HomeMy WebLinkAbout0117 HINCKLEY CIRCLE - Health 11 ����le
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
to ....-...._.oF.......... -=-------------------------------
Appliration for amit
Application is hereby made for a Permit to Construct (A) or Repair ( ) an Individual Sewage Disposal
System at
.. __ 1� .'l� .;1.... -Gl&4 Q r�' �/t��. ----------------------------------------
Location-Address r Lot No.
........................................
Owner p r Address
Installer Address
Type of Building Size Lot.,_.lai_G!.11J____.Sq. feet
v Dwelling—No. of Bedrooms.._.... .............................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ________________________• No. of persons............................ Showers ( ) — Cafeteria ( )
P4Other fixtures --------------- ----------------------------------------------------------_- -----------------•----------------------------------------------------
d -
W Design. Flow........... .................gallons per person per day. Total daily flow--------3.Q.0..........................gallons.
WSeptic Tank—Liquid capacity/04C)-_gallons Length................ Width---------------- Diameter---------------- Depth_..-__-_-._---.
xDisposal'Trench—No........ ,..� � ldth____________________ Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No....rlQ.,0,0---- I ain rt _____________ Depth below inlet.................... Total leaching area__ Q_ 1. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by....-------------------------------------------------------------------- Date.........................................
aTest Pit No. 1----------------minutes per inchf Depth of Test Pit.................... Depth to ground water-.---__-_.-_-__-----.---
(s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---------------.__--__--
-------------------------------- # ---------.--.:_..._..----•------------------.....................................
�...........................
.e - --------- .4 ------O Description of Soil_-- --------r.
U / -----------------------------------------------------------------------------------
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 Code— T e und5oa
i ned f ler r es not to place the system in
operation until a Certificate of Compliance has been issue the d f he t
o '
/6
Si e e 1 ......
Date
Application Approved /_---:-G=-- -----------------------••--
Date
Application Disapproved for the following reasons---------------- -- ----------------------------------------------------------------------------- -
......................................................... -----------••-•---•-••--••---•---•-----•---......... ------------------------------------------ - --
Date
PermitNo.. l........................................... Issued---------- 7 ............
Date
No..!C:_��__.............. FEE.... :......z, ....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD (�pO� F HEALTH
OF
Appliration for Ditipooal Worko Tonftrnrtion trrntit
Application is hereby made for a Permit to Construct (A• ) or Repair ( } an Individual Sewage Disposal,
System at:
Location Address Lot No or .
-------•-- . ......u..._......_ j !A .�.... ........................... ........................f'G ��._•.�... _.-_-/.✓/;� ,�_,��,
Oviner Address
Installer Address
Type of Building Size Lot... .....Sq. feet
.-, Dwelling—No. of Bedrooms.... ...:...............................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ------------------------ No. of persons............................ Showers ( ) — Cafeteria ( )
P4Other fixtures ---•----------------•---------•---•--------------•----...............................................--•---------------------------------------------
W Design Flow............4._0.........................gallons per person per day. Total daily flow------- ___:_._-._______-_-.--_-gallons.
W p Disposal an —Liquid capacity/0 gallons Length................ Width---------------- __ _-_ Diameter-- _._._._-_- Depth_. .........._.
W
x re —No.............. ..... Width ................ Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No Z :e;�£.•_..:Diameter'`-! ------------- Depth below inlet.............•...._. Total leaching area__,l f1.: q. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date---------------------------------------"
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water_-_--_-_--_-•-_---_.--_.
GLq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-----•___-_-----___-....
9 -------------------------------- -- -------••--•-•----•.---• .........................................................
0 Description of Soil... =r--k e_ .......... _�� 'r.P'. ,� /�J--1' , = �����&,4-7 l +!
--- ----------- --------•--••-----------
-•-• r
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 NI of the State Sanitary Code—The and signed fresher es not to place the system in
operation until a Certificate of Compliance has been issue- the boa dI f he It
t= S� C(1 .�.i� ..�.+�.... - �......•. �cDate "{
--
Application Approved BY---•''�- G ...+,r✓. ... --•--••--.----- ------------------6� --------_ -
Application Disapproved for the following reasons:............... ............................................................... Date
•-------------------------------------------------------------------------------------------- ----------------------•-------------------------------------------------------•--------------••-------
Date
Permit No.-,-/.• ::........................................ Issued..........4 ==14"= ..................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF.... Tf' -.r..c.. f �'..................................
(9rdif iratr of Tontphattre
THIS IS TO CERTIFY,IFY That the Individual Sewage Disposal System constructed ( or Repaired ( )
b ........... <f {
Y Installer
at-------- 1.,, /)'Fr L fC_e . `f -1 .?&C°PC
------. --------------------------------------------•------------------------
has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.__... s - -------------
PP P -�=`=-.;- dated------- ------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GU R EE THAT THE
SYSTEM WILL FUN TION ATISFACTORY.
DATE -----------------••... Inspector-------- ---•--•- .....---- -• --- --•- ... -
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
-' !�* OF.... ? s: �
No.---...... .
•=--•--•--
FED .....-_•-----
., , ' "� - �i��o�tt1 l�rk� (�or��trttrtion Yrntit
Permission is hereby granted........
✓_'.`_t °____.___ `
------••--------------•-••-------- -•------- ------.. ..------... •-•--•---•-- .......
to Construct O or Repair ( ) an Individual Sewage Disposal System
at N o. r` = f /�,!Vic'/. ; ` i>+r O< ` r T1 fY ex-le ur
------=-- ----- •--- -------------------------------------------------------------
Street
as shown on'the application for Disposal Works Construction Permit No.§,_�-...........f}Dated------------------
5
Board of Health
DATE.
____tii; ............................................. e
FORM 1255" HOBBS & WARREN. INC.. PUBLISHERS -
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PAUL C. MURRAY
HEALTH INSPECTOR
BOARD OF HCALTH
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TOWN OF BARNSTABL6 I
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