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LOCATION SEW GE PERMIT NO.
VILLAGE
I N S T A LLER'S NAME & ADORES ''I` CRAI MEDEIR
rucking d� Bulldo�,ing
Hyannis, Mass. 775-0828
GUILDER OR OWNER
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U
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED IA �����
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No.--•-•--i.....l.v----. FizB....4,, ..+.................
THE COMMONWEALTH OF MASSACHUSETTS
_ BOAR® OF HEALTH.
..- -'^ oF... ..'^.......
�7, Appliration for Disposal Murks Tonstrur#ion truti#
Application is hereby made for a Permit to Construct ( ) or Repair ( ,) an Individual Sewage Disposal
System at: ,l ,�
eel'
� cationi dre s or Lot No.
•--
- l..1.__ .......T ..a. Z ...........
.....••--------------------........._.. ---------..._ .......................--
��AA y ddr
o
A ss
Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type e of Building _______________ No. of ersons._.___.____._______.___.____ Showers — Cafeteria
f� yP g ----•---•---- P ( ) ( )
Q' 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 ( )
$_-4 Percolation Test Results Performed by-------------------------------------------------------------------------- Date........................................
aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.........................
0 Description of Soil...........
W - �•.� `
U Nature of Repairs or Alterations—Answer when applicable_________. __ -' s' �A i9 tP'..�..
-•-•- .
__-•- ........ ......... ._..-
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 issld by the board of health.
Sig --•-• ----- ----------------------•--•---....-----..---..---...__ .
Date
Application Approved By....._...
r.. / ..
Date
Application Disapproved for the following reasons_.............................................................................................................
--••-•..............•••--•-----------._...._..••-••----•------••-•-•-•-........_.._....-•--•-------•...._•-•--•-•....-••-•--•---•--•-••-----••-------•-----•--•--••-••---•-••---•••---•--•-•-•...•-•_..
a Date
PermitNo:........................................................ Issued:•••-- `-- � ------••---------...
n
No FEB.... ................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................._............OF... .........................................................
A11411iration for Uispoiial Worka Tumitrurtion thrmit
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System at:
.................................... ........ .....�..5 -i.e.?t
T. ration Ad�`dmrs: or Lot No.
it---------------------------------------- ...................................................................................................
Address
. . ..........
-.,............. ........
Q-
Installer Address
e of Building Size Lot..................... q
U Type ......1 . feet
Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder
Other—Type of Building ............................ No. of persons............................ Showers Cafeteria
Otherfixtures ........................................................................................................................................................
Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
1:4 Septic 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........................................
._l
Test Pit No, I................minutes per inch Depth of Test Pit______._............ Depth to ground water_.__..__................
44 Test Pit No. 2................minutes per inch Depth of Test Pit.__............._... Depth to ground water.._......_......._.____.
------------------------------- ------------------------------------------------------------------------*----------------------------------------
0 Description of Soil............... --- ------------------------
U ........................................................................... ------------------**------ ---------------- ------------------
-1....................................... 1162.b--J...40.) ----------------------------------------
.............. .......................................................................................... .......7.......................................
U Nature of Repairs or Alterations—Answer when applicable.P- .............
.................................W----—_-- ..............................................................................................
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 issued by the board of health.
##44
SILY al ........... .............. YE-11
ApplicationApproved By......... ..................... ............. ............ .................. ........................................
Date
Application Disapproved for the following reasons:................... ............................................................................................
............................................................................................................................................................................ ............................
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH .
..................... ...1W..............................................................
Tntifiratr of Bunt It nr�e aM
TH,TS-IS TO CERTIFY That thp. Individual Sewage Disposal System constructed or Repaired
by......_.. ........ ------------------------- ....................................................
__JnsIall,
at..... ..... . ....... .............5..... --------------------------------------
it a§,deF#ed in the
has been installed in accordance wit the provisions of Tir S ary C�de'�d X-he
V'�V
application for Disposal Works Construction Permit No.. ..
.. ............................. dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTI.ON SATISFACTORY.
DATE. ............................
....................................................... Inspector.. .... ...........
THE COMMONWEALTH OF MASSACHUSETTS
----------- BOARD OF HEALTH
!��... ..............OF..... .......................................................
No......................... ....✓....... FEE........................
Permission is hereby granted---- .................**.................*......*.......-----------
idual 5.��, ge Disposal System
to Construct or Repair ��aan' in iv
at No..x—,/./...�-I_s....... 'V,60--y............ ..........................
-----------
as shown on the application for Disposal Works Construction Pro N ate .............................
_'-4.)---ID d.............
7 1,W4,64) <---el I
................................................................. ............................
DATE......... H....................................... Board of Heal
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS