeteria ( —)
dOther fixtures ..---------•-------------------------------•----------.-•••----•-•----•••••---•-----------•--•------•--------•------•-----•----------.............----
W Design Flow........55...............................gallons per person per day. Total daily flow-------------330.......................gallons.
WSeptic Tank—Liquid capacity1.,OQQgallons Length....--......... Width__.n........... Diameter--------------- Depth......-.......
x Disposal Trench—No. ...X/A......... Width.......-........... Total Length.........-......... Total leaching area..........-........sq. ft.
Seepage Pit No.......1........... Diameter-----1.2.......... Depth below inlet...4............... Total leaching area.2.54..........sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
1.4 Test Pit No. 1___ 2....minutes per inch Depth of Test Pit._12!............ Depth to ground water_11==erwountered
fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
W ...-.................................................................................................................................... ---------------•--
O Description of Soil......'M I19am- &..sub---aoll.......Z'=4°...m_e iunL--sand..mixPd--w;Ltb-..grayel-,
U - 4 12 IQ�S�I�ICI__.^tryrld...---•----•---•--------•----•..........................•----•------•--•---•-----•--•----••--------------------------------•--•---------•---------•-
W
VNature 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 U 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been iss-ed b�y th board of health.Sign d----------• . --�.� ------`•-------------•-------•--•---• --- ---- •- ......_
D
Application Approved By---- . •. --------------------------------•-•--------------•-----•----•-------_.. 1'_= .:
=----------
D e
Application Disapproved r e following reasons---------------------•-------•-----------------------------------------------•-----------------------------•-•••-
--------------------------------------•-•-------------------...-----------...-•----------....--------•---•-----•--•------•-•-•-------------------.....•-----•---•-•-------...-•--------------•-•----••--
Date
PermitNo......................................................... Issued.......................................................
Date
NoV..:yz.- .................
THE COMMONWEALTH OF MASSACHUSETTS
r
BOARD OF HEALTH
..........................................OF........................................
Appliration for Disposal Works f Tonstrn.r#ion Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
.................._.kUI.P-r...Road................................................... ..........................L a.t.. J1t.......................................................
Valand,Inc., DofiocI ku'Vtrt% Pres, 765 West Main S'E:;t �annis; MA 02601
......................__.................................••--•----•-----•--•--•-••._.......----- •--....---. . ----•----------•-=-----•-------. ------•---
W Arch Construction °"°� Hyannis, MA 02 ess
a nstaller••------••--•--•••-•--•---•• ----- --•--------- --------- -------------------------
I
� Address
UType of Building Size Lot..20,_03.fi...........Sq. feet
., Dwelling—No. of Bedrooms.............3............................Expansion Attic ( -) Garbage Grinder (= )
aOther—Type of Building .WQ -•.Qd._Fxarle No. of persons........6.................. Showers (2 ) — Cafeteria
dOther fixtures .---.....-•----•----------•-----------------------•----•-•-•-••-----...-•----....-•--•--•-•------......--------------•-•-..•---•----------•----•--••-
W Design Flow..............55.........................-gallons per person per day. Total daily flow--------33Q_.............................gallons.
WSeptic Tank—Liquid capacity..L.A0 allons Length......:------- Width.... ......... Diameter--------------- Depth...-..........
x Disposal Trench—No...NIA-......... Width.........-_........ Total Length...--.............. Total leaching area.....-.............sq. ft.
Seepage Pit No...... Diameter....12_`......... Depth below inlet....4............. Total leaching area...264........sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
IH Percolation Test Results Performed by.......................................................................... Date..........=..............-..............
W
Test Pit No. 1..!...2--.-minutes per inch Depth of Test Pit.................... Depth to ground water-._-_-_------.-.-..-.---
GL, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
04 •---•----------•-•-------------------•-••---........---•------.....-----......--•---............--•.........................................................
D Description of Soil..�r.^2 . LQam__&•sub soil,._._ 2'.-4'.._Medium sand mixed with gravel,
x4----12 --medium__sand. ....... ............. .... .......•-------•-•----••---•-----•--•--•••---•-•------•-- ------•. •....--- ---------
V -
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 TIT11 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been�byt. d of health.
Sig d--
Application Approved By..... f"J•-•--•-------•--- •----•.. ..................•- -••---......
Date
Application Disapproved or he following reasons:..........................................................
--••.............•--------....---•---•--...-------•------•--•------------...----•-------.......-----•--------•-•-------------•-•-------------------••••-••----•-•--••-----•••-----------------•......._.
t. -f ...�. Date
Permit No-----------------------------------•--•---••--•...t. ; i Issued
.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.........................I................OF.....................................................................................
(9rdif irtt#r of Tnntplianrr
I S TO CERTIFY, That the Individual"I Sewage Disposal System constructed ( or Repaired ( )
by -!� --------.- '_ -- -------•-------.--•-----•-------•----------------•-------------------------•--•-------------•--
'Installer
�-
at----•--=-------------•--------•-----------•--..:..--•-'-----t... _..r_.._..._...----------•-------------------•----•--••-------------------------------•----------•---•- :i�e'd...
been installed in accordance with the provisions of T TLEE 5,Q The State Sanitary Cody as Ibed in the
application for Disposal Works Construction Permit NO.__-__�--°2_f�__________________ dated. fA ...............................
ISSUANCE.OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
i,.,:
DATE......................1:0.----....--.-•-5 A`-�'�Z1....------. Inspector-----------)L(e I.............................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
No......................... FEE........................
Works �aan #rilan lettti#
Permission is.,hereby granted.......... =•--- ----------------------------------------
------------------------
----------••-•---..--•--------
to Construct :) � r ( _fin Indivival a Disposal System
atNo. ___________________J.....__....__......_..._.._._......____.....___..__...................................................
Street
as shown on the application for'Disposal Works Construction Permit No.......... '_._0Dated..........................................
............................. -•------...............................................................
Board of Health
DATE -,ts---.�J..--�-•-----------•--•-----•-•----•--•-------.....
FORM 1255 A. M. SULKIN, INC., BOSTON
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