HomeMy WebLinkAbout0010 GROUSE LANE - Health 'Hyannis
x
� 1
No. Fxs... .-................_
THE COMMONWEALTH OF MASSACHUSETTS
BOARD ffQf HE
App iration for Uiiiposal Worku Tons rudion Vamit
Application is hereby made for a Permit to Const ct ( ) or Repair ( ) an Individual Sewage Disposal
Syst t
Pit) .....1--.. e . .... ............ ,�.�,.. _.
. oration ...dd. ............................. .................... .......�6p..... ................_.
.. ..... Owner Address
................................. ..............................................
..........................•._......_...... A ddress.._._....__._._.._......................---
Installer
U Type of Buildings Size Lot._l�4P_7�_.Sq. feet
Dwelling NO. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
d Other fixtures . --------------------------
W Design Flow........................ _gallons per person per day. Total daily fiow ..............gallons.
WSeptic Tank-(-•Liquid capacity. _____gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench— o_____________________ W. t i_.__. _. Total Length.......... ......... Total leaching area.... ______.____sq. ft.
Seepage Pit No.. Diamete 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........................
O Description of Soil____________________
x
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 XI of the State Sanitary Cod rsigned further agrees not to place the system in
operation until a,'Certificate of Compliance s oa�ealth.
Sim -- ••.... ................................................... ---•--•-•---D to
.._.._...--•-
✓�
Application Approved By---. . -� ---•-- - � -----• � 1 -(- ---�•2'
r Date
Application Disapproved for the following reasons:------------------ .............................................................................................
................................-----------------------------------------•---•-------...-•----•-•----......-•----------------------------------------------------------------•------••--•••-•---•-••••-•-
Date
PermitNo......................................................... Issued................ .......................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD 4.Zjr HE
.:....•....: OF...... ................
Applira ign fvr Bisposal WorkgConstrurtion Vamit
Application is hereby made for a Permit to Constr t ( ) or Repair ( ) an I dividual Sewage Disposal
Syst t
s
e at on Addres of N
... ... ... .................. ..__............. ................................
. --
....... ..._._ •..............- -.........
...
caner
..... �'? .. ... ................................ ............................................... .s.............. .........._.._.......-•-
"i. t�dcjies
Installer Address
Type of Buildinz . Size Lot.. _:l, '_Sq. feet
Dwelling-Ao. of Bedrooms........::...4* .......................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of. Building ---------------------------- No. of persons__._____.:._.._......_.._.. Showers ( ) — Cafeteria ( )
d Other fixtures ------------------------------
Design Flow:_.__. :_ _gallons per person per day. Total daily flow..__..__. gallons.
W =
P4 Septic Tank 4-Liquid capacity/ gallons Length................ Width................ Diameter................ Depth................
W Disposal Trench—No Wt h Total Length Total leaching'area _`. sq. ft.
x
Seepage 'Pit No.. Depth below inlet :----- Total leaching area.
•-,-._ _-__ Diameter g ft.
Pn
Z Other Distribution.bbx.{ °) Dosing tank ( )
a Percolation Test Results Performed by------------------------------------------------------------ .... Date.......................................
.
Test Pit No. 1._.. _.........minutes;per inch Depth of Test Pit..:................. Depth to ground water........................
t� Test Pit No. 2...............:minutes per inch De th of Test Pit_._......__._._..... Depth:to:ground water........................
O Description of_Soil..____.___ ' _
--------------------------------------------------------• ----••---------------•••-•--•---
U ...-----•-•-------•--••--••-•----•-••-•--•--•-------- --=-•-=----•-••-•-------•-------•-•-----•-•---------•--•--•••.................•....................
W ----------------------------------------------------------------
U Nature of Repairs'or Alterations:,—Answer wheti 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 ah d rsigned further agrees not to place the system in
operation until'arCertificate of Compliance ltas�]j s oard of health.
Stine .....................................
.................................
e
Application. Approved BY o�" .. f •.. •--•-.----- { e
fv `
Application Disapproved for thefollowing reasons:_,__'-_..,=---�--=------.
--- -----------.....----------------------------------•--------•--..............
......•-•---------•....•-••---•--•••••---•--------------•------•••---_....
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
..B®ARD 0 HEALTF�
e
fit
THIS 0 IFY, the Indi.i idual Sewage D sal S�ste , c nst ?acted ( ) or Repaired ( )
t .
"'"` ,-
--------------
t go
ape
at... ;: - --
�, ---
has een i st talledin accordance'cart lathe provisions of Article ? I of-T I. State Sam ary Code a describ d '1 e
a lication for..Dis�osaI.Works Construction Permit\o.____._
PP P �+ `- .dated - - �
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM'WI,LL,.PUNCTION,,SATISFACTORY.
DATE............ :.:.. '.Inspector
THE COMMONWEALTH OF MASSACHUSETTS
WAR F' " FI,EALTH r
0
No....., ,. .......
FEE ..........
IRS aq Can r,union rrmit,
Permission is -ereby granted-- . c. . ..-' . + .._.. ..:..................-----......
to Construe ( or Repair an Individual Se Disposal Systerp
Street - ►
as shown on the application for Disposal Works Consti u t.c i P - "t No... .. D ed.......
.. e�
th
DATE..............
FQRM 1255 HOBBS-& WARREN, INC.. P! SH ERS.,. -