HomeMy WebLinkAbout0018 DENVER STREET - Health 18 Denver.. Street
Hyannis' !I.' P:Y--*
A 291 -307 - 090
f
i
1
i
i
I�
I
I
TOWN OF BARNSTABLE
LOCATION e r/r%4A SEWAGE#
VILLAGE ASSESSOR'S MAP&PARCEL o7 9 b 7 -
INSTALLER'S AME&PHONE NO. Qd
SEPTIC TANK CAPACITY
LEACHING FACILITY.(type) (size)
NO.OF BEDROOMS X leo--L4.e.
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY
'7
No. 3�9 A � 71 307 - afe 9a j
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..................... ...........
Appliration -for Biiivviial Norkii Tonstritrtion Vaniit
Appli io is hereb made for a Permit tp Construct ( ) or Repair ( ) an Individual Sewag/posal
System at,*—
............. (�
Location.Add res or Lot No.
.... I Y��........t�.�� --------------�--=-�- -r.�...-----------
o.W er Address
------------ c ---- ---------- ....vj.� � ....
Installer Address
Q Type of Building Size Lot----------------------------Sq. feet
U Dwelling—No. of Bedrooms-------- ............... .. .....Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building -.___---------------------- No. of persons---------4-------------- Showers ( ) — Cafeteria ( )
Q' Other fixtures ----------------------------------- ------------------
W Design Flow---------------+ .....................gallons per person per day. Total daily flow................... !V---------------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.--_--_ 1 7 Depth b'a ..._._ Total leachin�.---..--•_-.. Diameter...... .... ..... p trea.____._.__._.--__sq. it.
z Other Distribution box ( ) Dosing tank (
) Q G -'
aPercolation Test Results Performed by-------------------------------------------------------------------------- Date----------------------------
Test Pit No. 1--------------•.minutes per inch Depth of Test Pit.................... Depth to ground water...--_-_-------.----.._-
Li, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--.------__--.----------
G
Description of Soil - r----------------------------------------------------------------------------------------------------------
U -------------------- -••-------------------------------------------------------------------------•------------------------------------------------------------------- ----------------------------------
-------------------------W
U Nature of Repairs or Alterations—Answer when applicable-----------------------------------------------------------------------------------------------
---------------------------------------•--•-----------------------------------------------------•------------------.--•---_------•---••----•------------------------------- .-.-------•-•-------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b R issued by the boar-' ea"lih.
sign G'- -_
�f n .... . ? C ............Da-----------------
�(/ Date
Application Approved B L ----.-7 '../ ._-
PP PP Y
--•-•.......................... •-----.................-•-•----Date -•-•--......-
.. Application Disapproved for the following reasons____________________________ ,
----.....--•.................................•--------------...-----------------•---------•-•-------•---•....-_......---------------•-•----•-------...---•------•-------------•--------...------------...
Permit No.-----. 9 ----------------------------------- Issued------ — - -7
Date
F �Id
` No.. Fia...... ....................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
vo. . _ .. ......... .... *�+ +,; .........................
Appliration -for Biipoiial Workii Tonitrnrtion Vrrulft
Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal
System at�
'► : ,.
Location Addres otr Lot No.
rt? ••' .... r '-•4 ! 3t i " ---------------
• ow r AddreAss
)04
...7!2 , 4.........4 -)..&&........... ...Kle ---T .....
Installer Address
Q Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms--------- "---__________________________Expansion Attic: ( ) Garbage Grinder ( )
Other—Type of Building ___________________________ No. of persons--------kt....--_.._-_. Showers ( ) — Cafeteria ( )
a
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 I_IVTX .... Depth AMG, '_P1M--9qbNTotaI leaching area.___ _.___...__sq. ft.
z Other Distribution box ( ) Dosing tank (
aPercolation Test Results Performed by---------- ---•----------------"-....................................... Date---•-•---------------------------------
a Test Pit No. 1................minutes per inch Depth of ".Pest Pit.................... Depth to ground water.________,.____-.___.
. 44 Test Pit No. 2................minutes per inch Depth of Test Pit_.......::__........ Depth to ground water------------------------
---------------------------------- --------•--------------•-----'•-----------•------•-----------..
GDescription of Soil------ �.--• ...................................... ----------------------------------------------------------------
x ----------------------
-------=----------------------------------
UW ----------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------- --------------------------
Nature of Repairs or Alterations—Answer when applicable._-____________________------------------------------------------------------------------------
--------------------------------------------------••-------------•-----•---•--•-----------•----------------...---'-----'----.... -----------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI 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 boa d f-healt .
Signed --�-)...•........ .. .. .. ... - ------
J t f Date
Application Approved By_________________________ _ _
Date
Application Disapproved for the following reasons:-----•---- ...................................................... ..............................................
...---"---------•---••...--••-----•--------•-------••-----'----'--------••--•---•-•'--'-'----•-••--••--•............•----'------------ -•------•--'•--------"-'--'--------------------------•---------
Date
PermitNo-----------------------------........................... Issued...................... .................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O-F `HEALTH
1 ......... .-1
Z
wrrtifiratr of feouiphaurr
THI IS O�CERTIFY,-That,..the Individual Sewage Disposal System constructed (O�or Repaired ( )
r Installer �(
- •l.._.: h/! - --•---------------
se''..._ w r -----._5 _.._ Y---._L:_./i�2!.�.._ _G.r�,/.... .... .__..._ .'.'.'.'.....
has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No_________________________________________ dated.....l-___,l -_-__ .7............
THE ISSUANCE OF THIS "CERT1F;CATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE-----------------------------------------------------------•'------=-------•••• Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
jj BOARD O, HEALTH
7' r
/r C ( ?r. ......OF..........: ..../LUS- :L:...............................................
No........ ' j I FEE....f ...— :..
Dinv alitt lug owitr.Arti, it rrniit
Permission t}reby granted_.....-.�-- - ---'�''- "
to Construct( ) or Repair (� ) an Individual Sewage Disposal nysm
at No.. - ;� C) .�.C��=tom a ._`�... L _....- ......
--�:... -
Streef
as shown on the application for Disposal Works Construction Pe rl3f No.,----- r_____ Dated__7.7_l_-�._.-.7..�_....
-----------------------
ry �/
DATE....---------'�"-`--r--,-'�'�'-----=--------------......................... Board of Health V/
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS -
�s