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Home My WebLink About0021 CROSS STREET - Health 21 Cross Street A= 308 —244 Hyannis � I i AsBuilt Page 1 of 2 LOCATION SEWAGE PERMIT NO. VILLL/A`GEE INSTALLER'S NAME i ADDRESS OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 6',9C Gf O F Ha v.fcf- i �' 60 I _ hitp;//i'ssg12/intranet/propdata/prebuilt.aspx?mappar=308244&seq=1 6/9/2016 s No-----------�5�-_ Fxs.., .-.f).b......._ .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -------------_70"Wn....OF....... ( TC -----------------•--•--------------- Appliratilan for Uispvii ai 10urkfi Tonarnrtion rnmit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: .............al.--C1.0 ........ AT=T.............. ... ..ov&;4..�---ll_. ................................................. Loca'on-Address or Lot No. � _.. c: x ...................... � ......_........ - ..... Owner d ress Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—.No. of Bedrooms.............................. .. _Expansion Attic ( ) Garbage Grinder ( ) P4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ 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........................ a' ODescription of Soil---------. ---•-•-•----------------------------------------•----•-----------•----............--------------- x ----------------=--------------------------------------------------------------------------------------------- - -----------------n --••• ------------ ............ U Nature of Repairs or Alterations—Answer when applicable -...__ ��.U.00.... 't��-,...[�� '_ b ............. •----------------------------------•------------------------------------------------...............-----•------------------------------------------------------------------------....--••--------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the pro)u5ions of iITL L 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be is ed by the boar f heal ,h.�� t 1 p • Si ?1 . .......--.... 0 ►(�'� y��f o Date Application Approved By..... _. ........ Date Application Disapproved for the following reasons-------------------------------------------------------------------------------------------- --•-------•-------. -----••-•-•.......................................•----------........-•-•••-----_.. Date PermitNo......................................................... Issued_ .................... Date No............. . _.. Fss. :,.. ?. ......... THE COMMONWEALTH OF MASSACHUSETTS BOARD yOF HEALTH 1 9 N ,o- i ,r s� qp .�.l i....OF......- ...,.., r v .............................. Apptiration for Uiip,aia1 Works Tonvarnrtinn rrM* ff Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: .. ,_. ,i Vim' J// , //' __•_______________________ .....••. 5 ._ :.'. s:rP-^-• . .r.�._c ------ -•••' t/r — h..�.•�!!C.�:r ZA :.... Location-,Address ✓ or Lot No. .......... - ' :� ..._ .f :$� _....._ _ .. ................. ............. .i, _:ia.i _:.1 ................................................... r y R Owner #+ �y y Address •a� 1. 7 4 7 - 3 '-_3._. .....it_1 _I.. .... ............Yv'_. ?4_A .:y...7�. ,1_.;-_..x. ....__....._•--•-•_-__-_._.........._•--•- F ..........................� B ..... Installer Address Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms................................ _Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers { ) — Cafeteria ( ) al 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. 3 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........................ f� Test Pit No. 2................minutes per inch Depth of Test Pit____-__---________- Depth to ground water-______ -_____________ •- ,- - -- ------•---------------------•-•---•-----------------------------••--------------------------------- ODescription of Soil , ,., v ...-----------------•------•-------••-•----••--•------•--------•---------------•--•-.........-•--•- - t rJ ------------------ •----------------------- ............... -_---•--•------...----•--------••------------------_•_-----------------------------•------------•-----------•---------------------- W --•••-•--•-•----- ---------•--------------------•-••-------•----------••----•-•_.._-•--•----••--•--•--••-------•- . -• --•-•-........ UNature of Repairs or Alterations—Answer when applicable____ _' _}''? ', _ , ............ ---------------------••--•-_....•---••---••--••---•--•-••-•-••••----•----•-•--•---.._...._.._.......---•......--••---------------•-••-•----••••..._•---•---------•------••-•-••-••--•--••......•-_-•-... Agreement: ft The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee is ue y the board of heal, . Si dt 1.........................Y'YJt / �. L � l � Application Approved B Date y..'�=_�wd . ..- -----•............•----------------•......--•-••......----•-•-•--•------•-_.Date•.........-- Application Disapproved for the following reasons________________ _ __.-••-•-•••-•••••_..._.....-•-•••-•-•-•.........................•••••......--•--••-•••••--•--•--•--... ••--•-....-••--•----•••-•-----•-•-----•--•-••-••--••-•--••--•----•--•-----•-----••---••---•--- Date PermitNo......................................................... Issued_................................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Trrtifiratr of Tomphatt e THIS.I,S.TO CERTIFY,.That the Individual Sewage Disposal System constructed ( ) or Repaired .. " by--- ---- - .................................. .•_. __° ...- .... ••. --- l Installer has been installed in accordance with the provisions of TLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No �___- c ............ dated__ .................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE---....a�E`'_`` ._.f!..T _..-----•----------------•--.. Inspector..---... _... .. -•------_.------_--__---__--•----------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH IT No......................... ......... �i��a��1 nrk� ��an,��rnr#ilan rrnti� Permission is hereby granted )-•----•.... .._`..`......_...l!_..:_1 a..z. ......:(fit' ` c � �<< to Construct ( -) or Repair (/') an Individual Sewage Disposal System � at No. >?11_ ;l-(!_�_�_ .4.§_;E_al_ -----------------•-•---;-----------------••----------------- --- --• l Street as shown on the application for Disposal Works Construction PeritNo�2�.................. Dated._...._...._____..:._......_.............. //,,, 2 t� Board';KKalth DATE..4�............................................................_.......... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS t�