HomeMy WebLinkAbout0103 FIFTH AVENUE (HYANNIS) - Health (2) 103, h' Avenue
Hyannis * ` ' 245 093 '
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LOCATION SEWAGE PERMIT M0.
VILLAGE
I N STA LLER' NAME ADDRESS
BUILDER OR OWNER
�a fez I
DA T E PERMIT ISSUED q --
DATE COMPLIANCE ISSUED
W
No. .......l.,r...... �r Fims/-5 .........
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
............ ..............-----------.OF.......................................
Appliration for Disposal Works Tonotratrtion lirrutit
Application is hereby made for a Permit to Co ruct ( ) or Repair ( ) an Individual Sewage Disposal stem at
.2=4. . .. . ............. ..................................................................................................
Location-Address or Lot No.
Owner Address
W� •------ . -•--------------------------------------•. ----••----••...........-•---•-•- ---.............-•--••-•-----....-------•------....----.....
Installer ., Address
UType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
d 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 ( )
1.4 Percolation Test Results Performed by.......................................................................... Date.........................................
Test Pit No. 1................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....................
P •---•--------------------------------------------•---------•--------...--------......-------------..._......----.......-----•------
0 Description of Soil...............................................................................................................................................
x
U ----------------------------------------------------------------------------------------•-----•----•------------••---------------------------...................................................
------------ - --------------------------------------------------------------------- ------- --
-
U Nature Repair or Alterations—Answer when applicable...f _._. .____/i/U�J_ ___ __ __________________
•------------•---•--•------------••-•-----------------------•-----------•--•-----...--••-----------------------------------------------------------------------------------•----•----------• �y !
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.
gned•--=-----------------•---------•.....-----------...-•----....------•-------...__---•- ..... ....._....
Application PP lication Approved B l �Y---••-•- --- ---------------•------..._.....-----._...------- ------ ------------------
Date
Application Disapproved f o t following reasons--------------------------------•----•-------------------------•-•-----------•---------------------•------•--•-
----•---Date
PermitNo......................................................... Issued-.......................................................
Date
......................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...........................................OF
Appliration for Dhipaiial Works Toustrudion Vamit
Application is hereby made for a Permit to Co truct or Repair an Individual Sewage Disposal
System at:
.....32. .. ... .. .... .. . ............ ...............................................
Location-Address or Lot No
A
414of...........
..
..................... ................................................................................................
Owner Address
.......... ............................................. ..................................................................................................
Installer- Address
- ----------------
U Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder
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 area....................sq. f t.
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. I................minutes per inch Depth of Test Pit....__._.......__... Depth to ground water...._.__......._.___._..
frq Test Pit No. 2................minutes per inch Depth of Test Pit___................. Depth to ground water....:._.................
..........................................................
----------------------------"--------------------"......... ...........?..........
0 Description of Soil...................................................................... ..............................
W
U .........................................................................................................................................................................................................
................. -- ---------------------------------------------------------------------------------------------- -- .........
..............
U Nature pfRepairV or Alterations—Answer when applicable_/ --- ------ ... ..... .. .....
------------
.......................................................................................................................................................................................................
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.
4igned...,'................................................................................ ....
. ..................................................................
Application Approved By........
t
Date
Application Disapproved fol t following reasons:..............................................................................................................
111
.........................................................................................................................................................................................................
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF
of Tautpliancr
A�i
I S s 1 /4
S�1,70 CERTIFY, That the Individual Sewage Disposal System constructed (,e�r Repaired
by. eL_.k.....................r..........................................................................................................................................................
2 Installer
at......... .......E&. 1.. rl_�f
xl�....
has been installed in accordance with the provisions of TI LE 5 of.The State Sanitary Co as the
application for Disposal Works Construction Permit No.KY_Z'�'�................. 2
- ----------at d. -------------_--------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.................OF
.. ........
No.. .................. A�'............ .
... FlZE0_F ff
. .................
f-e
Permissions hereby granted
t ... ............................................................................................................
to Construct (--I"orz,,R-e '
, %at ( ,y an' Individual Sewage Disposal System No...... .. ..... .��; ,
....................................................................
Street
as shown onthe V pli ion for Disposal Works Construction Permit No..-.............. Dated..........................................ap cA
........... ....... ....................................................................
DATE-- ............. Board of Health
FORM 1255 A. M. SULKIN, INC., BOSTON