HomeMy WebLinkAbout0022 CIRCLE DRIVE - Health 22 Circle Road,
A= 288—040
Hyannis
LOC&TION 5EW&C.4E PERMIT UO.
IWSTALLER S ►&NIE ADDRESS _
SUILDERS__.IJ./ VAF- _AD_ORESS.
DATE -COMP_LI WaC'E ISSUED : = 7�
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�O THE COMMONWEALTH OF MASSACHUSETTS
Q,O BOARDgF HEALTH
�D .........__....OF................ .....................................................----
Appliratinn -fur Biiipniitt1 Vokbi Cnnni#rnrtimn Pprutit
Application is hereb ade r ��er�rt Co truct ( ) or Repair ( ) an Individual Sewage Disposal
System at: .�c�� '" d°'
T
....................... ......... ------------------------------------
Location-Address or Lot No.
Owner Ad ress
Installer Address
Q Type of Building Size Lot----------------------------Sq. feet
U Dwelling—No. of Bedrooms________________________________ -Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Q' Other fixtures ......................................................
W Design Flow---------------------------------------------gallons per person per day. Total daily flow--------------------------------------------gallons.
1:4 Septic Tank—Liquid capacity------------gallons Length---------------- Width_.............. Diameter---------.------ Depth----------------
W
x Disposal Trench—No_ ____________________ Width-------------------- Total Length-------------------- Total leaching area....-------.--------sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area-----.------------sq. it.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed bY------- --- ---------------------------------------------------------•••• Date--------------------------------------
,4 Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water..-.__-.._-..--.--..___.
LL, Test Pit No. 2----------------minutes per inch Depth of Test Pit____________________ Depth to ground water..............--__--__--
9 ----•------------------------------------------•--••------•--••••--•-•...........-••-•--•----••----..........................................................
0 Description of Soil--------------------------------------------------------------------------------------------------------------------------------------- ----------------------
x
U ------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------
w
x ------------------------- --------------------------------------------------- ----------------------------------------------------- ---------------------------------------- ---------- --------------
U Nature of Repairs or Alterations—Answer when applicable r��` --_-. � _�t... .__... _,_!Vve -L,
77.
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 i ed by the bo d of alth.
y .� ✓ ",
Date
Application Approved BY -- --------------
-----------------------..---------------
Date.
Application Disapproved for the following reasons:.................................................................................................................
.................................................. ------------------------------------------------------------------------------------------------------------------------------------------------------
D e
PermitNo......................................................... Issued--- � - .------- -- ........
Date
7y
No. �` �� F�a.....�...rf.•��...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALTH .
------------OF........ .......... ...........................................
Aliphrtttion -fur 11,tipmal Works Tontitrurtiutt Vrrmft
Application is hereb ade r Per it o Co truct ( ) or Repair ( ) an Individual Sewage Disposal
System at:N
_�-------c�c��--� ------,Q�� ..... ----------------- �r z
Location-Address or Lot No.
t
----------------•-•---------•--••----- ------•-•---------- -----
w r 1ss �Ae � ....ig . W /............................... ------•� -f
Installer Address
QType of Building Size Lot_-------------------------Sq. feet
V Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building -_--___------------------ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Q' 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 ( )
aPercolation Test Results Performed by--------------------------------------------------------------------- •_.. Date--.------------------------------------
,� Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water__-.----.-.---.-_.-.___.
�14 Test Pit No. 2................minutes per inch Depth of Test Pit_.................. Depth to ground water--.--.._-_-______--____.
9 ---------------------------..................................................................................................................................
0 Description of Soil------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------
x
U -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
------------------------- ----------- ............ -----------------------------------------------------------------------------------------------------------------------------------------------------
U Nature of Repairs or Alterations—Answer when applicable... �l�t/ ..............{� .__54
f
------------------------------------------------------------------------- P�}G � =� c%ea6�1
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article NI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been ' tied by the bo , d f alth. p
Date
Application Approved By--------------------------- ------•----•-•---•----•-•----•------•-----------......-----------•. ....................
Da_-----
Date
Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------
------------------------------------- -------------------------------------------------------•------...............................................................................................
Date
PermitNo.---..................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD 9F HEALTH
Q.............. ...........OF....... !u.C-- .....................................................
Trrtifirutr of Tomplittttrle
T IS IS TO IDRTI)FIY�)ftiat the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by......- -----------•..............••---•-•....---•---•---•----
staller
In
has been installed in accordance with the provisions of -Art- e XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No(!�-__-- ................. dated.-. 7_'__ _. ___.7f ..........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE-------------------------------------------------------------------------------- Inspector------------------------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
j7; BOARD F HEA TH
oZ .....I; *' "tJ ............oF...... ....C.... .. ... .:.i... ...... .....................
No------------------------- FEE_ .................
Binp;__
Mork �ottu rurtiutt Vrrmit
,�
Permission. is hereby granted-..- Zvi
��---- - ---�-'`'' --------------------- --'---------------------------------------------------------------
to Constr �/� r Rep r ( ndual ewage D's osal Systeat No.--�CIi<L.. a..�! `----- -----�=. 4J-------•- '� �! y /.�-���
s eet (/
as shown on the application for Disposal Works Construction rn t No_! j!!�._. Dated..�"�.-)_ ._
-- ---------------------
------ --------------------------- �� --------------------
7SBoard of Hea
DATE-------------------
-------------------------••--------------------------- lth
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS