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LOCATION SEWAGE PERMIT NO.
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VILLAGE
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A & B CESSPOOL SERVICE
128 BISHOPS TERRACE, .HYANNIS, MA 0260
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BUILDER OR `OWNER
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DATE PERMIT. ISSUED
DATE COMPLIANCE ISSUED
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
vUry............OF.....%319 ......................
Appliration for Dispoii al Workii Towi rur#ion Ferttti#.
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at:
........
Location-Address
--! r nl, P-:_:.... ------------ --Q�tS /9NG%CGL-. .
�......._I YF� �!iis.........--
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Owner - Address
w 63...e,u.ssP00L . sdo�,ZLA AIC_�.....--•---•••••. -,62 ....... ..........
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms____. ..................................Expansion Attic ( ) Garbage Grinder ( )
04 Other—T e of Building . No. of ersons_._. Showers — Cafeteria
04 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 ( )
Percolation Test Results Performed by_________________________________________________________________________ Date........................................
aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_:.__________________._. .
fZ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
O Description of Soil........s.1u�...................................................................................................................................................
x
U ----•---•-••••-•-••---•---•-------••-••-••-----------------------------------------------------•----....------------•-•--••••-•---=-•----------•••-•--------------------•------•---•------------------•-
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U Nature of R airs or Agerations—Answer when applicable...._ 72'91,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 r agrees4o, place the system in
operation until a Certificate of Complian e h be issued by qF
h
.... -•-- ---- ... ----- --�� . _...
Application Approved"By.......... ... -•-•--•••--•------------........---------... ...._•--_._.. _L�
Date
Application Disapproved for ollowing reasons:. = -
.................................•----------•------•---------------------.....-------------•-------------'---------------•------------_ .-------------------------------------------------------.........
Permit No..... Date
�-=--------------=-- Issued
Date
L
No._.�.::_Ipv ....`.........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD
ROnF HEALTH
Is
Applira Lion for Dhipoii al Works Tumitrurtinn Prratit
Application is hereby made for a Permit to Construct ( ). or Repair ( an Individual Sewage Disposal
System at:
19A167 t-G,_ i2,0 A)Y14AA 1,, s
.. _.............•-•-•-••-•-•---•-----------.............................. ..........-••-•••......---............-•--•----.........--•-•-•---•--•-•--•-•-•--•----........
Location-Address or Lot No.
...................... 1.............'i2 ...........................................l . �Z 14 Y,9,".All S
_.... - ..............•-•-•------.............................................
Owner Address
c3 Cl .SS%aGUL__ -//c ................. �?i,5/ ®1°s'-•-- `C� f?= y�?/L/!t/i..s..........
,4 Installer Address
UType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms......3............. ..........Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ..............:............ No. of persons......... _............---- Showers ( ) — Cafeteria ( )
Otherfixtures ---------------"----------------------------•---------.-•-•••-•••-•--•----•--•.....••-••-•--•-•---•-•--•-----••-•-------••...---•--------------------.
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 inch Depth of Test Pit.................... Depth to ground water........................
G=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......--.....--......--.
O Description of Soil-------- 1.'�6 ------•-----.........-----.......----.................................-----------------------------------•-------------- ............. -----------........----
x
U -••-••-•-•••-••--••-••-------•-•••••••....------•--••••--•-•-•---------••.....••-••-•------•••--•••-------•-•---•--•---•-----•-•-•--•••••----•-•----••-••-•------•---•--•--•-•-------------•------
w
x •-••-•-••-•..................•---••••••---••-----•-•---••--•--------••-•-•-•••••••••••••-•--•--•••----•••-•......---•----•-••••••-•---••-....--•-•••-•--•-•••••-•-...•-•-•-......---•--------•--••------
U Nature of Repairs or Alterations—Answer when applicable--... . ..---.......3............ n^l!jlz./.v.S'C? .5
.............:..........................................................................................................................................................................................
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 undersigne&fu d er agrees not place the system in
operation until a Certificate of.Compliances has be issued.by the-N ar'd o�� he�a:th�
Gt�L�si c
......................
...................................... ........ ............
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ApplicationApproved By......... - . -•--•••••--....--•-•--•.............•-:---•--_•_..../..................-----• -------------
Application Disapproved f o h ollowing reasons:
................................................•------------...-•------------------........------.......------------------------------------------------------------------••---•••••--•--•--•----------
PermitNo.....U-----------...................................... Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
C BOARD OF HEALTH
V
a.`�`.: !.......oF.:....... ...
................. j-L.............................
Trrtif iratr of f umpliFanrr .
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (-A
by.....P -)` 43 C JS%'cruLr 5A==,?I/1 t /�- D._SiI�rJ �s �'�?/� J` �irvr
Installer
at....I5.. ,_---•--- �1 1� 1.� - -•-•-_---- /30W c i2 .
�ir � 1ti
............. --------------------
has been installed in accordance with the provisions of TITLE 5 of .The State Sanitary Code s d cribed in the
application for Disposal Works Construction Permit No.._- W�---------------•_ dated... ,>tr..._.-_._.-...._._...
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE AS A GUARANTEE THAT THE
SYSTEM WILL/fUNJC ION SATISFACTORY.
DATE_-/-.=/""* /.��.. ----------------------------------------------- Inspector...._.. --• ----=-----•-••-------•---=------•-----....----..........-•-•-----••---
THE COMMONWEALTH OF MASSACHUSETTS
--y-� BOARD OF HEALTH g�
............... ........ .... ...................................................... OU
NO.S.,'�11 7�• FEE__......e...........
' �i���a��a1 nrk� �nn�#raUan �ranii
Permission Is hereby granted ..•--•-•••.......'-ooc- .........._I// G....---••-------------------------•-•-••--
to Construct ( ) or Repair ( n Indiv�'d1uaI Sewage Disposal System
at No.. --1EC�I l7 f /V/ 1 ,_ U1/�/SY= �
- - ---------
Street e2
as shown on the appli ion for Disposal Works Construction Permit No: Date$!-: �'.................
Board of Health '
DATE. ..0 ,, ..... ==...
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS -