HomeMy WebLinkAbout0115 FIRST AVENUE (HYANNIS) - Health ;N
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
AvOratiou -for :43t,wiial Works Tutuitrurttou rrtut
Application is her by mak for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
•. .................
Location_Address oc Lot No.
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W / ow,/1r d d r e s s /
Insta r Address
Type of Building Size Lot.-. ------------_7q. feet
Dwelling—No. of Bedrooms.%--------------------------------------Expansion Attic (wo Garbage Grinder ( )
aOther—Type
of Building A ;-0-0-_°-______ No. of persons---------------------------- Showers ( ) — Cafeteria
d 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--*------------------ ft.
Seepage Pit No--------------------- Diameter-------------------- Depth below inl ______ ___._.__ Total leaching area----_.___._____-.sq. It.
Z Other Distribution box ( ) Dosing tank ( ) e)�- AC A/--/1�—— 7 d;oe e
aPercolation Test Results Performed by.......................................................................... Date----------_._..._____-.-._
Test Pit No. 1----------------minutes per inch Depth of "hest Pit-------------------- Depth to ground water:._._.__---- -_._..
(4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_..._.___-_.---.----_.
W - a-----------/--- = ----•---- ...........=•-••----....• ...........................
Description of Soil___.:`. -.._..--�_l.� .ff- 4�9 ��---------- --- - ----- - ------
U '�'�
.L ---•----- ----------------
W
x ------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------
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 ealth.
. Date
Application Approved BY --:igned
-- ---- . -----------•---
Date
Application Dis pr ved for the following reasons-........................
-OR- ----------/-------*------------------------------------------*---------------
•--•••-- ---- -- ---- _ . . .................. -----
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Permit No......................................................... Issued......X/Da/
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No.......f# = FRS , ....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH � ��
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Applirtttiu -for Dig uittt 1B.Orkii Tvtmtrurtioti rr i
'Application is hereby made for a Permit to Construct (, ) or Repair ( ) an Individual Sewage Disposal
System a
!; g'*.art
't l'f+ L.__... •--------- -------
Location'-4lddress or .ot_No - -
! Qrtf'i S.e �'! • "ate- tOV
' +
Owner ddress
InstalF r Address
Q Type of Building Size Lot- -.'Sq. feet
U Dwelling—No. of Bedrooms Al_....................................Expansion Attic (Wo Garbage Grinder
Other—a e of Buildin Type g � .�Q*_! No. of persons_____._.__________________ Showers ( ) — Cafeteria '( )
d
Other fixtures --- •-• r/ -------- ---- ----------------------------
W Design Flow............................................gallons per person. per day. Total daily now--------------------------------------------
Septic Tank—Liquid capacity------------gallons Length................ Width----------- ---- Diameter_____-.-__-_- Depth___________.
xDisposal Trench—No..................... Width-------------------- Total Length.....-___.________-_ Total leaching area---:________-_-___._sq. ft.
Seepage Pit No---------------_--_ Diameter-------------------- Depth belo inle ___. Total leaching area___. ___-_____-sq. ft
Z Other Distribution box ( ) Dosing tank ( ) d df f �. "t
Percolation Test Results Performed by----------:____________ _____ _.__.____ ____.4 �_ Date________.:___-__________,___a-..
._,.,.
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...---------------------
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y
Description of Soil------ -�--� &.1- 0.......
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sa
U --••-••------ --!' r -- " . ,. -- !__________________
W s
UNature of Repairs or Alterations—Answer when applicable-------------------------------------------------------------------------_----------------------
X-•------------------- ------------------------- -----------•..-- ........=-t-------------------•---•--•----------=
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.tlie board of, ealth
n �.,.00 AV
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Dat
e -
Application Approved BY -- ----------
Date
Application Disapproved for the following reasons:_-_----•-•-•------- ---•----------- -------------••--•-- ...........................------••----•----•••------
Date
PermitNo.......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........;OF........ . .... .
(Irrtifirtttr of fIplitttta
T IS TO CE T FY, That the Individual Sewage Disposal System constructed ( ��orRepaired ( )
by == -•-•-- �.t� 4X�ofi,�he
.,... ='-�'�- ----------------------------•------•-•-----
---- aller ---_--
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has been installed in accordance with the provisions of Articl tate Sanitary Code as described in the
application for Disposal Works Construction Permit No._._._._...!f._..___-__________________ dated-_-__/ .".--� ._.__._.._.._.
THE -ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.:.. . .:... . .. OF.. .-..
-----------------
Ii Y .. FEENo -- .............
q
�itivialial via 11 I�lt trltrttt�lt rrmtt
n
Permission reby granted,- - ;. - - ----- .�_:.....................`.. .!. ,. ............
to Constr t or epair ) n d idttal ewage Dispo ystem ✓
at No.-/-� :''' z-- _ �' I'' ' ---� '*! yk= -------------
rZ J
j ,
•���I Street
as shown on the application for Disposal Works Construction P it No. Zted____ _' i"'`� -----•
-
C
Board of He
DATE..............
-
FORM 1255 HOBBS, & WARREN. INC.. PUBLISHERS -
G oT Vie® cle
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