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Home My WebLink About0016 BROOKSHIRE ROAD - Health 17 Brookshire Road Sewer Acct# 1232 Hyannis A =328 —`043 i I Name -Sever Permit .......... h 09V Location: ..... . .......... .. . ....................................... ................ ... .......... ............ /7;5 Installer's Name and Address ...... -77�.............. ....... ..................... ...... ............ .................... ..........--........... .......... ...... Builder's Name and Address- —---------- ............................ ................ .................. ....................... .............. .............................. Date Permit Issued; . "�' FWA ER Date Compliance Issued ........................ J/ 'I 1 t> �,- YJ fir(„ 7Ce j. �� o��s D THE COMMONWEALTH OF MASSACHUSETTS BOARD HEA TH _. .. . .........OF........ . > .� Iiration -fur 43itpotitt1 Workii Tnnutrnrtimn Pprutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal 1.s u s ---)0_0................................... -- 7 Location-Address e� or Lot No. r•— Qwner '---_Address a --------------------------- ...... -a�/ -- ------------------------------------------ ---------•----------•---------•---•---- •---••..........-------•-•----------•--•-- Installer Address Q Type of Building Size Lot......7-3.1 20.....Sq. feet U Dwelling—No. of Bedrooms...._.................. _----Expansion Attic ( ) Garbage Grinder ( ) per, Other—Type of Building .--.0AF1eeF___ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtu�res •-------------- -------------------- - __ W Design Flow ___________ J • ... __..................gallons per person per day. Total daily flow............... ......................gallons. WSeptic Tank ____Liquid capacitvl/`l_..gallons Length---------------- Width.........--..... Diameter__.---.._-.-__-- Depth---.------..---. x Disposal Trench—No- ____________________ Width...._._____... Total Length-------------------- Total leaching area-------.............sq. ft. Seepage Pit No....1----------_--- Diameter----/__��_Aepth belowtlet-.. Total leaching area._-_.___.--..._.sq. ft. z Other Distribution box ( ) Dosing tank ( ) GG y �'17 Percolation Test Results Performed b ................ Date.....__.__________________-____.____.-.. a Y---------------------------------- a Test Pit No. 1----------------minutes per inch Depth of 'Pest Pit.................... Depth to ground water------_--__-.---------. (Xi. Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------ 9 -------------------------- -- --- , r --• --------- - - O x Description of Soil---- f -------- -----.' 1.__7.:.._._ _. ..-• - - ,S' c v G1={ U --------------------------------------- z-------;)Z4;c=- .. - ...................-------•--------- - UW ----• ------------------------ --------------•--••-------------------•--•----------------•-•-----•---•-•------------------------------•-••--------•-•---•----•------------•----------------------- 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 'ssu d by the bo d of health. Signed. ,.... ---- --"----- ----------------------------------- -----� �-1 Application Approved B ..........�1 /� G 'hl_e4'" '- ---------------- ----- r ate �/ ' Date Application Disapproved for the following reasons--------------•-----------•--------------------------------------------------------•---•------------------------- ...................................•-------------------------------....-----------------------------------•------•----------------•---------------------.....--•-------------------...---•-------------- Date PermitNo......................................................... Issued.-----------.._..---------------------------•---..--••-- Date 7 Ks . i . Ile) ` � 407. � 4 9 � _�� vU G�,� • Sq�J7C 4"T . 0 LLL °0 N '� C�vi ll f�� I S'��`♦Ot L S!^+�y��j\A�./y�{ ��M�P CRI E T p Ep PLOT PLA P4 PI T`C�TAt_ F"t.vv1J 15 o CAL:Z;/ ,\. f 7 6 3FaJ W IU il►pY1 # p tit l _vT17 03 ,Syot�,�iv �%,E'�E'a��CariiFp,�'.�-z�_ �"'�• r�,� R�s.s7�.pZ1~.t� �,,�r.S c� S€J 2v E�v RS „Z'c��,e//�� • �.9 W,� C��" T'.��' 7'0��JV c�:�' Q 6"t'�'i�yr t�..t...� , 't„'41d. a 5. yg7� t 4-UCH w" i -r F F_ �{ ��• �� `'� �` 7 6) No............ ......... FEE..... ....... ... THE COMMONWEALTH OF MASSACHUSETTS BOARD Of HEALTH ...........err ........OF......... ..' Appliration -for Dispoiial Works ( owitrurtion Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ,( ,� I�7 e/� J 1 15— or Lot No. w .........•---------------•-./�_.... .!-Awner---•------•--•-........................... ----------••-----•................._....._..Address.....--•-••---•--.......................... a ..... /i Installer Address 2310 � Q Type of Building Size Lot.......2..31v----Sq. feet U Dwelling—No. of Bedrooms_____________________________ _ -Expansion Attic ( ) Garbage Grinder ( ) Q, Other—Type of Building ............................ No. of persons-.______________-_-___--___- Showers ( ) — Cafeteria ( ) w Other fixtUre ------------------------------------------------------ ......................................................... w Design Flow__........................._..............gallons per person per day. Total daily flow................ ___------____-------------gallons. WSeptic Tank=Liquid capacity-/./I...gallons Length---------------- Width_.........___.. Diameter__-___..___._-_ Depth---------------- x Disposal Trench—No. .................... Width---------------�_,r__ Total Length____-_____-..--___- Total leaching area-__--_______.__._-.-sq. ft. Seepage Pit No-----J------------- Diameter_____—L/1_S�IIepth below inlet____f .__ Total leaching area_--_.____--__--_-sq. ft. z Other Distribution box ( ) Dosing tank ( ) - e h - — � - /7- -7 , aPercolation Test Results Performed by-------- ---------------•--------------------•------------ ---- Date------------------------------------ - Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-------.-___-__--__-.._. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.................... ........----------------------------- ------ --•-------•-------•-------------- O Description of Soil------ - ---___r _ �____ •�: .. .. ....... ...... 'U.t. a '. 1 zu ---------------------------------- w UNature 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 ieid by the bo of health. Y , Signedz (.�. -2/__------'--------`- ----------- --"----/-----c-.�- 7 -l-�f Date Application Approved By-------- - ------ =-_------ M=_ Date Application Disapproved for the following reasons------------------------•-------•- ••---------•--------------•-•-----._..........._•-----.....------------••--- ----•---••-------------•--------------------------------------------------------------------------------•-------------------------•-----------------------•--------------------------------------------- Date PermitNo.......................---------•----•----............. Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......... .........OF..........4,15 Y1.............................................. le . OUT,rrtif iratr of Quo ttpliaurr T IS IS TO CERTIFY That t ndividual Sewage Disposal System constructed ( or Repaired ( ) �j . by.......'� ,.% z } - sta- --lle--)---- ----------------------------------------------------------------------------------------- Inr - has been installed in accordance with the provisions of Ar I XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No--- �.__.._��2__�_........... dated-......9__-7__�1.-_7--......._.•.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT TIME SYSTEM WILL FUNCTION SATISFA ORY. b DATE-------- 17--- ......---- Inspector---- --- ---------- -- ----------------- ....................... THE COMMONWEALTH OF MASSA HUS TS BOARD OF HEALTH No............ FEE--- �i��>a,�tt �u�str�rti� t rrutit Permission is hereby granted....... - v - �___-- �t ---- --- ----------------------- ......................... to Construct,/ or Repair an ndivid� S/ wa e is sal S steem/ at No. �d` =�`�7-'. 1�7/` __� L-%l_:.---g -- . -- --=y fd-I..... `-c- y - �t A shown on the application for Disposal Works Construction PeVi o_____________ /' ated____ _'./ 71�---____.... /� G--------------------------------------•-- Board of Health DATE.---��- ----------�..-- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS f 7 COMMONWEALTH OF MASSACHUSETTS 17fDepartment of Labor & Industries and Department of Public Health o NOTIFICATION OF DELEADING WORK All sections of this form must be completed in order to comply with the notification requirements of M.G.L. c.111 § 197, 454 CMR 22.00 and 105 CMR 460.000 as most recently amended FILE NUMBER: (AGENCY USE) Contractor performing project Ucense #M. d S�OI �Exp.date Lead Paint Inspector " LLicense #4A Date of Inspection If low-risk deleading work is being performed, complete the following line: Property owner Agent(s) Address of Project Building Name (if any) Floor Street Address 1-7— Apt. No. City ff � � Zip D z (D d J Deleading thod: Wet Dr Scra in Heat Gun Caustics Liquid Enca sulant Covering Demolition R mt Other If "Other" selected, please explain Che�-k One: dwelling is multi-family single family96) !/ Start date Completion date Z When will work be done: A.M. P.M. `� Weekends? Project Supervisor's name Cfi� License # DC Property Owner Address . City State �Q . Zip OZ(o Z. Telephone !1 2-0 , 3Q 6, In case of emergency.contact Phone: day "'�- evening S �- (over) I In accoraance with Massachusetts General Laws c. III 4 193 CMR 22.00 and 105 CMR 460.000 notice of the date and methods(s) of removal or covering of paint, plaster or other accessible materials containing dangerous levels of lead is to be provided and must be received by the following persons, at least ten (10) days prior to beginning of deleading. 1. Occuuants -if the dwelling unit 2. All other ^rcupants of the residential premises, if any 3. Director, Childhood Leading Poisoning Prevention Program Fax (617) 753-8436 Department of Public Health, 470 Atlantic Avenue, Boston, MA 02110 4. Director, Asbestos 6 Lead Program Fax (617) 727-7568 Department of Labor 6 Industries Room 11006, 100 Cambridge Street Boston, MA 02202 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission (If premises is listed on the State Register 220 Morrissey Blvd. of Historic Places, this notification must be Boston, MA 02125 made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive deleading) Fax (617) 727-5128 Deleading Contractor The undersigned hereby states, under the pains and penalties of perjury, that he/she has read and understood the Commonwealth of Massachusetts Deleading Regulations, 454 CMR 22.00 and Leading Poisoning Prevention and Control Regulations, 105 CMR 460.000, and that the information contained in this notification is true and correct to the best of his/her knowledge and belief. Date Signed: Title: O� A� Company: Property Owner (If owner or unlicensed owner's agent will be performing low-risk deleading work) I certify that I have complied with the training requirements of the Commonwealth of Massachusetts Lead Poising Prevention and Control Regulations, 105 CMR 460.175, for owner/agent low-risk abatement and containment. I further certify that I or my agent will .be performing the following low-risk activities (I have circled all that apply) : applying liquid encapsulanr capping baseboards applying exterior vinyl siding coverinq Surfaces removing doors, -cabinet io u.s, shutters I certify that all the information -ontained in this notifii!at-ion is true and correct to the ::,f my kne-wledge and belief. 1 kEV Iti/1-