HomeMy WebLinkAbout0047 AUDUBON CIRCLE - Health (2) �'7 �d��n G'r. C�n��-
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III
THE COMMONWEALTH OF MASSACHUSETTS
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System at
ow: Address
nel
Installer 'OF Address
Other Distribution box Dosing tank 7 S-
-------------------
_-------._—_--------------.--_-___---'_--.----_--_---_--------------
Agrccoeot: -
The undersigned agrees to install the uforo6escribod Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code The undersigned further agrees not topLaje the system in
operation until a Certificate of Compliance has been is-sued y the b& of Walth.
Signed. .. ....k,"-".................. .... ................ ----------------- -----------------
ate
Application Approved By-------
Application Disapproved for the followin reasons:-------------------------;�,r---------------------- ODate ---
ate
Date
-------------------------------- ------ --'---' —' —
No....�.._`z •----• Fsla............................
_
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
� s lirttti�at� -for Di_qposttl Warks ( onstrurtion Vrrmft
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
n
<- J/ Location Address s^ *" or I t o e
r ! sa w ..r _ '"
W 1 f * Owner _
Address
.� -.............._.. == --------------- --------
� Installer � A ress
Type of Building Size Lot____________________________Sq. feet
�-, Dwelling-No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
per, Other-Type of Building ___________________________ No. of persons---------------------------- Showers ( ) - Cafeteria ( )
p' Other fixtures
d -----------------------••--------------•----
W Design Flow.................... __.___...........gallons per person per day. Total daily flow--------------------------------------------gallons.
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 below inlet_.__________________ Total leaching area_____-___-______sq. ft.
z Other Distribution box ( ) Dosing tank ( ) Gh ��� -/-.,*'lJ ' 7 `�-
�" Percolation Test Results Performed by__________________________________________________________________________ Date--------------------------------------..
Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water.-_-_-__-_________- ---
LT, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water----------------------
-------------------------------------------•---•---•----------------------•-- ----••- f ---•---•--•----
�. y _ f f
D Description of Soil - f.3 G �,!/��=L -..====`=`-..'.•-- �------� y----�'.' r', --��f `fi ---��--�"`z
x
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 i sued by the oard of `$alth. s !
ter/
/ - ` r -/I Date,
A licatiori Approved B
PP PP Y r
Date
Application Disapproved for the following reasons__________________________............................................................!/
------••-•------••---••••-
._._.._..---••---•.............•------••------------------•-•------_.__....-••------•••---•-••----•-•-....._•-------•-----•-•--------•--•-_._...---------••--•--------•••-•--•---••------•---•-•-----•--•
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF .1-�EALTH
oF..................:�.
` 01rrtifirate of�nmplitturr
THIS IS O��R�IFY, hat the Individual Sewage Disposal System constructed ( 4--o-r Repaired ( )
/t'
bye_.._.. =-` =-/------- -4-4 �' ---------- --- -------------------- --- •--------._
�~
�-` / , I er
at f r�_G+__. .. BUJ f_.! � '
has been installed in accordance with the provisions of A tiole XI of The State Sanitary G o de�described in the
2> tf�
application for Disposal Works Construction Permit No___• _____________�__-_-_.__________. dated'
_-_. ....6lc `_.;, �__'-----------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUAR�►WTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
.� C DATE . ,v ---- _✓ Inspector •---
THE COMMONWEALTH OF MASSACHUSETTS `
BOARD OF HEALTH
No......................... FEE
R-s ItiiMV orW Tanstrurtion Prrmit
Permission�s�bereby granted----� ? �� �`= -•--- G '`z- P - ..........
to Const ct_ 0 ) or R pa•r ( ) an/Individu 'jewage s osal Systeat N
m
i
Street r
as shown on the application for Disposal Works Construction Pe rrii 7No._____� ___________ ,Dated__ _-- --.._�--___________
tr--------...
� �. Board of H
DATE----------------------------------------------•-
-----------------•....••--•--•
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
PLOT PLAN SHOWING INLOCATION OF BUILDING
CENTERVILLE BARN STABLE MASS.
FOR
ALAN E. SMALL INC. 14y
SCALE: I "= 60' DATE JULY 23,1975
CHARLES IJ SAVERY INC REG. C.E 9 L.S. 712 MAIN ST HYANNIS . MASS.
I
22 z- 1 20 I
I
,24 15.
i
15, a ti
18
O o.
s
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v
P j
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I herchy certity th:,t the `wilding exists
✓� H OF as't
on the ground as shown on this plan and
J� N.,P1cf.T Sti,�
is in accordance with the zoning
requirements of the Town of Barnstable.
Registered Land Surveyor eUR��.
THIS LOT IS NOT LOCATED IN A FEDERALLY DESIGNATED FLOOD PLAIN ZONE. 72 2 3 S A