HomeMy WebLinkAbout0085 WACHUSETT AVENUE - Health 85 WACHUSETT AVENUE
- HYANNIS
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ca�0 CATION r SEWAGE PERMIT NO.
V I L L A G E ."-44,Zit T gtie.gv, AVE
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INSTA(LLER'S NAME i ADDRESS
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BUILDER OR OWNER'
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OA T E PERMIT' ISSUED
DATE COMPLIANCE ISSUED ��/it�_ 7,5'
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No....... V! ..... FIc$.............................
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® . F' HEALTH
. .........OF...... ................................
,� fir #ilan for Disputiaai Works Tomitrnr#inn Vam'd
Application is hereby made for a Permit to onstruct ( ) or Repair ( Individual Sewage Disposal
Systeth at:
Locatio dress o--
.... .. ...................................
Owner Address
a ..................•--••-....----•----------.....--------._....................................... ...•---•-------------......•...................... ......................: :.
Installer Address
Pq Type of Bu;;ldir�� Size Lot___________________________Sq. feet
Dwelling !—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons___--_______-__--___-_______ Showers ( ) — Cafeteria ( )
Q' 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....................sq. ft.
Seepagd`,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. 1----------------minutes per inch Depth of.Test Pit.................... Depth to ground water.......................
Grq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
9 •---•-------••---------------•-----•-----------------------•----.....-----------•---....•-••--..............---••------••--------.................-•••._-----
0 Description of Soil.................................................................... ---•--------------------------------------------------------------------------------............_..
x
v -----------•••---------------------
W --------------------------------------------------------------------------------------------------------------- -------- ----- ----
-------
U Nature of Repairs or Alterations—Answer when ap licab --� - _-_
------------------------------------------------------------ ------. - .
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITI,L 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.
>gne ....................................... •--•------....................
Date
Application Approved By........ • -- ---•- l�!LI j -....- . 7
.w.........
Date
Application Disapproved for the following reasons:................................................................................................................
......................................................-..............................--.......----------=-::............--•--------------------•------------------------------------------------------.
Date
Permit No..............................
........................... Issued_--- -�-----l ----�-'r--�----._.._..._...---
Date
16
No.:` . ` !...... F�s.....�. ...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD 9F HEALTH
............. t ° .........OF...... . :.f !l�'..
Appliration for Dwvosal Works Ton,strnrtion Vamit
Application-is hereby made ) a
.for a Permit to onstruct ( ) or Repair (Fn Individual Sewage Disposal
System at ,
.. .. y
./ r Locatio ." ,dwddress K / or Lot Ro.
Owner R � Address
W ca.
a ....::._ ....--•---•---»M•-•------ .::................................ --........-----••---..._..............._....Address
ress
UType of Building, Size Lot............................Sq. feet
H-1 Dwelling ff No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther 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....................sq. ft.
Seepage"Pit No--------------------- -Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
IH Percolation Test Results Performed by.......................................................................... Date........................................
►4
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Gr., Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
...........
•-------------------------------
••-•-------------
•--•---------------------------------
•-•----•----------..........-------•--•----------•---.------
Descriptionof Soil..................................................................................................---•-----------•-------------------------••-•--------..........------
V
U Nature of Repairs or Alterations—Answer when ap licab ___.._..
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance.with
the provisions of TITS 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.
} igne
D to
Application Approved By. - lr ! :. . ,_...... . . ..--
.............
Date
Application Disapproved for the following reasons:.............
........................................................................................................................................................................................................
Date
PermitNo......................................................... Issued—.....................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
?......:..O F........ .. .. ......... ...................................
Grtifirate of Toutplianre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by . .
......
`� 9 ins r
at-. .r ..... . ...... e�LM Y"�ao .. 441 j /
ha been mstalle in accordance with the provisions of TIT F 5 of ThetatefSanitary Code as described in the
application for Dis osal Works Construction Permit No.___-_ �" � dated_..._ ._C?-"__��t^.�_�'�.
PP P
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY )
DATE........1. =�.....Z J�----- -�........--•---------- ----------- Inspector......�` f L �� '�- 1 d.-f
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O,FJ HEAL /
., ,. : .......OF...............:....�'G'S.+ . .... .: ..............
No
... FEE.................
Elisposal Works Tylons#rnrtion rrmit
P _ ,fission is hereby granted. ...........................
to Conser uct (' ) or epa ` (' Indio ual Sew'ge D posal S s
jk at "�.
Street
as shown on the app Pication for Disposal Works Construction Pe No.__
Board of Health
DATE.................................----•-- : .......
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS