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Home My WebLink About0006 DELTA STREET - Health 6 Delta Street Hyannis A= 292-084 i i I' i Oi W W i.7 N a= N I W U� � ' W r 44 V N W � W N � \ J � ✓ O d V cj W t tQ O W Is FN (3 � I 77 ON �o z o tiCIO No....... THE COMMONWEALTH OF MASSACHUSE77S BOARD OF HEAL.TH .......OF.... c ............................ Appliration for Dispaoal Marks Tonstrurtion Permit Application is hereby made for a Permit to Construct or Repair >0 an Individual Sewage Disposal PY tem at: ........................................................... .......................................................................................-------- p Lo.t No. Loca Po dd,.e., ......... ...... ... . ..... ....... ............ . .... k ......................................... ......................................... .. .......... ... a Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder 04 Other—Type of Building .............................No. of persons............................ Showers Cafeteria -(---->- Other. fixtures .......................................................................... ------------------------------- 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 a'rea....................sq. ft. Seepage Pit No..................... Diameter......_.._.......... Depth below inlet.................... Total leaching area..................sq. f t. Z Other Distribution box ( ) *Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ 1.4 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 --- ------------ ........ ----------------------------------------- ------------------------------- ---------------- Descriptionof Soi......... Ll-�Ij................................................................................................ -------------------------**-------------------------------------------------------------------*1--------------------------I------I------------ -------------*--------------*-------------------- ................................................................................................................. -----------------------------7-------------------------------------------------- Nature of Repairs or Alterations—Answer when applicable.---____P ao-a l -P-4--_ --------------------------------------------- ......................................................................................................................................................................................................... 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 keen.issued by the board of health. Sign od•_ --------A-aj*-Jxk......... Date e —0(w- Application Approved By..--. 4--------------------- -C7----------------------- ----- ... Date Application Disapproved for the following reasons:................................................................................................................ .........................................................................................................I............................................................................................... Date PermitNo......................................................... Issued....................................................... Date No THE COMMONWEALTH, OF MASSACHUSETTS BOARD OF HEALTH i - ............................... Appliration for Disposal Works Tonotrurtion ramit X an Individual Application is hereby made for a Permit to Constructor Repair Individ Sewage Disposal System at: .............................................................. .................................................................................................. o), j r,Location,-AdI or Lot No. ......................... K 6 .................... ........... Ownei 'j K� k d A .y?c ............................................. ...................................I........ ,4 M Installer Address 14 Type 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 ( 04 Other fixtures .......................................................................... �11 ...*..................... ------------------**"*......"------- W 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. f t. Seepage Pit No..................... Diameter................._.. Depth below inlet.._......_......_.__ Total leaching area..................sq. f t. Z Other Distribution box ( ) Dosing tank ( ) Percolation 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........................ -------------------------------- -..........• ;:....................................................................................................... __r_1 Y-1-0 V 7-V Q / 0 Description of Soil........................................zZ ........................................................................................................................ x U ......................................................................................................................................................................................................... ..................................................................................................................................................................................................... -� r , " U Nature of Repairs or Alterations—Answer when applicable._..___./........,.../...'.....i............/ ..................................................... ....................................................................................................................................................................................................... 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. Signed. ......... .................................................... ................... Date Application Approved By. ._ - Date Application Disapproved for the following reasons:.............................................................................................................. ........................................................................................................................................................................................................ Date PermitNo......................................................... IssuedL..................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................. ...�OF.... 11i ............................... ............. ............ Tbrrtffiratr of Toutpliatta THIS.-IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired 09 �' I-, 0') 0Q'0"_� El(�k' I_ ),2 J� Im by.........................................................................................::t....................................................................................................... Installer at...... Y( ... Ll j,//)).//—S - n ............................................................ -------T.............................................. ............................................................... has been installed in accordance with the provisions of/ 5 of The State Sanitary Code as described in the l'TLE application for Disposal Works Construction Permit ................. dated-.//.--.1.6....�7.c)................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....... ZX1 ..................... Inspector --------------- --------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH BUJ' I..........................................OF..... ...Z o")-5- ................................................................... No.......... .......... . .... FEE..................... RoposaliVorka " nstrurtion%D11 _Vrrm-ff-- aaz/,7 r -t /j,/(f . .............I.....................................7....................................................... Permission is hereby granted_...: ut I to Construct-( or Repair �rran Individual Sewage-,-Disposal System at No.... 6/L=.......................�_. �W6 7.................................................................................. 7 :Sfieet as shown on the application for Disposal Works Construction Per!!t ... ...... Dated..)).::�_Lv.....f .......... C,/- ZZ), 1,. . . ............................... Board of Heait' DATE................................................................................ FORM 1255 HOBBS & WARREN, INC., PUBLISHERS