HomeMy WebLinkAbout1649 HYANNIS ROAD - Health H�1 H yann,'s i?�( .
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LOCATION SEWAGE PERMIT GO•
AS
VILLA -E
00
IaSTA_ LLER'S NAME b ADDRESS
DUIL0Eft. OR OtMER
D:A-TE PECIMI.T ISS-UED
D-ATE C0MPLIANC-E, ISSUED
♦x
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.-THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
. "
Appliratiou for Diupntia1 Workii Tondrurtinu nutit
Application is hereby made for a Permit to Construct ( ) or Repair (van Individual Sewage Disposal
System at:
T ' •�
.. � ...... ..4..� ........� _V�C c7tfd�__.... ..y�_l_.....................................................
Location-Aid ss or Lot No. �
X._/.� ..:G.� ... + .---...----•--- �� ire' t " +�4��Q /�1�� ...ef/, i..----•----•--
Owner F Address
z
W �� ! � ry _ �. am„ .. -- -------------------
a ------------------ - . ......--------..
- Installer _ Address
QType of Building Size Lot............................Sq. feet
aDwelling—No. of Bedrooms...........I..............................Expansion Attic ( ) Garbage Grinder ( )
pa Other—Type of Building .........__.•.:............. No. of persons............................ Showers ( ) — Cafeteria ( )
a Other fixtures -------------------------------- .
W Design Flow............................................gallons per person per day. Total daily flow......................................._....gallons.
WSeptic 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........................................
aTest Pit No. 1..........:::...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........................
•-•-----•-------------------------------•-..._......----....---.........................•--•-----•-•.........................................................
0 Description of Soil.......
----•------•----•-------------•-----•-•--•------------------------------------------.
x
W -----•-------------------------------------------------------•------------------------------•--------------•------------....------------------------. .......--••----
U Nat u e of Repairs or Alterations—Answer when applicable.-------___- SN�..........!....�...va.. _.. `R..�. r�.
-------- ----
^- ----
Agreement:
The undersigned agrees to install the aforedescribed Individual .Sewage Disposal System in accordance with
the provisions of iITL i� 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be is by the board of health.
Signed........ .... . .. ..........----
/ Date
Application Approved By----` `-��-•, .. .. ... ........................................ ..... sf�i-_-----------
Date
Application Disapproved for the following reasons----------------------------------------------------------------------------------------•----------............_
--------------------------------------------------------•-----------------------------••---•----------•---•-------------•--•-------•-----•-•----------------------------------------•--------•....--....
Date
PermitNo.................................. Issued........................................................
Date
No.. .. _ ; Fss....... ...............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
,q;
............-"."...... ....................O F.....:..................................--------------------..............................
Applirtt#ion for Dispusttl Works Tattstrnrtiun rrmft
Application is hereby made for a;,:Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal
System at:
--...._ , .. ... . - ._..GF' i�.:��. ... .....................................................
/ - Location-Address or I No.
ner Address
a ••. ,• '✓l� .�.. .............................................................. .........&-.0c�-°-!_.- .....=®iG ..................
Installer Address
d Type of Building Size Lot............................Sq. feet
aDwelling—No. of Bedrooms.__.,3.................................:.Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Buildin ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Otherfixture ------------------ ---•----------------------•••------•--•-••----•••-----•••....••-----•--------•--------------•--••-••---------------------
wDesign 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........................................
aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
L14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a ------------ - -- --------------------------------------------------------------------•---••-----....•---•-•----•---•--------•-•..............--------
DDescription of Soil-------��1 11 .......:.........•-----................----------------------------------------------------------------------------------------------------
x
w ......................
x Nature of Repairs or Alterations --------------- ---------------•------------------- -------.-•----
V P —Answer when applicable.____ yt�S,v -.-.-- ................
� -----------•. . -••••--••--•--------------••----...••---••------•-----------•--------------•-------.............•..........
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITL% -,5 of the State Sanitary Code—'The undersigned further agrees not to place the system in
operation until a Cerificate of Compliance has bee • su y the board of health.
Signed...........
Date
Application Approved By. �._ y.... . ... - /
Application Disapproved for the following reasons:__....... {%
..-•----•......•--•---••--•---------------------•-------•-•-••••-•-••-•••-------------•---••--------•--•-•-------------------••----------•-------•---•--------•--------------•-----•--•---•••---........
Date
Permit No................. Issued.-----...: �
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�F4Y
..........................................OF.....................................................................................
C�rr#if irtt#r laf f�ant�littnrr -
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by-;-.-...--•---•- --------- - ------------------------------------------------------------------------
Installer
has been insta ed in accordance w t the rovisions of I?L j of The State a.nitar• Code as described in the
application for Disposal Works Construction Permit atedy-_.......:......................:............
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.......................................... ...[.i7qs7--••-----........ Inspector...---.....------ -"..................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........O F.....................................................................................
No. t� FEE........f.
Dispoi ntl Works TDnntr i an '"unfit
Permission is hereby granted
-------• .Y. .
to Construct ( ) or Repair ( n Individual Sew5t6s;-
rSystem
atNo.. + -------------•---•-•-------•••--•--•-----••--
as shown on the application for Disposal Works Construction Permit No..................... Dated..........................................
h
{ ----------------------------------------
DATE DATE
FORM 1255 HOBBS &WARREN. INC., PUBLISHERS