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HomeMy WebLinkAbout0107 HUCKLEBERRY LANE - Health MvAAS tie2�- 1 2 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