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Home My WebLink About0077 THIRD AVENUE (HYANNIS) c• C / No..._...... .. Fss. .......s........... ; . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �C ....... ...............OF....................................... Applirtttiun for Di,gvuiittl Workii Tunutrnrtiun Vamit Application is hereby made for a Permit toConstruct ( ) or Repair ( ) an Individual Sewage Disposal System at: 7 �j'leG -O" /O1 Alm" ___ _ _ _ -.......................................................... ,n Location-Address or Lot No. Owner Address ;W .v �A•G T'e� ---•• ..............•---••------•---.....................---..........-•---- Installer Address Type of Building Size Lot............................Sq U,f . fe Dwelling/-No. of Bedrooms._..___._ _____________________________Expansion Attic ( ) Garbage Grinder ,. Other—Type of Building �4.4._ No. of persons............................ Showers a YF• ng �----.. P (. ) — Cafeteria ( ) Q' Other fixtures .....--•• . d 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 ( ) Percolation Test Results Performed by.................................................•----•---•-•......_-•-•-- Date....................................... �-1 - . Test Pit No. 1................minutes per inch Depth of Test Pit.._.............__.. Depth to ground water........................ Gz, Test Pit No. 2................minutes per inch Depth of Test Pit............ :'Depth to ground water........................ _>. O Description of Soil............................. ---------------------------------------•-------------------------.....-------•----......•-•••••......_._.....•. -• ---- --- ----•- ------.------ ------------------------------------------------•---. --• . U Nature epaarAlterations—Answer when applicabl �.. :_. .. ._ ..:�......... • ✓ 11 ..........................................................••------------•------------------......... ----....... •----------- . -----------------•---•--....----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of ITLi; 5 of the State Sanitary C 'de—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued b board of health. --- -- ---- --•--------------- SigneDate Application Approved By... ...... .....�...... .............................................................. ..--•--...-•---•----Date------......._ Application Disapproved or t e following reasons-----------------------•--------•------------------------------•--------------------------- ................ •--------------------•-------.........---•--•----...-----...........----•-•-----••----------•-------............------------•----•---------------------------------------.-•-----•••••••._............._ Date PermitNo......................................................... Issued....................................................... Date --- - - - - ___ _ -- .�.��._..............�..�._� No...... .I..^// FEs......�.........I.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................O F................................_............---------------......- Appfiration for Diapo,itti Work,5 Tonitrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 7 ..�'. o... Location-Address or Lot No. ............... .•••••---•----•-•-•-•-...••---••............. ............................................... Owner Address .��!... �.✓�.�i 6i � W Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms------+ Z.............. ___..Expansion Attic ( ) Garbage Grinder Other—Type of Buildin,',neA -_---_____-. No. of persons............................ Showers " a YP � •-•--••--`�.._._._...-•----•--.-.... ( ) 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 ( ) ~' Percolation Test Results Performed by-------------- -----------.----. Date........................................ Test Pit No. 1................minutes per ingVXDe t f Test Pit.__.__..........._.. Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ------•---•--•---------------------- -----•--------..:•--- -•----•----•-----••---•---•------•••......................................................... Descriptionof Soil--•-•---•-•---------•--•-•--•----...----•---•-•-•••.........--•-••--•-...............................----_----------•--•-•-------------------••----•---••-......•------ x c, - - W -- -------------------------------------------------------------- ' =- UNature I fig air .or Alterations—Answer when applicably --C.__. K,. ------------..-----•----•••--•-•-----•-•-------••••---•-•-•--•--•-•---------••••----.....•••------•--•.-•-•------•-......-•.....---•• -=--............................................................. 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 Complian a has een issue he board of Health. • Date Application Approved BY-- •----- -- ........... Date Application Disap?roved for the following reasons-----------------------•--------•----------------------....------------------•----------.._....--•------...----•- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....................................OF................................................................................. J� Trrtifiratr of Tontphatt r 14 CERTIFY, That the Individual Sewage Disposal System constructed (. or Repaired (• ) by . --• •--••-••.... ..... -•-...... -•--•-.....----•.......•---••••.....--•................. ......... r ..istaller 07 at------------------------------ ---------•----------=- -------- ••--•-•-••----••--•---------••-----•---------•----------••-•--•••-------•----------•....-----• ...................... has been installed in accordance with th visions of T � o The State Sanitary C d`e d ribed in the application for Disposal Works Constr c 'on Permit No.--................. ................ dated?.. _ ��.____.........._..... THE ISSUA CE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE AS A GUARANTEE THAT THE SYSTEM W L UNCTION SATISFACTORY. DATE.... .l.D. •-----•---•------•-------.---•-----••------••-----------. Inspector.. ..... ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....................................OF..................................................................................... ............ ...... FEle................ Big orkv Tontrnrtion famit Permission ' her y rant --------•• ....................................................... to Con/tt��gct„ 1 r ( ) an Individual Sewage Disposal Sy atNo •----/......-----------------•.----...... _._.........----...---...----•-------...--•------.----------- ............ --- -- st a :Yl p p on P it o__ 'as shown /the h tron for Dis osal ��'orks Constructs ecp ..... �� .. B rd of Health DATE.. -•- -- .•--••---...-•-------------••-•----------- FORM 1255 A. M.'SULKIN. INC.. BOSTON I I �I II Q 1__ 1 ti. f�