HomeMy WebLinkAbout0017 CUMNER STREET - Health F17 Cumner Street Sewer Acct #.3470
Hyannis - 4
A = 306 — 134
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LOCATION SEWI E PERMIT NO.
VILLAGE
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INSTA LLER'S NAME & ADDRESS
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B U I L D E R OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
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-- . . .__..............
............. .. of .�-- ............-----------------
ApplirFaiion fur Bispvii al ork,i Tonstrnrtinra rami#
I 'Application is hereby made for a Permit to Construct or Repair � an Individual Sewage Disposal
System at
................__cu - - -----•------------------------------------------. ......------------------......-----------------------..............._..---------------
e ®�Lo ..�dre.. !' & ��..... Lot No... •.........................................
Owner Address
Installer Address
dType of Building Size Lot_____--_-------_------_-Sq. feet
U Dwelling—No. of Bedrooms.__ ........ .Expansion Attic ( ) Garbage Grinder ( )
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P4 Other—Type of Building .. ....................... No. of persons............................ Showers ( ) — Cafeteria ( )
04 Other fixtures ..... .........
W Design Flow..............................!_......... s per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacit .._.......gallo Length---------------- Width................ Diameter................ Depth................
x Disposal Trench—No. ............ ...... Width....... ........... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... D am ter...................
Depth below inlet.................... Total leaching area.........---------sq. ft.
Z Other Distribution box ( ) Dosing tan ( )
�' Percolation Test Results P rfo med bY-------------------•------------------------._....------------------------ Date........................................
Test Pit No. 1________________min e per inch Depth of Test Pit.................... Depth to ground water.........................
GX, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...............-........
R+ •----------------------------------------------------------•---••-•-•---------------.......----..............................................................
0 Description of Soil.........................................................................................................................................................................
x
U -----•-------------------------•---------------------------------------------------------•---•-------------------------------------------------•-----------------------------------•-----------•--------
W -------------------------------------------------------------------------------------------------------------------------------------- °
x Nature of Repairs or Alterations—Answer when a licable. / _f___ ___._. ___ �.�`G..'!....._..
U P i PP
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Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System�'n accordance with
the provisions of TITi IL- 5 of the State Sanitary Code— The undersigned further agrees nof"to place the system in
operation until a Certificate of Compliance has been Wissuedthe bo'rd of health.Signe -----------------------------••. -----------......-- ... --=� ... -
Application Approved BY = . . . --. '- Z _.._.
Date
Application Disapproved for the following reasons:---------•---------------------------------------------------•---------------------------•---•----------.......
0
------------------------------------------------------------•-----•---------------••------------•-----------•-•--............---------.......--------•---------•----------••-------------•---•..........
Date
PermitNo......................................................... Issued..--------•---•-----__._-------��- ---------------
Date
S
._....... FEs..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD. -OF I-IEALTH
,�' . Ae
A plira Lion for Disposal IVIrks TonstrnrttWtt fermi#
Application is hereby made for a Permit to Construct ( ) or Repair O an Individual Sewage Disposal
System at
................_.CP .. --------------•- --.. .. -•..........••......••----- -•••----•••••-•--.._.._._....._.......---
L on.,dress or Lot No.
_sa!!�.. 1........:............ - ..................Jr • ---------•-•-•--------•----------------...............
Owner / + Address
----. Installer----- ________
0... ----------------------------------------- -----�:��"-.. ---.._' .. ............-------------------------------•
Installer Address
d Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms._ ........ _Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building __ ____________ ______ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures ----- ___________________
W Design Flow............................... .......... s per person per day: Total daily flow..........................................gallons.
WSeptic Tank—Liquid capacit _. ....... Length________________ Width................ Diameter---------------- Depth................
x Disposal Trench—No............ ...... Width....... ........... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit !o.__------_----_--_-- am ter................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distr' ution box ( ).. Dosing to ( )
'� Percolation Test Results rfo med by--------------------------------------------------------•----•----------- Date........................................
_a
a Test Pit No. 1................min e per inch Depth of Test Pf' ............ Depth to ground,water____............_..... .
Test Pit No. 2________________minutes.per inch Depth of Test Pit.................... Depth to ground water........................
---------------------------------------------------------------•-•-••-•--•------•-----------•---•-•........................-.................................
- Description of Soil.......................................-................................................................................................................................
----- •---- ---. --_- -3 ---- . -•--
U Nature of Repairs or Alterations—Answer when applicable. . .........._ ._�t� t".............
_
Agreement ''
The undersigned agrees to install the`°,aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT11Z- 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 the bo rd of health.
Application Approved By---------- ......................... ................
--•----•-- � 7 _---
Date
Application Disapproved for the following reasons: =- -------�------------------•--------------•-------------------------------------------------
.............................................•----...----•--•------------------•--...----...------....-----•----•--------------•------------------------------•---- ---------------------•-------••---
f y F Date.
t.
PermitNo.................•- ..:--•••-•-•---•------------- Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD �Oj�F,t H ALTH
OF
........................................................................
Trrtif irtttr of, f ouipliatta
T TeERT,jj~'Y, That the Individual Sewage Disposal System constructed ( ) or Repaired (. )
b !s� °
y...._. •••• ------------- - ---
• has been installed in accordance with the provisions of 5 e State Sanitary ode s de• ribed in the
application for Disposal Works Construction Permit No: Y ........ ......... dated . --:_lk-`--?y-
THE ISSUANCE :OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE s
SYSTEM WILL FUNCTION SATISFACTORY.,
,..
DATE................................................................:... Inspector.... =
THE COMMONWEALTH OF MASSACHUSETTS x
:, BOARD OF HEALTH
............... .-
N ..................... FEE.....
INS�r` nn ion rrmit
Perm> sion
is hereby granted.------ -A--Tffhs
.. .. .......... .•-'- ----•------------------•-------------= ---,:._.-------._.....------._._...,.:.._._._
to Construct ( ) op Indwiriy�l Sewag�ej Dosal System r
at No......... .... .._..... --••--•-•-.....-`��-.---------- --__C:!.
-----------•---------..............................................
St
et
as shown on the application for Disposal Works Construction P t No Dated--- -------- --•• /.....••------•-
............. •---•-- - ..............
/��...2 c Board of Health
DATE----•- f- -<-•-`----....---••---
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FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
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