HomeMy WebLinkAbout0025 MAIN STREET (HYANNIS) - Health (3)ras
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No........
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
T.Q.w..w_...------OF.........
§*��Avvfiravvtt Disposal�tspnsa1 oxks gomitrurtion Urrutit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at:
e y-------••-•- L '�/G/C /I/f/��u /S
-------------------------------------------------------------
Location-Address or Lot No.
............
..••---•-- :_..---- ✓ /i'al� != .......
Owner Address
Installer Address
d Type of Building Size Lot-----_......................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____ No. of persons____________________________ Showers ( ) — Cafeteria ( )
Otherfixtures - -----.. ------------------------•---------•-----------------------------•------------ --•----•--------•------------------------
W Desgn 1 /00 g_ P Y Y -----------gallons.
t Flow_��'__���___�___________ ally s p��erson per day. Total daily flow.__-____ .-3.�?__:_______ _
WSeptic Tank—Liquid capacigal ns Length------------- Width---------------- Diameter---------------- Depth_--_-__.-_
x Disposal Trench—No....... kidth__,�_ ___. gip Total Length.................... Total leaching area....................sq. ft.
Seepage Pit Nol, /a__f�____ ianter_______S__ :_._ Ifepth below inlet____________________ Total leaching area------------------sq. ft.
Z Other Distribution box ()() Dosing tank ( )
aPercolation Test Results Performed by.....- ---------------------------------------------------------------- Date........................................
a Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water.--___-__-___-_____-----
f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
a' - ---------------------------------------------------------------------------------•----•---•---:--'-----------------------------------------------------
ODescription of Soil..... •-----.....J*,O•Aw =---'•-- - ------------• ----------•••-----•-----------.--------- --------------------•----------------------------------
x
U -----------------'-----------------------------'--••-------------------------•------'--••-'--'•---------•--'---•--------------•--_____----------•-----•--'-•-----------------• -- ,,'A-------------
'-------------------------------------------------•------__-___-------------•------------•------------.______-•----------••-----••-•---------------_______-•---•------------------------•--•------------
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 aI 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 rd of h th.
Signed.:-•�!--
Date
Application Approved BY � L/
® Date
Application Disapproved for the following reasons-----------------------------------------------------------------------------------------------------------------
Date
Permit No. J`� -----------------------------•-------• Issued...... 7"—
Date
THE FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINALS)
I M ^C&L
DATA
No. ................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Appliration for Biiipnsal Worbi".Tomi#rnrtinn lbrutit
Application is hereby made for a Permit to Construct (A'*'Or Repair ( ) an Individual Sewage Disposal
System at:
--- ---------------------•--------------------- ----------- '-- ...........................-_.
Location-Address ? J or Lot No.
Owner Address
Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms............................................, Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building
fr
aYP g '-'=--•-•:-•-- ----•-------. No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures , ----t--------------------------------------------------------------------------•---------------------------- •-------------••--•-•-------------------
Design Flow...................................t y '__'gallons per person per day. Total daily flow___-_- =='........................gallons.
W /(:",
WSeptic Tank—Liquid capacity-, '...gallons Length................ Width_.___._.-._____ Diameter____-_.__-__:_ Depth---------.__---.
x Disposal Trench=No..................... Width................. - Total Length-___________.._----_ Total leaching area_...................sq. ft.
Seepage Pit Nol.r::_.____....'.. Diameter.......:%'_.-____ Depth below inlet.......:............ Total leaching area..................sq. ft.
Z Other Distribution box O Dosing tank ( )
aPercolation Test Results Performed by------ -------•---•---•----------•-•-•-----------------------•---••-•-'-- Date----------------------------------------
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water._.--__-_.-__..-___-.---
ff;l, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-.--____-__--_-________-
W ............................................................................................................................................................
ODescription of Soil........-----•-=-•-- '-'----------------------------------•-----------------------•----•...-------------------------------------------------------
x
W
--•--------------------------------------••---•-------------------------------••------------•------------------••----------------------------------------------._------------------------------------
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 issued by the b4'hrd of health.
Si ned ' ---..: .......I - r t ;
.g-.. -•----
Application Approved By--------------- ;F
Date
'----••----•---_.._....-'-^------•-s._..-------'--•............................. --------•-•-----• --------------
Date
Application Disapproved for the following reasons:................................................................................................................
------------•"-••'-•------'------------------------------•-------------'•••------'----••-'-•-------.._......--'•------•.--------------------------••--------------------------------------•----------'
Date
Permit No,--_`!.,% =-f
--•-_.: Issued--'---••--
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
h4
AT
Qw ifiratle of Tomplittnrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (ior Repaired ( )
b ' � .
.,
Installer
•. -
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__________ _____________________________ dated.__.---_--..________- .._.. _________--•-------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE-------3- = ......................-••-••-'---------- Inspector-----..'PO................................................=---------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
, n.
- - -...:`.............OF.......... ..............
' No......!................ FEE---'-•---=--•'--..
Permission is hereby.granted......... . '?'---=----------=--'... `-- -------"---------------------------------•-•-•-•------•--------•-----------------------•----
to Construct ('` ) or Repair ( ) an Individual Sewage Disposal System
at No.--------' .� r
-- ------------------------------------------------- -----
Street f ,
as shown on the application for Disp eosal Works Construction it No.__ � ated_ ._
Board of Health
z DATE ..
FORM 1255 OBBS & WAR EN. INC.. PUBLISHERS -'
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