HomeMy WebLinkAbout0028 KINGS WAY - Health (2) 28 Kings Way
Hyannis
A= 328-007
o
THE COMMONWEALTH OF MASSACHUSETTS
—� BOARD OF HEALTH
........ l..UI.L?Y�........oF....` B" ?S G ----------------------------------
Appliratiou for Uiiipnsttl Workii Tomitrnrtiun Frrmit
Application is hereby made fora Permit to Construct ( ) or Repair ( 4-)—an Individual Sewage Disposal
syst J�117 S ...v C..... . .............. - ---------•----------•--........ .......
Location-A ress or t No.
------.... 'C hD. ...... .C..l..----•-------•-•.......... ..........•--- :._.. � °.........----------...: ••
$OOww er ° } f Address
.................
?nL C........
-----L•
a Installer Address
dType of Building Size Lot............................Sq., feet
U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other=Type of Building ............... No. of ersons........_._.................. Showers —
a yp g ............. p ( ) Cafeteria ( )
Q' Other fixtures ............................
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
W Septic Tank—Liquid capacity............gallons Length................ Width.._............. Diameter................ Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leachingarea....................s . ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by...........................:..................•--.----_------.......---•-- Date.................................-......
Test Pit No. i................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........................
O Description of Soil..... ... � 1..1�--1.4rall .............................................................-----........................
x
W ----•••••-•----------------••---•••--•-----=-••-•--•-•--••--••••--•----•-•-•---•----•......•----...----•--•--•---------•-•-•----•--------•-•---•-••---•------------------- p
VNature 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 health.
/� 2Signed....... . .. ---- w........ .--_ .... .
Date
Application Approved By............. -_... .... ............................ ,?l.�l�?.......
Date
Application Disapproved for the following reasons:.................................................................................................................
-•---•---------------•-----...-••-••---•----•----------------.....--••----•.......•----...----------......---....------.......-•-----•--............-•--•••---•---------------------------.........------
Date
PermitNo........................................................ Issued.........................................................
Date
No.., .&Zg. j FEs..............:...............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HESA{LT, H
- ...........1...(.1 ._.....OF..... �' . /((..:.-- �..-.._..._..
Alivi ration for DiopooFai Workii Tonotrurtion Vrrmit
Application is.hereby made for a Permit to Construct ( ) or Repair ( �an Individual Sewage Disposal
Systet t, .3 '
..................•_... ......-•----•---_. ---------
•-••------------------------
---•---•-------
Locat... .. ...... ........ on Addres's� //__� /d ,€of No.
r ''" "/ ....... 1 /C �G/ / dress
----•- -- -- ---•- --•----------•--...
� Installer ' Addre•-ss
d Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
04 Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures -------------------•--•-•----- -
W
Design gallons P n Per day l daily
... ___
P , -•-------•-------•-•-••---•---•-•••••----gallons.
WSeptic Tank—Liquid capacity.._._..._._gallos Length Width . Diameter____________ _ Depth................
x Disposal Trench—No_____________________ Width.................... Total Length........... _____:_. Total leaching area....................sq. ft.
Seepage Pit No_____________--------------------- Diameter.................... Depth below inlet.......... ....... Total leaching area..................sq. ft.
z OtherUstribution box ( ) Dosing tank
Percolation Test Results Performed by__________________________________________________________________________ Date........................................
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........................
--------------•••-- y� ••-•••_-----•-----------
Description' of Soil_____________________________ ..'�.�... .......`-2
U ----••-•---------•-- ..............................................................................................................................---•-----.........--•......-a--•--•-----------------
W ----•---------------- '------------•-------••---•---•--•--••--------------•----••--•-----•-----.....------•--------•------•--•-•-•-• ---------------
-
VNature of Repairs or Alterations—Answer when applicable.................... ............................` __
--------------------------=--------------------------------•------------------------._..._._........__...---....---------------------•----••-----------------------•-•---------------......._......--•-
Y 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,a ued by the bb�qud o ealth.
Signed
_________________ _D ~ 7
Application Approved By
l �..........., ---•-•--------•--------- ----•-------.. ---
Date--•-----------
Application Disapproved for the following reasons:--••-•--•-•-•-•-•-•-----=---------------••--•----••--••--------•-•---------------••-.........................
....................................................... •---------•-•-•----•--•-••--------•-•-------.......----•---------------------•-•-------------•--•--------•---•---....---• ......................
Date
PermitNo.............. Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............I•1-� .....-...OF.........-':�"!-�°'- : Jl jc...........................
CIrrtif irdr. of Tantlilittnrr t
THIS I_T(� ,CERTIFY That the v1�ual .Sevt age posal System constructed ( ) or Repaired ( )
by---•---_•--- • •---....
star 1
at
has been installed in accordance with the provisions of TITLE „jf Tl}e-, tate Sanitary Code as described in the
application for Disposal Works Construction Permit No......................................... dated................................................
THE IrSSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEMWILL FUNCTION SATISFACTORY.
/ Inspector.:. ._...----••......-•_•-----DATE................. d
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
X)//�''�� //��JJ ................ .(.. �......O F......-.....� -. s/ > '
No........ .. .� S FEE............:.:.:.....••
. , �io�rrottl k onotr uan � mit
T
Permission is hereby granted..............._........................�'l-_�.� ._______� _. ��
to Construct ( or Repair. ( )La Individual j.S .wage Disposal System
at No / �'
r . -•-.--
Street
as shown on the application for Disposal Works Construction Permi ____________________ D d..........................................
-------------••. oard ---Health----------•------•---•---•------••-------------
- � o of f
DATE....-.............tole ' .....................................
FORM 1255 A. M. SULKIN, INC.,:BOSTON ,.