HomeMy WebLinkAbout0022 DALE AVENUE - Health 22 Dale Avenue
Hyannis
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LOCA ION SEWAGE PERMIT NO.
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VILLAGE
IN.STA LLER'S NAME & ADDRESS
8UItDER OR OWWERR
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DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
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No......... .... F�> .P
THE COMMONWEALTH OF MASSACHUSETTS
�O� BOAR® OF HEALTH
/.........OF. C /z .......�
Appliratiln for Uiipnsal Works. Tonstrnrtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an I dividu ewage Disposal
�ystem at:
.. ��... ,... - - .. -------------- ---
Location-Address or Lot No.
....»... ................................ ............ .. -•-•-•-•••--........---•--•••-••---•-•-•......................----••----
Owner Address
»....�
W
ler Address
Type of Building Size Lot...........................Sq. feet
U Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( )
............... No. of ersons._.......................... Showers — Cafeteria per., Other—Type of Building ............. p ( ) ( )
QOther 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........................
f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......_.................
Descriptionof Soil........................................................................................................................................................................
x
c,
x ...........•................................................................................................... --`--- �i- . --- ------.
V Na r of Re irs or Alterations—Answer whe `appl' le..- .
•1���� ���c-- ------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the'provisions of TIT L- 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has en ssued bb-the board of he007
It
Sign •.... .r. ..... .. =- et Q_
Date
Application Approved By.......... ... .....
Date
Application Disapproved for the following reasons-...........................................----•------------------------------•-••••--•--•-••---•............--
•--------------------------•-•-----•-••-•------------------••--•---------....--------••---•--------•----•-----•••------•-----------------...---•-••••--•-••---•-------••---•••--•--••••---•-••--•-----
Date
PermitNo......................................................... Issued.,,. .....................7..........................
Date
76' //II _
No...... !�p Fx G�
_. .
THE COMMONWEALTH OF MASSACHUSETTS
_ BOARD E HEALTH
App-R-nation for Disposal Works Tonstrnrtiun jhrmit
Application is hereby made for a Permit to Construct ( ) or Repair n I dividu(�d 'ewage Disposal
system at,
�
....
Location Address or Lot No.
/�... ... --.------
_..C.-•.�... ............. ___............................... .........._-......................................................................................
Owner Address
a ..::......... ... ... .............. I ller t, Address
UType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
`4 Other—T e of Building No. of persons............................ Showers — Cafeteria
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 ( )
Percolation Test Results Performed by.......................................................................... Date........................................
1
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
fi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
•---•----------------•---------••-•-••-----••-••--------------......------------•-------------------.........................................................
0 Description of Soil'----------------.................-•:.................................................................................................................................
W
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-------------------------------
---------
-----------
•-----------4-------------------•-------------------------------•----••-------------------------
..•............................................................................................................. ...... _ ... f ................
U Na air or Alte ations—Answer wh
R ' e appl, a le_. _ / D 0 a
-...
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TLIT11 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has een ssued b the board o h It
Sign .---. ..... .!?' _ ..� �?evl-'
�O —/O
................................
G Date
Application Approved B ~`
Date
Application Disapproved f orlhe following reasons:....................................................... .......................................................
Date
PermitNo.......................... ----------------------...... Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
....�, .....................OF......... l.`a4-14..«..............................................
(Intifiratr of Tumpli anrr
THIS TO CE IFY, t the ndividual S age posaystem constructed ( r Repaired ( )
by '`.. insr.. .....
er
at-- Xinst
----•-•. *---------- - ---
application for Disposal Works Construction Permit N __ . ._.._..._>r .-. ._._�� datedy..s : '!z_ '__
PP P `c��d in the
hasbeeled in accordance with the provisions of of e Stat Sanitar Code as des
=THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR D AS 4 GUARA TEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
L ..........
_
}3 DATE.........3 ` .. .. ,.'„t.Inspector' �*
i3 �. �,' �• km x�,,,� C.`E..,.•4-_.
THE COMMONWEALTH OF MASSACHUSETTS 77
BOARD OF HEALT
............OF............. ................. t
FEE.... .........
Disposalirk. uatrndwit. emit
Permission i hereby grante ~. ` .._. : ....................................................._._..
to Con u Repair an IndiPidual 'ewa- Dis o em
( ) Y
at No. . 1 ..�."' �" - --------------------
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-
as shown on the application for Disposal Works`�onstruction Pe -t N .. . Dated.._33._._ e....�..............
DATE „ .� Boa d of Health
"FORM 1255 HOBBS & WARREN: INC.. PUBiISHERS