HomeMy WebLinkAbout0007 DELTA STREET - Health 7 Delta Street
Hyannis
A= 292-209
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LOCATII�ON /f �j SEWAGE PERMIT NO.
VILLAGE
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INSTALL R'S NAME & ADDRESS
4&15J A9 106Ll- Se
0 U I L D E R OR OWNER
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DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED ��„
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THE COMMONWEALTH OF MASSACHUSETT$
BOAR® OF HEALTH
.............Town-.........OF.........Barn-.S.tabl,e----------------------------------------------
,� Appliratilau for Uhgp aal Workii To itrurtiuu JIrrutit
h made for a Permit to Construct or Repair X an Individual Sewage Disposal
Application is hereby ( ) p ( ) g p
System at:
...Hy.a n n, s.,...D2bD1-----••---------- ..................................................................................................
Location-Address or Lot No.
................................................. 2-- 1t ... ..,...Uanniz.....026Q1.....................
Owner Address
W ..A...&... Se .viicie-------------------------------- 128...Bishnpa...T.exxace.,...Hyannis.,...D2LO1
a Installer Address
QType of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms.............. .......................... Attic ( ) Garbage Grinder ( )
Pk ............. Showers — Cafeteria
p, Other—Type of Building ............................ No. of persons ( ) ( )
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........................................
Test Pit No. 1................minutes per inch Depth of Test Pit___-__-_...__-.-___. Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
Q+ .............................................-...............................................................................................................
® Description of Soil--------------------s-mod-•-•--•-----•••-----••--•-•----•-••--••••-•----•----•---•----•-----------------------•-•----•-•----•-•......•--
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U -•--------•-••••-----------•••••-•••-••-•-•••-•--•----•----••-----••....----•-----•-...........•--••.....•••--•---------•------------------•---•-•---.._...._...•--••-•.............._..-•----••---•----
W -•-•----------------------------•----- •-•-••-----•------------••--•••----------------------•-----------•--•---•---------•-----•-------•------------••-•--•-•-••••------------•••......-•-•--•..........
VNature-of Repairs or Alterations—Answer when applicable.-----Inat-allati.Ori---of...a...1,.0.0.0---gallon-,
ire-ca.s-t r sAne {�aeke .:-•-1.eaeh...pit..............................................................................---------------------- _
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iIT1.; 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 b the boar f 1 althi.
Signed �/ ........V ..1-• ---------- ............... ----41111- 79•----•--
/� Dats
Application Approved By.....--....-f��G-�-�------.--1 111 •.----•----•--------------------- ------------4113..79.....---
Date
Application Disapproved for the following reasons:................... —--- ---------------------------------•--.............................. ••-••-........
--•------•-----------------•--------------••---------------------•---------------._..........-----------------•••-•••••--••--------------•---•-•-••-•-•--•-----......--•-•----.........................
Date
Permit No...79-............................................. Issued.................4-1IS 79------------------
Date
No.-79
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.................._TOTt .......`..OF.........Bad`lC"aA•tab— e...'-----......---:..-----.................._._.
Appliraation for Biopooaal Works Tonstratrtion anti# : `."
Ap`lhcaliow is-hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal
„System,at
"EP r�>??, + 'Location-Address or-Lot No.,:',, a
a . '- 1P.--••-••....-•---•-----•......_..... �... : 1 .. ..,..: Y� � .,.. 6 'u..........v Ownez• Address
h r } t
w � ,.
F t¢ 1 r s F Installer Address
d Type o sBuild>nng Size Lot_____............... ..Sq. feet
aDwelingl to of Bedrooms_______________33...........................Expansion Attic ( ) Garbage Grinder ( )
p, Ott r s ype of Building ..........................___ No of persons...........3.............. Showers ( ) Cafeteria ( )
a; Other fixtures
d -----------------•••-•- -•-- •---•-----•••--•----••---------------------•------- ..................... .
w Design lows p : • :-- gallons per person per day. Total daily flow____________________ �' ;___gallons.
R: uid septic an Li capacity gallons 'Leif th________________ Width._..____.__._.._ Diameter-_-____ _____ Depth__:_________._..
w P � q P Y -------g g
x Disposa1�;�Ttr ric 'Jo _ _: Width____________________ Total Length.__________._____._. Total leaching area. ,_ a -----sq. ft.
Seepaget'�ri No Diameter____________________ Depth below inlet.................... Total leaching are2 r .___sq. ft.
tii a
Z Other Istrlhutron•box ( ) Dosing tank ( )
F,
aPercolation Test�Results Performed by_____________ :-_---- Date---------,-----
a
minutes per inch Depth of Test Pit.................... Depth to ground water ._.. ................
Test ?it.,No;:2_...............minutes per inch Depth of Test Pit.................... Depth to ground water____-___:__________,___.
---- ------------------•--•----•-.........................______----•-•-------•---------•------------ -----_-•-•--
01J
Descri ,pn,00£ oll r €1 1t ..:--•----:----=•-----
p ••-•• ---••----------•-----
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w _
k. :_. ,
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U Nature�of•Repairs,or Alterations,—Answer when applicable.____=:�,F}_�.�.,.�:w��,.,.�rli---�3�---
�__.]��f,3n� ;,,•, _,. i
i ==?� ek , Al ear-?v. :t-.-----------------------
Agreement,:z,
They undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of ITIL 5'of the State Sanitary Code The undersigned further agrees'n'ot to place the system in
operatio!%ntil a Certificate of.Compliance has been issued bthe boar of 1 alth. ;
Signed -- ---- -----.ti ---------------- -- � �
_ ,i' Datg
Application Approve&By............. ` = 1� �, Gl�i�. -------•-••--------------------- -----------= -i _-9........
� e Date
APplicatibh Dtisppproved.for the following reasons-................................•--•------------....--------•------•-------•--------• •.....................
5 --- .
••. -•ayZncr�ia "', fry ________________________________________________________________________________________ ______ ._ .________.___
Jrn s{ y E Date
�i r� r7 4 i
w4 T y 7` � +,I
�mt,No -��•�_--�--.:,---•----•--•........................ Issued.................. � Y--•-- ....,.------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Twr
rtifiratr of TontpliFanrr
�THIS,
'-IS,ry TO,CERTIFY, That the
Indivfi]d(ual":Sewage Disposal ySystem constructed ( ) oj�r Re{P}aired (x )
by...1L..s�C>r"�c�iS x 7 lJSldL...h � 7 .Y.5fJ....a�aLG1--13i• Ly® _..3 L-CA�i�I.. ++ iA�ts.....�`... -+4601--------
Installer
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has beenkinstalled ni accordance with the provisions of TITLE- 5 of The State Sanitary Code as described in the
is
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applicatio'ir"for"h osal \Norks Construction Permit No.____L __._.__ _ ___._.____ dated..-.. �:7� ____________________
P
THE.;ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE.THAT THE
SYSTEM ,WILL FUNCTION SATISFACTORY.
DATE.. ; `.,._.. .mod............................. Inspector-•- .........................................- ..:..............
r r' • -�
ryc� r ep• J. ,
X. THE COMMONWEALTH OF MASSACHUSETTS �
BOARD OF HEALTH
1l.........OF.............8arris!,'CE ble..................................
No......,: .... FEE _................
a r Rapos al Works (9ono#ra ion rrntit.
Permission is.he eby granted..:A__A---D... !g.8t_091-__.aoxyl.ok,___22$.._B, r a .. `l_anniB
to Cons6iici-(i�'U or Repair) an Individual,Sewage Disposal System
at No • :. annis, 01 1 Ma B. a1�r�ymbp e- ..........'R V -:----- - .. .. .•....... ............. . ...
3 Street y
as shown on the application for Disposal Works Construction ermit � 7 9 ---
,
.............
dofHeBoa/ a DATE_ 7 ------------------•-- J ,
FORM 12$& H.OBBSz&`WARREN, INC.. PUBLISHERS 3 R
9/7/21, 1:51 PM Assessing As-Built Cards
OCATION SEWAGE PERMIT NO.
VILLAGE
INSTA LL R'S NA/ME i ADDRESS
BUILDER OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED L� 4C_�7 5.
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