HomeMy WebLinkAbout0201 COMPASS CIRCLE - Health 201 COMPASS CIRCLE
Hyannis
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IOC, N SEWAGE PE SIT
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VILLAGE
INSTA LL R'S NAME i AD RESS
BUILDER OR OWNER
DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OFHEALTH
� el..............................OF... ..........:...........................................
Appliration for 14iiVntiai Work,5 Tnnitrurtiun rrntit
0 oApplication is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
- e4;;.O*
......5��.lBPaw...d .c a....... Address ........................ .�... . ..........................................
Wwner Address
.............:. ........
Installer Address
Type of Building. Size Lot...1&14117?........Sq. feet
aDwelling—No. of Bedrooms............I............................Expansion Attic ( ) Garbage Grinder (A
p, Other—Type of Building 9 n^i� .......... No. of persons......(................... Showers Cafeteria ( )
Q' Other fixtures ......................................................................................................................................................
W Design Flow....-5�5.................................gallons per person per day. Total daily flow...............Z.3_o....................gallons.
WSeptic Tank/-Liquid capacity.Irono..gallons Length..... ....... WidtO..f......... Diameter................ Depth................
x Disposal Trench—No...................... Width.................... Total Length.......... _.... Total leaching area ft.
Seepage Pit No----------f-------- Diameter........ ...... Depth below inlet....... ..... Total leaching area... ...sq., ft.
Z Other Distribution box ( ) Dosing tank ( )
''' Percolation Test Results/ Performed by._-/1Ann "'_..
ss�.3.!............................ Date.... ®�_.!!+.LP.� -.
,aa Test Pit No. l._..IC -___minutes per inch Depth of Test Pit.................... Depth to ground water.-
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---_-_____-•--_-._ --_-
ODescription of Soil_..S_ .....5,ple.--+---�rAjjx.,j•-------------------------------------------•------------- ------...-•-••------.-------------•----------
x -
U ...-------•----•-•••...............•---•-••-----.........•-•-----------------------------------------.....------------•-----••-••••--••---•-•---------•-------•-----.......-------•------------------•--
W ...........................................................---------
txj 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 iITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance hakbeen ' ed y the board of health.
gnedC.............Application Approved By-- = i/ d
Date
Application Disapproved for the following reasons:............................................................................................:................_
7 w � Date
PermitNo......................................................... Issued... :.............................. .................
Date
No.' .�. ...... FEg... .?.:...�.......... .
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
......_- -.............OF. 19/LP-•, �}r,c s
Appliration for Disposal Works Tonstrur#inn Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
........10" 7 ft Pr t Q.wG S..i•5 r-i C i i 5 //•% 5 S ....................... ..........--............................--...
n /'� Location-Address y rf " .
....................... --•- ....................................... .... 4.'1_" .•-- al;o...........................................
wner Address
W / t2 ....... ............................................................
Installer Address
UType of Building Size Lot.....!_n_:.12U, .......S feet
Dwelling No. of Bedrooms............e............................Expansion Attic ( .,.;) Garbage Grinder (A
`4 Other—T e of Building �.I.,"' No. of persons.......L________________ Showers — Cafeteria
04
Other fixtures ==------------------------------•-•-----._....--------.._..-------••...----
W Design Flow. .................................gallons per person per day. Total daily flow................?.'_o...................gallons.
WSeptic TankT;Liquid capacity_12�ew_gallons Length.____Q......... Width.ti............ Diameter________________ Depth................
Disposal Trench—No_____________________ Width.................... Total Length_______-...__ Total leaching area......, -..sq. ft.
Seepage Pit No'...........,�........ Diameter......... Depth below inlet________ _______ Total leaching area___ _a_ ..sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
'-' Percolation Test Results Performed by.... ......................... Date....l 00 17
Test Pit into. L._.Z?�-__minutes per inch Depth of Test Pit____________________ Depth to ground water_.....Q^!_.�_._._ .
G>r, Test Pit`No. 2...........:....minutes per inch ,Depth of Test Pit____________________ Depth to ground water..........................
fL' 10=2w ................. - �........`..................................................................................--...................................
Description of Soil....
= t ...:::.... tm. ...................
x ............................•••--•---•-......_...---•
V .._...-•-----------••--------•---•••.....-•-------•----------------------------------------------------•--•-•-•--•---•---------•---••-••-•---•-._......--•-•----•-------......._._.._--•••--...._._...••-
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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been 'ssued by the board of health.
ned
�(" r j Date w
Application Approved By----,. i; G �d � ---- ...... ..? '
Application Disapproved for the following reasons_______________ ...__.._...--.••--•••.__._•---••----•-.--••.---•-•----__...._____..________________«
i
•..................................•--_._.._.._.......-•-----......_....._•--•_._._.....--••-----......---•---••••..._...•-•--••----------•--------•----•-•••--•----•-•...----.........................
Date
PermitNo......................................................... Issued.........................
Date
THE COMMONWEALTH,,OF MA$SACHUSE,�T�,TS
BOARD,-"}OF HEALTH
r.!�✓.......................OF..J .... JS�:. ! ... ..................................
Trrtifiiatr of Tompliattrr
THIS IS TO nCERTIFY, T�,hat the Individual Sewage Disposal System constructed (,-/) or Repaired ( )
by..../ `...._.`✓�..I:� ? =- � - ._...... ........................................................................................ ......
/j Installer
-------------------------------•••-
has been installed in accordance with the provisions of T` j of The State Sanitary Code as described in the
application for Disposal Works Construction.Permit No. �� �✓ •--•----- dated � ./" ' "d4 r
THE ISSUANCE OF THIS CERTIFICA"hEa SHALL NOT BE CONSTRII ®AS GBJARANTEE THAT THE
SYSTEM WILL FUNCT1�ON SATISFACTOJRY. - '?� y
f �� ,)DATE.. ---_c Ins pector..:......�•--•--••..............••----•--•----........_...__....-••--••---.....--
�,-••-•-•-•-----
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OFAHkALTH
•..•••-
......................OF...., �_..�:'!1:<,_ !!�c.c
No.__......1 `' FEE......;..............
Maposal Varks nstrudinn "permit
Per _ _________ _mission is hereby granted___ ____��4.._-
`�'T
...........:..........................!................................................
to Construct ( A or Repair ( )fan Ind* idual Sewage Disposal System
�7 -•-•................ .....................................Street -•--•--._.._..__.____.__._....--••----._...__..---..__.._..----.......-----•-•
f� - y
as shown on the application for Disposal Works Construction P it No, Dated.....� _/S .7-----.•.-•----.
E Board of He
DATE.......1 _'_---
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS -�`
AsBuilt Page 1 of 1
LO C ON S EW A G.E PE . IT
VILLAGE � r
ILAI)INIT
INSTA LL R'S NAME i AD RESS
8 UILDE R OR OWNER
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DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
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