HomeMy WebLinkAbout0107 SECOND AVENUE (HYANNIS) - Health (2) /�� �econ� 9trencee , ln�s
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No............... FEs.' ..'...............
THE COMMONWEALTH .OF`MASSACHUSETTS
BOAR® OF HEALTH '
Appliration for Bi_gvaaal Works Ton5trurtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal I
System at: v ���
• - •- -... -..._... ..............
- -• - atrn
ess / � �or bt No
= ..................................... . ....•-•-•-...- -- -----........_... .-----•....._..._....
Address Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms________________________________ _Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) Cafeteria ( )
0.� Other fixtures ---------------------------•-••. •--
w Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity_.(_t�. ..gallons Length................ Width-----------_.... Diameter---------------- Depth...._________---
x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No... _ -0_._.. Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box O Dosing tank
~' Percolation Test Results Performed by.......................................................................... Date...................
-__-----__-__-____--.
aTest 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_-_____________________-
a'
ODescription of ....'0 ............L.,dJ ...............................................................................................................-------••-••-•---------------•-•••-•--•••-------•-•••--•---•--------------------------••••••••••......-•-- =" --------------
-
U Nature of Repairs or Alteration — er when appl' able._._-1�___-__ -.__
Ory
Agreement:
�`�
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITf is 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been ' ued by the bold of jiea th.
Sig d---•• ................ ` Grrin� a,!
" __ _
Date -/ -
A Application Approved B _._..__.,
PP PP Y � -••-•--•------• --•4�� ••---_---•-- ----
�/� Date
Application Disapproved for the following reasons:_______ l
••••••-•••••-••---•-•-•-••-•••---••--•-•-•---•---•---•----•..................•---•••••-•--•-•-•••---...--•-•-------•••••-----•--••-•--••-•------•-•-•-••-•••-••-••-•••••----•=•------------•-••----••--.
Date
PermitNo..........................._____........................ Issued_.......................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OZEALTH
.......... .......OF............... e?Z2 ..o....._...........
%Lyrrtiflrate of TlImpliaurr
T S T RTIFY, That e Individual Sewage Disposal System constructed ( ) or Repaired
by------ .... ...f ............................. Z.........................................................
^^77��-- Install
at........... t�- -• ••• ... L� �0-� ..-- ---
has been installed in accordance �it the provisions of T, jai j of Th State Sanitary .de as describes)+ in the
application for Disposal Works Construction Permit No. d.'______ -_- ......... da.ted------1�_..�s5�__"'_��'"._.___._
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.......................................•-•-----__•••••••••••••-••-••--•.._...... Inspector...................................................................................
No................. .5� Fss. ..................
THE COMMONWEALTH OF MASSACHUSETTS
HEALTH
BOARD OF HEA
� � fr ,
.. ............_....OF......a....I......................................-------•----
Appi irtttiun forthiji al Workii Tnnitrartinn amit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at //
_ Location=Address ` , or Lot No.
......# .-�. ........ .. .:�`jf. t` ....................... ......................... ..°.......:n . ..............................................
, -Owner Address
W r ?: i• p . � . F� � vv1 }.---- �---------.:rl--- _.....t.............('.................. '............................................
r ,
Installer Address
Type of Building Size Lot..........------------------Sq. feet
U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
'_l Other—Type T e of Building No. of persons............................ Showers — Cafeteria
a YP g P ( ) ( )
Other fixtures
. -- ---------------------------------"-----"-•---•----.-•-------
131
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..1_.......... ------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z- Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
a
Test Pit No. ]................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.........................
LY -""•"""-------""-------".--"•:••---."."""••-"•--••--"--••---"----"""-"--"-"----•........................................................................
0 Description of Soil......-"..................""""----.. ..•-•-"----••-............_..--•-•"--"-•---------"--"-•--"-"---•-•"•-•-•"-""-•"•-""-"-...""""""-""-"-""•--•---•-------------
U ""-....."""-""•••••"•"--"""•-•-•••-•-"•••.... -•---•-•--- ----•• ...............................
W ............................................................--------------"•"--"•"--•-•""-"•-•••......---" ------- -- --------------------.-.-----------
VNature of Repairs or Alterations—Answer when applicable_ ___ Cr .......................................................................
--------------------------------•••"-"-•""""-------""--"-"•••--••"-•...••--"-""""-•".....-----""--•-•".........-•------"------••-•"•"-----•-.._...•--•-•---•---""-"-•""•••-•-""----•-"............"-•-
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of T IT i.;
p 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 ofihealth.
Sig .d y" r --•-----f......---�.---� �.. ........................... •=�..-- --.=:._...�_..._
. -
Date
Application Approved B
-----
Date
Application Disapproved for the following reasons:_ a.
..............................................--•-•---........................................ =--........-•---....---------------------------------------------"•-•-
Date
PermitNo......................................................... Issued......................................................
Date
r.,r THE COMMONWEALTH OF MASSACHUSETTS y
BOARDc OF HEAI,...TH ' ' }�
� A
,..,� �rx#if�rtt#r of f�u�t�r�ittnrr aT:
T IS T RTIFY, That e Individual Sewage Disposal System constructed ( ) or Repaired
by... �a .. - ----- ..... .......................... ----
t Instal
has been installed in accordance rth the provisions of j of The State Sanitary de as described in the
application for,Dis osal Works Construction Permit No - ._ ._s-_-.r-------•- dated _
.....
THE ISSUANCE OF THIS CERTIFICATE'S'HALL NOT BE CONSTRUE® AS A,GUARANTEE THAT THE
SYSTEM WILL FUNCTI,;,),N SATISFACTORY.
DATE............................•-••---•---------•-- •"----•-••••......••••_..._. Inspector.....................................................................................
THE COMMONWEALTH OF-MASSACHUSETTS
I '
BOARD OF HEALTH
..........OF.......,,��........ _.
No......__ � FEE..... ............
Dispos rk� omitriirt' n rrntit
Permission is hereby grant d i� ....:
to Con st ct or Re air n Individual evtge isposal Syst
atNo. y i a a.Z_-- .'V... ...f/ ------------------•------•----....
,Street .
as shown on the application for Disposal Works ConstructionANo.. ..:......... Dated.___+ '__.__....._.....................
--- � � ,L{. •---------------•---•----
w y Boar of Health ��
!.
DATE=--y7�-----:��---------- •------•-•----...--.........................
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS