HomeMy WebLinkAbout0055 WEST HYANNISPORT CIRCLE - Health (2) 1
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No..... ................
THE COMMONWEALTH OF MASSACHUSETTS
B 0 A R D 0 H EAL_Ij�l
...... ..........OF........... ..aosvd ..*--___ ----_---_---
Appliration for Dig pmal Workii Tongtrurtivit Vrrnfil
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System at,
.......................................................................
ion-A�4dress or Lot No.
gz-aje. . . . .... .... .......................................... ..................................................................................................
......4 "' , ' 9
rnerAddress...............e. .. .................................................. ........ ............................
14
14 Installer Address
Type of Bulldn" Size Lot--h5r;1_47 ..Sq. feet
U
Dwelling-yNo. of Bedrooms.......................7-_--__---_-_______Expansion Attic Garbage Grinder
Other—Type of Building ............................ No. of persons.__._.__.................... Showers Cafeteria
P4 Other fixtures ----
----------- ----- ------- --------- --- ---- ---- - ------- ---------------- ---------
Design Flow - ----------- ----------g'a"llo"n"s...p"e"r"person'-per-day.-,_Total
"da'1_1'y'
W
9 Septic TankTL"_iq__ui'd' capac,ity",(A'OTOgallons Length................ Width________________ Diameter---------------- Depth----------------
Disposal Trench—No..................... Width----------__ �tal Length..._..__._. Total leaching area--,.- .......sq. f t.
Seepage Pit No..................... Diameter--- hre�th below inlet___.__ ....... Total leaching area_ _ ft.
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by......................................................................... Date----------------------------------------
Test Pit No. 1................minutes per inch Depth of Test Pit-__.._............__ Depth to ground water-_-_-___________.___-__.
fs, Test Pit No. 2................minutes per inch Depth of Test Pit____..............._ Depth to ground water..-_..._...._...__.____.
04 ........ -.�:-" - —----- ---------------------------------------------------------------------------------------------------------
QDescription of So1------------------ . ......... .................................................................................... -------------------
U ..........................................................I..................................................... .. .............. ------- ........
-----------
----------------------------------------------------------------------------------------------------------------
------- -- --- ---- -----------------
Nature of Repairs or Alterations—Answer when apy�l le.____ ......... .- - _/
U ------C------ -----------
------------------------------------......................................... - - ----- --------
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Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitar, Code The undersigned further agrees not to place the system in
': " " 'g " In'i iss f
operation until a Certificate of Compliance s n iss e by the oard of health.
Si
... ... ...... --
Date.
Sign, --- ------------ ------------ ......... .............71.../ . ..............
Application Approved By....... . ........ ...... 414��4.. -.......................
... ...........
Date
Application Disapproved for the following reasons:...............................................................................................................
.................................................................................................................................................. ---------------
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PermitNo......................................................... Issued---- ...................................
Date
..................
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No --- •-• Fl@s .
THE COMMONWEALTH OF MASSACHUSETTS
s BOARD OF H EA,U
: rya' - ---- ..OF......
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Appliration for Uiiipooa1 18orko Tnnultrurtion runfit
Application is,hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System ate +
catioo �dtress or Lot No.
.........................
t Owner Address
Installer Address
Q Type of Buildi �. Size Lot.. . .. ..:: ...: Sq. feet
U Dwelling No. of Bedrooms___________________________________________Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No. of persons............................ Showers — Cafeteria
a' Other.fixtures ................................................................................................ m m
0" 1
w Design Flow ........................:k.`1?_ -_ allons per person per day. Total daily flow-------------`---___: -_____-_.--.--.--.gallons.
WSeptic Tank l Liquid capacity__A_!�'__..gallons Length................ Width....._-------__ Diameter---------------- Depth----------------
x Disposal Trench—No..................... ��'ldth r 9 ,Iotal Length----------- Total leaching area........
. »,:. . ft.
3 Seepage Pit No..................... Diameter--_ .D.epth below inlet.................
__. Total leaching area------------------sq. ft.
z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed bY-----•------------------------•--•••---------••--------------------------- Date--------------------------------------
Test Pit No. 1................minutes�Iper inch Depth of Test Pit.................... Depth to ground water------------------------
r3.1 o Test Pit No &=2 .... minute I.r inch Depth of Test Pit....................:Depth to ground water_.----------------------
W • p:',i'3`�"a vet... �... .. 7 .
O Description of Soil------- - ---------'� � -' -
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—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has -een iss e by the Poard of health.
Si e _
?__r
- ,I ° _ "
Application Approved BY
Date
Application Disapproved for the following reasons:.....................
----•--•---•-•-•---------------------------•-----------------------------•-•-••---------------•••-----....------------------------------......------------------------------------------------•----------
Date
PermitNo......................................................... Issued---•---------------------------------------------.......
Date
THE COMMONWEALTH OF MASSACHUSETTS
a ;. BOARD-'-OF HEALTH
.............................:...OF........... ...?:< .............................................................
�le�t�ir��r �af� f�unt�ig�ttz�re
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( c or Repaired ( )
bye� r (� r »�
i.!= 4_'i,,{`¢C: „ - -•----••---•-•-------------------•-----•-----------------------
t, Installer
XMIa j ,
- r----- .
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 CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector..........................................................................:.........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALTH
No.•-• FEE .
Permission isel herebygranted�_.. aF� i ..t 3 ��r Y,-_.---_
to Constru t) or Rep air an In ividu 1 Se age Disp osal S stem 4
at NO.,- ... zx. �Sr rrt ✓`� r$ � Y" <� ' ` 'a
8' f'
as shown on the application for Disposal Works Construction Per;gait Street
3_ ------- Dated----- �
a
� Y oard of Health
DATE..... --------------------------------
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FORM 1255 HOBBS ARREN. INC.. PUBLISHERS /'