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HomeMy WebLinkAbout0024 WEST HYANNISPORT CIRCLE - Health (2) FimuZ.................. THE COMMONWEALTH OF MASSACHUSETTS BOARDeF HEALTH ... ....�1gv.. v.........OF. ------------------------------ Appliration for Raposal Works Tamitrurtion Prrmit Application is hereby made for a. Permit to Construct or Repair an Individual Sewage Disposal system at* 144-- ...... ............. . ... ......... ..... .... .... ..... K11L.?............................................... Location- t No, J------------------------------- .... . ............. ;r . ......... Address ..........I, ,.,.&--_----_------------------ --------------------------------- IV in—staller Address Type of Build17 Size Lot_-_-/4.0!�_Sq. feet U Dwelling No. of Bedrooms...................3..................Expansion Attic Garbage Grinder ( 04 Other—Type of Building ---------------------------- No. of persons-__-____________------------ Showers Cafeteria ( Otherfixtures .................................................................................................................................................... Design Flow ...—gallons per person per day. Total daily flow........... ".._...........gallons. P4 Septic Tank c,,a,,p,`a_,c,itv/?!!7�llons Length................ Width_--___-_--_---_ Diameter---------------- Depth---.-- ......... Disposal Trench—No_____________________. Width.- T tal Length____.._...... ..__. Total leaching area.. sq. ft. 0 Seepage Pit No.../............... Diameter ........... Depth below o .....&-------- ...... Total area.........".f'sq. ft. Z 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------------------------ Test Pit No. 2................minutes per inch D pth of Test Pit......_............. Depth to ground water...----____________-.--. P4 ........... ..... ............................................................................................................... 0 Description of Soil---------------------- 01................................................................................................................. x of --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ............................................................................................................................................................................. -­----------------------- 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_9, o en e undersigned further agrees not to place the system in �ss operation until a Certificate of Compliance has - by the board f health. Si ... .. .. ---­ - --------- ----- - ------------ ................................ D to Application Approved By.- .` . ...... .. ... . ­_ ....................... .. - --- -- - --------------- Application Disapproved for the following reasons:....................................... ... ....... /..... ------------- ...................................................................................................................................... -------D--------------- -a-t-e--------------- ------------ I PermitNo....................................................... Issued.------------------....-----------------.....--------... Date ---------- ------------ ------------ --------------------------------- i � t will y �:oi-. s FED.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH` .C�f 4�, App irttfiun for,Rapood Works Tomitrnrtion Prrutit Application is hereby made for a"Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sys at A r e 4 ! r Location-Addres Eta o;Lot No. i --------- ----------------•-------------• --ep11 1141 . , n Owner Address . ......••• - - •- •............................. •-••••-•-•--••---•--•--=--•••••-•-•••----•--•---•--•••..................------....... Installer Address Q Type of Buildin ; Size Lot--- "^ _.Sq. feet Dwelling No. of Bedrooms.................. -------------------Expansion Attic ( ) Garbage Grinder ( - ) `4 Other—Type of Building .... No. of persons____________________________ Shovers — Cafeteria .< Other fixtures------•----------------------- - W Design Flow------•...................: ... . .gallons per person per day. Total daily flow........... :__0 ---------------- WSeptic Tank•k Liquid capacity/_F_ gallons Length---------------- Width------------.... Diameter---------------- Depth._.__._______._. x Disposal Trench—No..................... INidth.........__�, _ Total Length......._....,..._.. Total leaching area_._____;,;_._--_.____-sq. ft. �. Seepage Pit No.................. Diameter/r__'d--- epth below inlet........jam........ Total leaching area___ *�_i� _'sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------------------------------------------------------------------------- Date---------------------------------------- aTest Pit No. 1................minutes per,inch Depth of Test Pit-------------------- Depth to ground water-__________-__-___-__-_ !Zq Test Pit No. 2................minutes per inch Depth of Test Pit-__-____._-____..__ Depth to ground water........................ P4 -----------------)- -- --.. .......-----•------------------------- ----- ---------------------------------------------------------------------------- W :...:------------------------------------------------------------------------------------------------------------------- x "- V 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 o e The undersigned.further agrees not ao place the system in operation until a Certificate of Compliance has bodissued by the board of health. ` t Date Application Approved B ;�'; .,r° - PP PP Y ( Date Application Disapproved for the following reasons:-------------------------- -- - -- - --- ----------------------------------•----------------------- ....-••---.........••--•--•••-•-•-----•--•-------------•••••••-••----------------••-•••--•••••••••-----...--•---•--••-----------••-•----••-•-•--•••••---•--•----•-------------------•------•-----•••--•- Date PermitNo------................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . �� x .fl............OF..... ..:"tom raw .. . ............................................ Tprtifira#r of Ton0fitnrr I IS TO * RTIFY, t the I dividual Sewage Disposal System,constructed � ) or Repaired ( ) by --.-- �l�-� ...........� ----- e In ! staller s has been installed in accordance with the provons of Article XI of The State Sanitary Code a desc ibed in the fi-,, * . application for Disposal Works Construction Permit No------------------_�,�: ._...�._------ dated ........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT,BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM /WILL F NCTIO SATISFACTORY. p.; DATE l-6� ......................................7 .- f --•--� .. Ins ector---•----- •----- �- - ---------"�. .- - ------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL-+H - � . 1 ,�1�,�+�`� �� Bvr OF..........:.rT ...h....: "xK. F°�. "ese.._.._:.�..... ............... No.-IJ.-I--- --- FEE----- . }� V r� C�l�n>� 1�tlt print Permission is hereby granted---- to Constrt cx �� or Repair ( an I dtvtdu l Sewage Disposal Sem r at No._ �..:'_. y. ---- .e°ox l ''� �' .. dt_ R ._..�... - -- -" - � Street as shown on the application for Disposal Works Construction Permit No Dated____ , _ .......... -..... Board of ealth DATE... 7 FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS A - - l