HomeMy WebLinkAbout1372 HYANNIS-BARNSTABLE ROAD - Health J? Fl-nnis sl-b/e (POD
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LOCATION SE GE PERMIT NO.
VILLAGE
INSTALLER'S NAME A ADDRESS
BUILDER OR OW4 ER
r
DATE PERMIT ISSUED
DATE COMPLIANCE -.ISSUED 1-714
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3 THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF..........................................................................................
Appliration for Disvaa al Marks C ontitrurtinu 1hrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
...... .L, . L . ..........................
Loc i n- dress
:�. ......._.. .L. tiA-c �?.......... .......... - t7i.ALE....................................
Address
----•---- ----- ..... ..._ ...............•-••----•--....._............ .....-•---•-•--._....--•---^.....---^---•
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type 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 ( )
a Percolation Test Results Performed by..........................................................................
Date........................................
Test Pit No. 1................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' -----------------------------------------•-•-------------... ----• -••-•-------•----------- -------
---------------
0 Description of Soil.......................................................................
"4
V ...............••-••-•-•--••••-•••-•-•--••-•••-•.............••-•-•--••••----••-••-•...-•----••-•-••--•-...-••----•••••-•--••---•••-•••-•--••--•...•--•-••••--•--•••-•-•-••......--.....-••--•-•----•---
W
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U Nature� Repairs or Alterations—Answer when applicable___-.I _ %0✓L wee _ � '`7' - �C —
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been s�by � /
igned ...(� �
e
Application Approved ------------------------•----
Date
Application Disapproved r th ollowing reasons------------------------
..--•------------------------------•--------•-------------------•---------•------•-----------•---------•-----------------•-----------------------.....................................
Date
PermitNo......................................................... Issued...................................
Date
No 2 a_.!` f _
Fxs.. _.. ......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
-...........................OF........- .............................--------------..............__._.................
Applirativat for Disposal Works Tonstrurtiun Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
......... [ ............... �v ------------------------- ----------••----.----------•-------.._...._...._..-----•...--•--------.-----.....----.....----.---
Loca'o d ess
..... . .` c......... .. '.�' !� < .......It
,,L4 or Lot ..................................
W a Address
.._....... �� J �. --------------------------------------------------------------------------------------------------
Installer Address
Q Type of Building Size Lot.................... ......Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
pi Other—Type of Building .....:...................... No. of persons............................ Showers ( ) — Cafeteria ( )
QIOther fixtures ----------------------------•......--•--Q --------------------------------------------------------
------------
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........................
f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_.....................
a ............................................................. ... ----•-
0 Description of Soil.........................................................................................................................................................................
x
U •--••--••-•-----------------------•.....------.....----------._...--------•...-----•...---------••.....--------•-----••._....••------••-•---•-------•--------•----•----------•-------...---...---•-•----
W
U P pP • + Ls
N ture of Repairs or Alterations—Answer when applicable �_
7 !�`.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been islsu-ed by o rd o ealth.
Pe-Si ne(
] -- .... --•-----••-------.•.............................................................
Application Approved l �
t! Date
Application Disapproved or th ollowing reasons:.................. -------••-----------------•--•------••----•••---------•-•-----•--------•---- -••--------
....-•--•-•---------------•--•-----------......--------------...-•--------...---••-----...........--•---.•------:...----------•-•----------.......................................................------
Date
PermitNo.........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................O F.....................................................................................
(9rdifirate of TompliFana
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------/--------.
Installer '
at...........................
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No...:..................................... dated-...............................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WI FU C ION SATISFACTORY.
DATE._.. 2
..................................................... Inspector-- .............................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF..................
FEE. :f.S.............
Disposal nk"s* Tonstrwtion Vamit
Permission
s on is hereby "-? ------
..
to Construct ( pair ( ) an Indivldual Sevir gDysposal Sys em
1
• • Street �
as shown on the ap ic�artion r°�Disposal Works C(!17ction Permit N. ..<;70�`�...... Dated................................. ........
Board of Health
DATE..... -�------••----�--------• ---•---•-----•-•-•----•------- -
FORM 1255 A. M. SULKIN, INC., BOSTON �-