HomeMy WebLinkAbout0107 HUCKLEBERRY LANE - Health MvAAS tie2�- 1
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LOCATION SEWAGE4 .PERMIT NO,
Z69 -7 A Y Cie Z-f
VILLAGE
INSTA LLER'S NAME i A""D'DRESS
J. CRAIG MEDEIRaS SGw
. _ Luc i;ag d�° Bailldo�,irg`�
OWN ER Hyannis, h,ass. 775-0828
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED �' �/ �
t14V \ \
I
FEs60-v......_
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O. F . H EALTF6rnst �
� abl con
P�R o v E D
...- O / - `?L_✓1 � � rvation C
o m c ..• • • . - mjssjon
App iration for Mipaa i al lftrkii Tumu i _ _
Application is hereby made for a Permit to Construct ( ) or Repair (A an Individual SewageDpos
System at: �y
Loc lion-Address or o.
----•• /� .Q....�N..•--•--•••...-•------•-•-------•---------• -/--a-z-!-� � �.� ............!?�:
\ Owner^ dr ss /�/�
Installer Address
dType of Building Size Lot............................Sq. feet
V Dwelling—No. of Bedrooms______________________________ __ .Expansion Attic ( ) Garbage Grinder ( )
04 Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures ..........................................
W Design Flow............................................ per person per day. Total daily flow............................................gallons.
9 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................
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 ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I................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------_----_---___------
Description of Soil ---- v�i i'2'y- - -- --- --• ------•---------------•------•------••-------------------------------------------
----------•--•-•------•----...---••-•---•-------•----------------------------------------------------------------------------------•••...
x
W ------------------------------------------------------------------------------------------------••----•-------•••--
U Nature of Repairs r`Alterations—Answer whe plicable_-_----- 1't. .....a........
- o. •.( �- �� � 3
cam"•-• ` .•-'�� 19�,1_�;.... �G �L� •--
1-:
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of 1-1 L
p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b en issued by the board of health.
- Signe . ••••-•-•••-•-_. ..... •--
- _ -........
_ Date'
r Application Approved By•••••••-`;� . -•-----•••---••••--•..._..._•--•-•. `�-D�—�il----
Application Disapproved for,the following reasons------------------------------------•----------------•---------•----------------------------•---••••------_-----
-------•-------•---------------------•--...--•-----•-------•--•--•--•-----••---------------•---...----•-------•--------------------------------------------------------------------------------....••---
p Date
PermitNo........9r... ._ -------------_ Issued.......................................................
Date
No... 2!......2 .k FEs.. ..
THE COMMONWEALTH OF MASSACHUSETTS , -
BOARD OF HEALTH
n
`.. ---------------OF.......:.:...?.---...''.: --..............
Appliration for Elhipau al Works Tumitrnrtiun famit
r
Application is hereby made for a Permit to Construct'( ) or Repair ( t-)an Individual Sewage Disposal
System at
................__...............................................................•-_........... ......------•.....................--•....._................-------•-•--..........................• `
/ Location-Address , t or Lot.-No.
Owner Address
•-•--- ... ...................•----...Installer--• ----•---------------------
..........
----------
�•..............
�~.............
- -- ..........Address + -------------------•--------
VType of Building Size Lot............................Sq. feet
f-1 Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( )
a'4 Other—T e of Building No. of persons............................ Showers
YP g ---------------•-----------• P ( ) — Cafeteria ( )
dOther fixtures ------------------------------------•--•--------------.•••-••-•--•----•-•---•-••-•••-------. ...-••-•------•••--.-•-• -----------
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.-_.-..-_--_---_-_-. Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by......................................................................... Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
(s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-._--_•---..-•.---_._...
a ••------•---'-•••---••--•.....................•-••--•--•........---•--.._...............---•-------........................................................
DDescription of Soil................(-�-`- .-.)'�...r.............................•-•-----••-----------
x
UW ......•-•------- --------------------------------------------------------------------------------------------------------------------------------------------•-•=..............
Nature of Repairs or Alterations—Answer when..applicable..........- ...?.:�•_._"_. ---_-/_._...�'. -- a-_-`': -/ , = 'R
t J C f )
----------•-•-•---------
` -----------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of i T'�p 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 of health. ?
r
Signed`._....
~' ........................................... r•.... -.......
Date
Application Approved BY ... tg� �; u-``
Date
Application Disapproved for the following reasons--------------------------------•-----------------------....-•------------------.........••--•-•-•-•-•......._._
--------------------------------------------•------•------------............---------•-----•-•-•..........---...._....--•--••------------•-------•••-•-•--•-••-•-•------•-•--••--••--••-•••-•---••-•-•---
Date
Permit No........... L Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH,.
-- - ,..
711
� ......� '`' j
(In tifiratr of Tuntph anrr
THIS IS-TO CERTIFY, That the Individual Sew ige--Disposal Systet�n constructed ( ) or Repaired ( )�
by__...-...,.._
F ' . ..........6... .........J- � .........'.................. .. . --- ---_ F { --:—lInstafler
at_ x -L_ .. .....................? .. 1 r_ ` ; _, .. ..1 '(r... ,--w •..�...
•••-- . ---....... = - T R
has been installed in accordance with the provisions of TTTIE 5 of4The~State Sanitary Code as described in the
application for Disposal Works Construction Permit No......... ....... dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRkED AS A G UARAN E THAT YHE
SYSTEM WILL, FUNCTI N l FACTORY. v
DATE .��1..._-• Inspector ... ..................•---
THE COMMONWEALTH OF MASSACHUSETTS
_ BOARD OF HEALTH
. ,
4
OF........j. :....:: ... : ...................................... FEE...... 2D
pro._ :�-.�.� .......................................... �.�.
Uispaao a1 fir � �a n rnr inn pram
Permission is hereby granted-
.............. : •--•-=.•-•----••••.............•-•---•-•-•-•-•••-•-----•--...............••---..................--•-•-
to Construct( ) or Repair ( v) a`n I Individual Sewage Disposal System
• -r� / t
is 1\TO...._.;_-..`�....-._._.. ...__._�_ -: _..__ ! �, R .r 1 1/.
{ -) - .I..../ ;. ,;'e.' :� *Scree r' S�.ad
_- K" b,as shown on the application for Disposal Works Construction Permit No . - _3 ated.... ......... .......... ..........
................................... . .......................................DATE. - (•' .............................. of Health
FORM 1255 HOBBS & WAFREN. INC.. PUBLISHERS