HomeMy WebLinkAbout0267 FALMOUTH ROAD/RTE 28 - Health (2) 267 Falmouth Road
Hyannis
A -292 - 013
No..........7��..... Fps. :" .,i. .�
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEA TH
2 VI 0 F.. i�dY e..............................
Z°I � _
Appiiration for Bispos ai Works Tonstrurtion Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair (A) an Individual Sewage Disposal
System at
.................. . ........ --.....- -
..
lion-Address or Lot No
.._:. �1.-.................. .. ...... 1 �1 . ....-••-•-...........•.......................
O-ner ..Address
ltcom. ....... 1? .- - Y�?� ...................................................
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
a Other—T e of Building No. of persons............................ Showers — Cafeteria
Otherfixtures --------------------•------------------........------..-•••••--•-••............--------
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.
3 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. 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........................
R+ --••.............................................. .--•-
x Description of Soil......... � /-----------v --
V ----•---••--------------------------------------------
...---------------------
--------------------
•----------------
•------W
U Nature of Repairs or Alterations—Answer when applicable-----J-'-`�Q.0....P J1................................................
--------------------------------------------------•-----............---------------------•------•--•:-•--••......-••••-......----•-••-•--
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TI'7U 5.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.
Si d._! - _
Date
Application Approved By....... ,,(- ------ _-_: (�!j-
...._ `mod=
Date
Application Disapproved for the following reasons:............................................................................................ ._.-:____.-_._
-------------------•------...-------------------•---------.....---------------------•-•--------....----------•••--•--•.....••----•-•-•------••-••----••--•-•---......••-•-----•-•••--•----•••......----
Id "Date
Permit No..... - - - Issued -------------------•••--........- -
Date
G,7�,
.. �
No...... ... ,1.... ...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
App irFatioat for Klispau al Works Tonstrurtioat Permit
Application is hereby made for a Permit to Construct ( ) or Repair (A) an Individual Sewage Disposal
System at:
-•R00J.----•------------- ............................................... ......-• -•- _:............_.
�L• . lion-Address or Lot No.
•-- 'P��r._r. --._... .....r...-u _ ----------------•. )____��_ -. .........---------------.........................._.....
--• � � O ner T` --• Address
/ L.j ..... ���...... .........�!:r���).�����`'
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers — Cafeteria
Other 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........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
-----------------------------------------------•------------.----------------------.--.------•--------•-•----------.-----
ODescription of Soil------.... l:t(......... f S': .. ..-•--•.....-------•-------------------------•------•-----•-------...---•--........._......-------------
W -----•-•---•------------------•-----------------•---------•--•----.••--•--••---------•---------------•--•----------------••---•-•-•---------- -----•-
------
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 TITI.% 5 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.
�...ti.........._t_...I'v .. Azh�o.....
j� Date
Application Approved By...... ------------------------- ..... -.....
Date
Application Disapproved for the following reasons:..............................................................................................................
...r
Date
PermitNo.---•----•-------....•-•------...I•-------------•...... Issp -=-----•---- .........................................
s Date
s` `• THE COMMONWEALTH OF MASSACHUSETTS-�BOARD OF HEALTH '•
............. ...... .... ........ o- 01Z�
...............................................
Trrtifiratr of TompliFatta ,
THIS.I,_)TO CERTIFY T}iat�the'Indiv dual Sewa Disposal System constructed'(',) or Repaired .K ).
/ Installer
...: ....... ... .....•-•----.. ....._._. f_. �': 1: ..f.:...___
has been instilled in accordance with the provisions oV � 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No ........�'1A---------------- dated---,1A_w_r�.k... _f.�_...............
• THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ fInsP ector....------•--........................: .............................................
THE COMMONWEALTH OF MASSACHUSETTS
--#- — BOARD ,OF HEALTH
' � l .�J/. .......oF..... �' i .J� ...........................................
N ......................... FEE .....
Diopo,oal f orks Tonotr ion Permit
Permission is hereby granted-..—.- , I............................ ( _y... _.......�!1 �::f .........................................
to Construct,( )-or Repair ( �i an Individual Sewage Disposal System
. -:
at No.. r. _: ....�::T .7 i i/ 1........................................•----.......-------�'�...�,l/
7
Street f
as shown on the application for Disposal Works Construction Permit o.-_..__ Dated/ ................
...............••......
........ Board of Health
DATE---f�--�---��--�--�``"
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FORM 1255 HOBBS & WARREN. INC., PUBLISHERS Y
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