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Home My WebLink About0104 CONNEMARA CIRCLE - Health "' ,w104 Connemara Cifet6 ': Hyannis A';291 i s -/oq o G C3V /4426� • r � 0 0 0 "' 4 ? Q No......I•-L....••.. Fas� ..................... THE COMMONWEALTH OF MASSACHUSETTS J BOARD OF HEALTHf .........OF......... tl. .k.� 4.(L�. `�................ - •2 ` I,. 2 p Appliratinu -for Uiopasal Vvrrk ( onotrurtion Vrrnift A- lic�.ation is hereby made for a Permit to Construct or Repair an ndividual Sewage Disposal PP Y ( ) P ( ) b P qq system ' .... ��._..._.. Lo ,ti Address or t o. ----•---•----------•--••--••--•-----------•-- •-•---••---- CdstailerwnerAddress ---4;G�J----A V.....•-•-•-••---•......-••--•--•--•• ......••••-• e -.�------------••-------------- -• • ••---• -----Address / �7 �l U Type of Build* Size Lot.. Sq. feet n ........... i Dwellings/No. of Bedrooms____________________________________________Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ....... ....................... . . ................ W Design Flow ____________________ ________________g. Ions per person per day. Total daily flow____......._.-✓___- ._______................gallons. WSeptic Tank Liquid capacity Ions Length................ Width--------------- Dia ter..... .......... Depth------------.... x Disposal Trench—No...................... ��1�idt ._._....... L gtl __-_--___ _ Tot eaching area.__-.--.____.-.-__--sq. ft. Seepage Pit No/----------------• Diameter.�.1�- p elo ire o 1 leacltitt e:� _. ... ....___sc. ft. Z Other Distribution box ( ) Dosing tank ( ) L� Percolation Test Results Performed by--------------------------------------------------------------------------—Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water...---_--:--.--._-.--. Li. Test Pit No. 2----------------minutes per inch epth of Test Pit..................._ Depth to ground water--.__--________---.-.... O Description of Soil................................... -. . -- - -- --•------------------------------------ U -----------•-••-•••---•-•--••--••--•----------•-•---•-------------•-------••-•----•--••••••••••-•......------•--•-------••. ........................................................................ 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 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. 4------- --------- --------------- ned....... L--•••---------------------------- --- D e Application Approved BY................ --- - --- •••• . •• •-- ••. ••. --------- --•• �lo --- ------ Applieation Disapproved for the following reasons:..................................... ........... Date.... .... .........................................................................:.......•-••••••-•••------•••-•.•-•---------•.-•••-••--.•....--••-•---..............-------------•----........-••.......----- Date Permit No...........=............................................. Issued..... i ---- ----- �W��-_--'--------------------------------------------------------------------- f h No...... A-------• Fss. THE COMMONWEALTH OF MASSACHUSETTS ..,,,,,/ BOARD OF HEALTH ttJ .........OF......... Appliratiun -for Uiupuuttl Works Towitrurtinn lirruti# Application is hereby- made for a Permit to Construct (v) or Repair ( ) an dividual Sewage Disposal System y�,e� n ta • -------------- ---------- o do -Address p- ! ------------- - ----------•-.-- •------------------------•-•--•-----------• caner - Address W — .......... �nsfaller Address ��11 ��,/ U Type of Build' Size Lot.. F/ll__,%-` �'._Sq. feet �-, Dwellin;VNo. of Bedrooms--------------_-------_----------------- ----Expansion Attic ( ) GaZge Grinder ( ) per., Other—Type of Building ____________________________ No. of persons.......`--------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures ___--__ --------- --------------------------------- ''---_________------•------- W Design Flow__ ___________________ ____ __. g,, Ions per person per day. Total daily flow___---------�_�1__:.. .._......_-_-_gallons. WSeptic Tank•(Liquid capacity/eons Length................ Width............... Dill er................ Depth................ x Disposal Trench—No_____________________ Widtl .. .___ ... ._.._ : Le gtl of eaching area....................sq. It. y Seepage .Pit No/________________ Diameter. _ r.. pt e o ire �x.._._ 0 1 leachin ea 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........................ f34 Test Pit No. 2................minutes per inch epth of-Test Pit----------------------Depth to gr and water........................ --------------------------------- ---- ----------------- ----------------------------------- ---••-•--_-•-- D Description of Soil----------------------------------- „ ! _ U -----------•--•----••----------------------;---------:---------•------•---------•--•••-----_-:............................ -------------- ............................................... -------------------------- •-------------------------------- •-•-------------------------- 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-un'til^'a'Cert'ifica#e'4of Compliance has been issued by the board of h alth. ' ed..... :_... A-00 / r D e Application Approved B t Date Application Disapproved for the following reasons:-=.._:.:_'______________________________________ --.____._-•--•-------•-•-•--------------------------=-------•--_..-------..-.-•-•-----------•--------•-------------------._....._._._._.__.__._...----- Date 't Perm-4�No.--------•-------•--•--------------------•-•--------_._.. t Issued.---- ----- .......... ...... -•��_ iP Date THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH 2 �~ L � tit wIn if irafr of f9Autplianrr T I T0• CERTIFY, a the Individual Sewage sposal System constructed ( or -Repaired ( ) Ins. by------ .� l e, at.....- -------70....... ------- csc•�se�.--- --- -- ......_-- = -----_------ --------- has been installed in accordance with the provisions of Article XI of+The Stat anitary Code as desc •bed in the application for Disposal Works Construction Permit No...................../�_'�'__`__.___...... dated-:..��_��.. _._�-_4� __..____.__ x� THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE C�NSTR•UED AS A C�•�ARA EE T� THE r SYSTEM WILL .U T N SATIS ACTO • ATE............. c ,a ----��-- •--•---•-••------ Inspector_- ��------------------ ................................. r THE COMMONWEALTH OF MASSACHUSETTS BOARD. OF HEALTH No----- --- ........ FEE...� �i5�g� 1 gr�,� �nnsfrur#i,an �rruti# :. Permission i reby granted <Q10 to Con tr or Repa' ) an In ividual Sewage'D' Sal\S em atNo. ----7..d------ - ...............' yy Str t ' "., as shown on the application for Disposal Works Construction P No. . ._ Dated_._ /4%_ .._7_�........... f • oard o ealth { ' DATE-----^ -'---•---....•--•-----•---••------------•14 -------•----•-• - FORM 1255 HOBBS•& WARREN. INC.. PUBLISHERS •• e _4,..�-1----*1-'--+.-.__^.�. :-v -..r.;. q 1� .J►j`7`�r. .t�'„�..- z _ .l� "' �.r�,r:. '��,:�'.:,�.�s.�^r..,..,...�y,,.,,,..�,,,.-�--- _ .�`. 4 �-.cam%, 1-+ ...�� -�- r� f-•� )Cl - - �,. ? ..,.- •:T } ti-tta r y� .t -.� •.r� "ems�'► a►�: _e4#-� � _ � __ � _ .sw•�f�r r;�. 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