HomeMy WebLinkAbout0084 SIXTH AVENUE (HYANNIS) - Health (2) 0
Fxs............c7,•......C/
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® 9F HEALTH .
...-...... f�-.....OF_........." �!`L�.��f,�,�d�`�................
Appliratiun for BiupuuFal Works Tom1rnrtiun famit
Application is hereby made for a Permit to Construct ( ) or Repair (Jan Individual Sewage Disposal
System
�at:
.....11.7...._. ..1.� .. �% .��.....G '� _--•----------------------------------••---------------•----•--•------- ....-
• Location Address 1 or Lot No.
.... � .
W ^ y . ' •--------------------------•---
O Address
J�� ----------------------------------------------------------------•..............---•--....u
Installer Address
Type of Building!! Size Lot.............................Sq. feet
Dwelling 4K. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aa Other—T e of Building _.____• No. of ersons_._._.._•-.___•_____________ Showers
YP g --------------------- P ( ) — Cafeteria ( )
dOther fixtures ------------------------------------•--.._..----------.••••-----•-••••----••••••••-•-•••--•-••-•••••-••-••--•••••••----•••••••••••-•-•••-.._......••--
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
W Septic 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 ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
a Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water_--___-----_-__-__-__---
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
O
Description of Soil
x •---------------------------------------------------------------•---------------._..........•---
� ----•-•----•----------------•--•-----------••-•••-•----••----•--•--•••-••-•••----------•--••-•••••••-----------••--•-•--••...--
U Nature of Repairs or Alterations—Answer when applicable---/-=:4/e4-�-
� •----•--••-••••--•-••-•-••-•-•-•--••--••-...-•----
..••-•-••••-••-•-•--------•••••-••-••••......---•-••--••-•-•-------••-•--••••••-••-.....•• ,re40.....
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of'ITLU 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee issued byee b rd of alth.
Date�/(�
Application Approved BY•-•••• •• -••-•••• '_.P--/_...._..._
Date
Application Disapproved f t e following reasons--------------------------------------------------------•----------------------------------•--••--•---•--•-•-•
--•--••--•--....-•--•-----•-••..............•------•-----•-------•---•--.....-------------•-•---.....-•----........-----••----------------------------------------------------------------------•--•----
Date
PermitNo......................................................... Issued_.......................................................
Date
-- ----------------------------
THE COMMONWEALTH orMASsAonuSEzTs
BOAU�K�
� _��
OF HEALTFt
---------- .....OF.......���*�������� �
�
�x��
.�v1���lir^vtio*� *�"� Disposal Works Tons+*urt"o*» ��r*mot
1.
Application is hereby made for a Permit to Construct or Repair (,?,,--fan
Location-Address or Lot No.
--------------------
Installer Address
Type of Size LoL---'-'_'_'__-'Qn feet
Chwell'Building
of Bedrooms............................................ Attic Garbage Grinder ( )
Other—Type of Building ............................ No. of persons............................ 66mvcra ( ) -- Cafeteria ( )
Other fixtures.
Design Flow............................................ per person per day. Total daily flow............................................ .
Septic Tank—Liquid*capacity ---ou}lona Lcuoth------.Wildh................ Diameter-.---.... Depth................
Disposal Trench--No..................... Total Total leaching area....................og f t.
Seepage Pb No--------------------- Diameter.................... Depth below inlet.................... Total area.--------'sq. f t.
(}�h�c D�n�Unzdoo 6 �r ur / \ Duo6tuo� � )
�� ` ' ��~ ` ' ----
~~ Percolation Test Results Performed by-----_-.-----_-------'--'---.^-----' Date------------------- -
TestPit No. l._-__'--uz6nutcs per�cb Depth of �eo ��'__'-----' rnt6 to D urnood nmtec._------_.
� Test Pit No. per inch Depth of Test Depth to ground water-.....................
o4 _____---'---__------------------------------------__-'___--
xV
O -
Description _ --___-=~-_-__'--____ ____'-------_--___-_-____----__--_____-'
___-----------------------------'-'-'---'------------------------'-------'-------------------'------
---------------------------------_-_'--___--_'_-.--'__'--'_---_-_-
U Nature of Repairs or Alterations Answer when applicable
-----_---'--__-_.-__'-__.___'---'-__-____.__-_--_.-w- -----W........e...........................................................
------__-__----------.-_'-__-'-'-'---_
Agreement:
The undersigned agrees to install the afnredesoribed Individual System in accordance with
the provisions of'I'IZ 5 of the State Sanitary Code undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by he board of�,ealth.
Application Approved By Date
0/-------------------------------------------------------------------------- ...AZZ�nz ......
Application Disapproved f1t lefollowing reasons:.................................................................................. ------Date............
---------------_____-__--'-'-'-----'----'------'----__---------__-------------_----_----_----_'--
� Date
Permit
Date
THE COMMONWEALTH ormASsxCnuasrrS
BOARD OF HEALTH
............. .......OF...... z .......................
Trrtifiratr of Tomptiaurr
ERTIFYII'hat the Individual Sewage ep
�osal System constructed or R aired
Ins, 11
has been installed in accordance with the provisions of T]�;F' 1)D
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. �
_-- Inspector_
'
THE COMMONWEALTH oFmAssAo*uSETT `
~
BOARD PF HEALTH
'
2�o__-----_�- --'----- ----' --
- ------
Disposal Works Tonij. TIn Jkrunt
` to
at No.....A�11......................
--
Street
us shown oothe application for Disposal Works Construction Permit Dated..........................................
'
Board of Health
/^A^ .
`
ronM xamm A. M. svLmw. INC.. ooarom
NN �
mm