HomeMy WebLinkAbout1560 HYANNIS ROAD - Health /sue� j-�j����►,�s �. , Ys�n s
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THE COMMONWEALTH OF MASSACHUSETTS
o BOARD OF HEALTH
1 _ _ -----------OF .................................... ....._ .........-----.................---
Applir�ation -fair Di-qVuiittg Workii Tonstrurtioaa Vrruiit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
or
Lccation:Address ............................................Lot No.
Owner Address
a ..... of%/i_(d - �0 !C:.
Installer Address
Type of Building Size Lot-...........................Sq. feet
V Dwelling—No. of Bedrooms------------- .._.__--_-___----`.__Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ............................. No. of persons---------------------------- Showers ( ) — Cafeteria ( )
G4Other fixtures --------------------------------------------------------------------------------------------------------------------
W Design Flow............................................gallons per person per day. Total daily flow-------------------------------------------- allons.
WSeptic Tctnk—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. 1----------------minutes per inch Depth of Test Pit..._-__-________._ - Depth to ground water-------..-_-.-..---_._.
rZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...--.-----_-------..._.
O Description of Soil--------------•- .............5et
x
W
x -•------------ ------ -------------------- ----------- ----------------------------- --------------------------------------------------------------------------------------------- -----------------
V Nature of Repairs or Alterations—Answer when pplicble.-.-_--_.- ----------
AZ--------------r .......... ----------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article Xl of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued y he board health.
e
Signed..... .-- --• --- ` f,� -------------------•- -- L--�=. '._7Y_ .
Date
Application Approved By.................. ------/� .. -••-•----•----•-••-----•-•-----•-•.......... .......
Date
Application Disapproved for the f oll ing reasons-----------------------------------------------------------------------------------------------------------------
------------•••------•--•----...•----•-•-------------------------- .............................................................................qi
Date
PermitNo..------ ................................... Issued...................... ......V....................
Da e
Fax:....... ..........
THE COMMONWEALTH,OF MASSACHUSETTS
BOARD OF HEALTH
_. ...._-----------OF..................................... ............. ................-----
Applirtttiott -for Bi_gpwi tl` Norbi Cnii.tistrurtivu Permit
Application is hereby made.for a Permit to Construct.( ) or Repair ( ) an Individual Sewage Disposal
System at
�---•----- ---------- - --
Location-Address or Lot No.
.1T� ; -----------.............. ---------------------------
W Owner Address
....... I......Pz C....---- --•----------------------------------------------••----•-•---------------------------------------
Installer Address
Q Type of Building Size Lot----------------------------Sq. feet
U Dwelling—No. of Bedrooms............. -------------------------Expansion Attic ( ) Garbage Grinder ( )
1:14 Other—Type of Building ---------------------------- No. of persons___________________________ Showers ( ) — Cafeteria ( )
Other fixtures ....
----------_----------------------------------------------------------------------
W esign 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. it.
z Other Distribution box ( ) Dosing.tank ( ' )
~' Percolation Test Results Performed by------------------------------------------------------------------------------ Date---------------------------------------
Test Pit No. 1............:..nunutes per inch Depth of Test.-Pit:::;-_,:_-___' .... Depth to ground water..-._-_-------.-__-.._..
�14 Test Pit No. 2................minutes per inch Depth of.Test Pit______________:_____ Depth to ground water_:-.-_.-__--____--_.-.
0 ------•-•-------------------•-••---•--•---•--------------_---...
Descriptionof Soil------------- ....------.. -------=------------------- ------------------- --------------------------------------------------
x
V ----------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------
W ---------------------------------------------------------------------------------------------------------------- ��------=-=--=---------=--.._.__..... -------
x .
U Nature of Repairs or Alterations—Answer whenble X.�r2 ' -! ..---. '
, -�-`-�-- ---------------------------.
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-been issue y he board Qf health.
Signed . --•- ---- (/ -------f
Applicatoi�Ap�royed By .-- r _-__-- Dace
�, ac t t s. Date
Application disapproved for the f of wing.reasons: ------- ------- -------- -- ----- . ........ ......................................
•-•-•---..__.--•-•-•--------•---•---•--------•---•--------•---------•---...-•-------------------- •-----_----______---•--------------•-----------------------•------------------•----------------__----
Date
Permit No.------- Issued.---------•-- --- ._.: �{ - , r
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
......oF....:. ,S i ,b: ..................................
...
yr F. Trr#ifiratr of Tantpliattrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
Installer
at �a/ • --------- -!!!!I� ------------ 1 'f ._._._.._...
has been installed in accordance wits the provisions rof� Article jXI of.The State Sanitary Code as described in the.-
for Disposal Works Coi3struction Permit f f o.:' 'ya r ___________ _ __ j A,_ _dated------. ----------
applicationTHE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE HAT THE
SYSTEM W1 L FUN TION SATISFACTORY - 7
DATE --- -----••---- Inspector
a -
------- ---
q; -:4!v':� .�t.. W b".4' � 2t i"t -l� ':• b 9.'' 7p{.': 6�
THE COMMONWEALTH ?F MASSACHUSETTS ?y
BOARD OF HEALTH
/."a�. ........OF...... /'A•e. T .......
No......... FEE-
Permission is hereby granted----------Cam--&FI-76-A.14.0------- ...t0v,s- -----_----------- -----------------------------
••-
"to Constru�y1( ) or Repair ( ►) an Individual Sewage Disposal System
,{ "`,,. -c^ ,.Street ------._...-•---------•-------••---••-•---•---•--•
as.ashouvncan,the application for Di'posh Works Const`rtac>ioti�l3;etnit No._.._ :__ Dated__________________ ____ _ ______
- --- - --- ----...........
F N o Health
DATE _ *'._. ... _n
oard f
FORM 1255 HOBBS & WARREN JNC.. PUBL(SHERS � 1:< °'""�1�r ��9 yf'_4fs_•
.. ',`-;:�` ,•.. .,.,Ld*4-y.snx! f.�r ,r.:,i-. mn.�si r'ts.