HomeMy WebLinkAbout0137 HAMDEN CIRCLE - Health 137 HAMDEN CIRCLE.HYANNIS ,
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'ILO CAT IO SEWAGE PERMI N . "
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V I L A E C;291 51;�/
IN.STA LLER'S NAME & ADDRESS
B U I'L D E R OR OWNER 4COigalk
DATE PERMIT ISSUED . �6 ���
DATE COMPLIANCE ISSUED � � �w �w _
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No:.......... ...--••-••-- f Fim$..............................
THE COMMONWrZALTH OF MASSACHUSETTS
� 3 BOARD OF HE H
-t-........OF......./3 C_ -. ..
-
13 �.
Ippliration. for Dtipn, al Works Tomit `ur#inn Prrmit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at• /
f
................. -... - - -•--•- - ._..... ................
Location ASS or Lot N - - -• ..................
Ow r. - Address
W
a ....................... --------••------._..._.
Installer Address®`'ape! t'
e of Building Size Lot____ S feet
U Type g ���-�- --- q•
Dwelling—No. of Bedrooms__________ ______________________________Expansion ttic ( ) Garbage Grinder ( )
Pk Other—Type of Building ____________________________ No. of persons._._:____-------------- Showers ( ) — Cafeteria ( )
a' Other fixtur
d ----------
W Design Flow_____________________ gallons per person per y. Total il� flow..........._______..e...............gallons.
W Septic Tank—Liquid Li uid capacity./acit allons Length Q_� Width_._ Diameter________________ Depth___ ___.___.
P 9 P Y g G? --- - -----
x . Disposal Trench—. o..................... Width___. _�'::_.__._.__ Total Length:________r___ _�1Fotal leaching area............_.......sq. ft.
Seepage Pit No.'
Diameter....____._.___.__ Depth below-inlet__ __ Total leaching area _ sq. ft.
Z Other Distribution box ( Dosing to 3 �
Percolation Test Results Performed by---- &_-UAld 1_... _ *�ate__.___�
W 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........................
-- :.� .
, ~�- r -.....-•----- J
O Description of Soil 1,�. ----.._ dam_... ..-- ..`..r�` ,�z
F
x
W
V 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 iITI.L 5 of the State Sanitary Cod —The undersigned further agrees n t to place the system in
operation until a Certificate of Compliance has bee ued by the board of
Signed. . ............
1 Date
Application Approved BY `,— �ti - ff'••� �� � = j .' � __..._..
Date
Application Disapproved for the following reasons: ---------------------•-----------------•-------------------.............................
..------•-----•--•---•-•-----•-••--•-•._...----••-•----•--------------•---•-----......_...-----•--..._....__.:..--------•----•-------------•---------••---------------•-•--...-----------•••-•----......_
Permit No............................................. .._. Issued___ - --. ----------------
Datea r
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Alip ration for Uiopuua1 Works Towitrnrtion rrmit
Application is hereby made for a Permit to Construct {«s -)-or Repair ( } an Individual Sewage Disposal
System at
................Jt Ln9 t� '' ...t " '": ........ ' ,,•t ,off..% ......:...:...
Location- �`ess or Lot No r
rr
Owner t Address
a ................ ... ` -- - ...........------........... . ., -;`!'.:----------..-..--..----
Installer F Address—
Type of Building /y Size Lot...122J. ..3---/.-Sq. feet
U Dwelling—No. of Bedrooms........... ................ .....Expansion Attic ( ) Garbage Grinder ( )
a Other—Type of Building ............................ No. of persons......... Showers ( ) — Cafeteria ( )
Other fixtures. ..:«».------------------•---- �...
W Design Flow.................. gallons per person per day. Total daily flow............
'. ...............gallons.
04 Septic Tank—,Liquid capacity J gallons Length...... ........ Width... - Diameter _-_ -__- Depth................
'"Disposal Trench No. ..................:. Width....,-Y........... To al Length.........f �PTotal leaching area....................sq. ft.
Seepage Pit No _..__.__ Diameter....___.:_ __----• Depth below inlet.- Zs Total leaching area.. 47'?sq. ft.
Z ' ( Dosing tank ( ) t R
' Y `` ? "l ... ate.....
`� f ``
Other Distribution box
Percolation
Pit Noest .
,m nutesPerformedr me --
a p h Depth of Test Pit.................... Depth to ground water--_----______-___--____.
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
O Description of Soil------------:L& ` .........f-� � * '
c, - ------------------------------------
W 4
U Nature f Repairs or Alterations—Answer when applicable..............:................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLZ 5 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
f
Signed :... • :.a x.�I.._.._....t 4f "" 'a•
h Date
Application Approved By-----------. • ------•-----. x = '
Date
Application Disapproved for the following reasons:-------•--------------•--------•----------------......-•----_..........._._..._...---____. ..........----
...............................................................................................................................................................................-........................
Date ,
....... Issue(L �C� `7
Permit No-------------------------------------------------- ------.....- ----...----...-------
Date
r
i"
THE COMMONWEALTH OF MASSACHUSETTS #'f
BOARD OF HEALTH .
f t ? ...OF..... :...v .C -� .:::..... "..:.. ..f...:. .
Trrtif iratr of Tompfiattrr
THIS IS TO CERT `F'Y That tV Individual Sewage Disposal System constructed ( ) or Repaired ( )
by----------- -------_** -". .. ----. :- ____..... ... .........-- . ------..... ....--------.....-----------....
Installer
at ---- ---- �... ..
has been installed in accordance with the provisions Of T r of T e State Sanitary Code as described in the
application for Disposal Works.Construction Permit No. _..._ '6 ........... dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT Bt CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATEr` � ........=., Inspector Y.-•••• .......................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
No.......... ... .... FEE........................
Disposal Nophii Tonstr ion :runt
Permission is hereby granted...... ......._....
to Construct( ) or if,�t ( ) an Individual Sewage isposal Sy tqn ,
' -------- ._l - ` " F r
.„
4^"'� Y Street
at No............
as shown on the application for Disposal Works Construction rmit _--__ _.._ ... Dated..........................................
DATE-------------------- ............................... Board of ealth
r FORM 1255 HOBBS & WARREN, INC., PUBLISHERS - f
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