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Home My WebLink About1150 SHOOTFLYING HILL RD - Health llS��Shoa��y�r►�-��'�� Morro/ C�-rvi its, E/ E MEAD No.2-153LV UPC 12934 anead.com • Made in USA OSU5TAWTRYABIE FORES WMATIVE Cadl411 Rev sourdeo wrr.esMe..�.� 7 J. CR 142 Cerperati®n Street Hyannis, Mass. 775-0828 1 e1 � --- � P, ink _« �� 1 .�� '' �� y.E �� No...._.:.?k�..... F�a:V�.. ............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . . ...........OF.... 1.""' .. .0.................. .� fir tiun for 4i,spuuttl Worku Tonfitrurtiou Vrruiit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: r,.t-e-) J Loc��'.n•Address - T1f, L/ o �ort- . L L. / �/G ......----. l ..... a --- ..� 2C? 7 ,_ ' . wner Address .. :.. e4c ................... .......................... Installer Address UType of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) QOther fixtures -------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow-----------------------.--------------------gallons. USeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter----..........-- Depth..---.----.:.... xDisposal 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 "Pest Pit..-_------_-.._--_-- Depth to ground water......................... �14 Test Pit No. 2................minutes per inch Depth of Test t-------------------- Depth to ground water------------------------ -------- -........... --------............_.-------•---------••----•--. ---- ------- --... O Description of Soil------------------------- ley ..(/y�yp� U ---------------•-•-•---------------------•------.............---------------•-••.. ........-_............----------.............-•-•--------------•---......................----•-•--•----•-----....... W hT1 --------------------------------------------------------------------------------------- _ ` y ---- U Nature of Repairs or Alterations—Answer when applicable...--- G ra -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------.. 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 isstrd by the board of health. ne .... :. 1'�'\ .. J 5/� I __::;K00A1/ - te Application Approved By--- ----- -f -•-• . - - ............................................... Date , Application Disapproved for the following reasons-------- -------------------------------------------------------------•..................... . ......._..__ ----•----•-•----..--.•-...-.-...--•---••------------------------------------------------------•---------------------------•---•--•-•-•-•-•-•---.-....-------------------•-------------......------------ Date PermitNo.......................................................... Issued........................................................ Date t` - --- ------------------------------ THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA .l No....... ��.... FRS.-s THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH F , Appliratiou -fox UWVoott1 Works Towitrurtion Prruiit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at:...........................................1 _ to ,....._,. / Location-Address _.•-.-/ ,r or fLot No.,-) ' J f� r J -, tr- t- f'u`/ , r-1). 1. / ` -t- Q,.-_C- -N f�� ....: t Owner — Address 1410 �S Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building .-.-._-------------------_ No. of persons---------------------------- Showers ( ) — 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 ( ) aPercolation Test Results Performed bY.........................................................................- Date........................................ Test Pit No, l----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water................__..._." rs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ Of 7 ..---------------------------•--. •------------------------" Description of Soil------------------------�--f � _; 1-rDL. -`- r=' `,6` V ----------------------------•--------------------...----------•-••--. W U Nature of Repairs or Alterations—Answer when applicable.__.._._r'_.. --------------- _._..:..... :}_.ic.------ <c -----------------------•-•-----•-•-----------------•---- -••------------------------------------------------•---------------------•---•---------------------•-----..._...------------------------------ 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 issued by the board of health. Si' ned... C,,�- �c._t �i' z� L - 7 t 6 -•-•-------••-•-----•----------------- .--- -- -- A lication Approved B Date '' r r i J j f Date Application Disapproved for the following reasons-....----------------------------�-'------------•-------•------...-....------------._........-•----------------- ..............•--------.-------•--••......-•-•------•---••-••-------•.....•-•---------•.-------•••--•--•-•----•---------•.---------------------------- --...----------------------------.----•-•--.----- Date PermitNo........................................................ Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................O F... ....._.`.�..`..•......... ..................................................... T.rrtifiratr of (TLImpliaurr THIS IS TO CERTIFY, That he Individual Sewage Disposal System constructed ( ) or Repaired by .----.�...... `........'r......------ r r•l E;., S � �'' �� ems- '_ -�._�.. �j '��J' ------- Installer.-•- / at.----- l...a^? ' ------ -- --- ------ --------------------•------••--•--•--••---......................................................... has been installed in accordance with the provisions of ;Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit NOV, ----A��._.f------------_ dated.....:.. ?—.------1----..-?------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED S A GUARAN rEE THAT THE SYSTEM WILL FUNCTION SATISF CT RY. DATE .... Fj Inspector THE COMMONWEALTH OF MASSACHU TTS ------ __ BOARD OF HEALTH 71 ........................:............ .. No.- - - FEE........................ RnVmial IUqrkii TIuustrurtiou Errant Permission is hereby granted-------:4.- `.. ;--- - `- `t1 I-.....-----------------------------------........................... to Construct ( ) or Repair (L-.)"an Individual Sewage Disposal System at No......... ` r ` ' " '' r ' -- s--- ------ ------------- --- n?` ' Street as shown on the application for Disposal Works Construction,-Permit o , ..,='1..._.. Dated....._-... .. -.._�......_.. -- r �, _ Mir �, , � ,� ---------------- ,..y�l�e...--------...------------------ �`` Board of Health DATE... -------------••••• FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS fj J