HomeMy WebLinkAbout0412 NYE ROAD - Health (2) i
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THE COMMONWEALTH OF MASSACHUSETTS A
f 00 BOARD OF HEALTH
OF......... ...........................
Apphration -for Rapoiittl Workii Towitrurtion Prrinit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
Location-Address y or Lot No.
�� 1 y/
Owner � Address
W /
'--•-•------ Q
Install Address
UType of Building Size Lot_-1. �-____ Ei._....Sq. feet
U Dwelling=No. of Bedrooms-----3...................................Expansion Attic (;/} Garbage Grinder ( )
Other—T'y`ptr of Building No. of persons____1/--------------------- Showers ( ) — Cafeteria ( )
a' Other fixtures 1 :----�----:$�e8_ -- ----------------------------•---• ......................... .........................................
Q
W Design F low-------------- per person per day. Total daily flow..............3_A0__________-.__.--..gallons.
WSeptic Tank—Liquid capacitv_1.D110allons Length-------------_ Width................ Diameter...........----- Depth----------------
x Disposal Trench—No_____________________ Width-------------------- Total Length------------_---- Total leaching area--------------------sq. ft.
Seepage Pit No----1--------------- Diameter...6_w �____ Depth below inlet-------------------- Total leaching area----.-------------sq. it.
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...___-.._.-
1:14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....
-----------•-------- ------ -,y-------------------------------------------------------
----------•---•----------•-------••----•-.-------- ... "!
G Description of Soil------�c�,,_r�_F--`........te4-"'-`Z---•----.=.r..-•-•'-'--..._.....1-baS/T/ote - � =- `z-,Ar/c ESQ
Af
V F►;✓-c
-..1�-C-
OL
-----------------------
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 Article \I 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
Application Approved By----_.-__ _- --------------
Date
Application Disapproved for he following reasons:----••-----------•---------------------------•-••-----•-•- =-------------------------------•-_..........
....................................................--_....--•-----------'-•------------•---•--'-'_........-•-"---•"•'-....-•---•-••----------------------•'-•-------_...__....._.------------------'-
Date
Permit No..-•�d-y Issued
Date
No..............'�.....•(.. FES..... ............ �
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........... ... .............OF..........................................................................................
Appliratiou for Di,4poiial Morkii Touitrurtiou Vrrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
-•••--••...--...'-
/�� Location-Address or Lot IVo. /
Z.i...a..�............ .......
Owner Address
--... -----------------------------•-•--•-•--•_------------ ..-......_...
Installe� - Address
UType of Building / Size Lot.-.1._6-r-J_�_6______Sq. feet
Dwelling—No. of Bedrooms--._-_Z----------------------------------Expansion Attic (PI Garbage Grinder ( )
p-I Other—Type of Building of persons.--__4!.................... Showers ( ) — Cafeteria ( )
a
d Other fixtures -----/.._;: ------3•q:dJ.__.._
W Design Flow---------------5�-------.--._.............gallons per person per day. Total daily flow--------------- - --.---------------gallons.
1:4 Septic Tank—Liquid capacity---/.�_-Igallons Length---------------- Width................ Diameter__-.-.. _----_ Depth._...--.___..---
xDisposal 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. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water...-__.__----.._-------
rZq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_.._...___4-��`- �
a ------------•- ------- -----•-------------------•-•--•-----•-----------••------------------------------•-----.-----••----•- --_---- •--.._.._......-!
Description of Soil------- "%
r r c
r° l -----Tf ----- `'
U � >rL
W ---•--------- ------------•--•- a_6<.a. ` N4�:.- d _y----------------------
Z y----- �_/
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_Z_�' _ r . %G -,• � . y-------- j 7................
Application Approved By....... .: -
ate
f Date
Application Disapproved for the following reasons-----------------------------------------------------------------------------------------------------------------
...................................................... ---------_------•----• ••---•----------------------•---------------------•--------------•-•-------•------------------•---------•---- ---•-•-•--
Date
PermitNo.----- G.....-••_••......-•--•••••--•---........ Issued--------------------- ..................................
Date
THE COMMONWEALTH OF.MASSACHUSETTS
r
BOARD OF HEALTH
.............OF....... am
Tertifirate of fQ1,11impliuure
THIS,IS TO CERTIFY T Iat tre ndividual Sewage Disposal System constructed ( ) or RepairedIf
( )
b
t
G
r
Installer
at............. C !�_:... /J -k`���� /`�G``:'_.__... t,-/=/TC'f V/Ll,>
• . ._...----•------------------------••-••---•--••••••...............••-
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------- GL/:...................... dated.______,-] �-...7-/,............................
THE 7
THE ISSUANCE OF THIS CERTIRCATE SHALL NOT BE CONST E® AS A GUAR NTEE THAT THE
SYSTEM WILL FUN TIQJ S TISFACTORY.
C
DATE.----/w.14.7-(-----------------•---------_.--------------------•----•-- Inspector-- ��`-------------------=
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
/ s„�� U!:.` ........0F............� _���.....................
,f No - --------- FEE------ -----:.
inoa1' ork_q Chou �t' ti rrmit
Permission is hereby granted-...--
ranted_.'__ �2,_____.....__/-_�`.-_-_-.-_ ..-_ ----
to Construct (�O or Repair ( ) an Individual Sewage Disposal System
S
fa`'s shown on the application for Disposal Works Construction Per'mi No.�2_:1 _.__i ated.............. ...........................0
............
Board of Health
DATE.---�----./..
;r -• ---- ---"-------------------
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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l HEREBY` CERTIFY THAT THE € FBI-IAN OF LAND 8( STF2'UC TURE
STRU,CTRE SHOWN HEREON WAS • LOCATED
9 BY AN :,ACTUAL 'FIELD, ON
,SURVEY ON
4rC� f J`c•G/ 8 .19*?' AND.--CONFORMS TO THE z/-7 ZO
r
20NINQ' BY t AW OF THE=TOWN OF
'MASSACHUSETTS. IN
i •L
, MASS.'
REGISTERED,_tLAND s4AVEYOR
/.
$ s •I r SCALE I =�/O JAL / ,197 L
OF MqS c iv
n r
f Yt DATE44, WILIJAM J1`
APE. COD SURVEY CONSULTANTS
BRYANT NI
O / S, INC
.
`" ° 1Ir �` . F��STEc�� �/� ROUTE 132
!q
SUFv�y/�.a HYANNIS, MASS.
t ;
e t"I - r .I 4t
_..#�4 f.. ;..,,r .,-_r.m. ,.r. .�...t d�., ,:., ......
TOWN OF BARNSTABLE
o - OFFICE OF Re tre3i WeW Z
B�HasTsnr, s BOARD 4E HEALTH
O� 16g9. �®
'D1gQ�AYp? 397 MAIN STREET
HYANNIS, MASS. 02601
To : Building Inspector
From: Health Department
Subject: Test hole and Percolation Test .
our,
on,
the soil at
A examination of Pip� Rldp -e
AD I
(Lot) (Address) ( Village)
was made on dIP and found to be
(date
suitable for sub-surface se;•Ta ge- ,f at site of test hole.
Building Permit will not be approved or sewage permit
issued until Health Department receives two copies of plan
showing building, sewage systems and all other details listed
in Board of Health instructions to sewage applicants.
This annroval does not constitute a final decision
concerning the installation of a sewage system.
All State and. local Health regulations apply to final
approval.
(Signature) i
s
i
6/20/75