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Home My WebLink About0119 FIFTH AVENUE (HYANNIS) - Health 119 Fifth Ave 245-091 West Hyannisport iI TOWN OF BARNSTABLE LOCATION 1 ` S 1 l4 A SEWAGE # ' VILLAGE �V e �� ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. & SEPTIC TANK CAPACITY 16 0 o LEACHING FACILITY:(type) �±& S Tx NO. OF BEDROOMS —3 PRIVATE WELL OR PUBLIC WATER_ BUILDER OR OWNER �C k,6 DATE PERMIT ISSUED:� � DATE COMPLIANCE ISSUED; °— VARIANCE GRANTED: Yes No 4�-" �/ ,�S'•. > �, 1 f ;i ' �� i ``\ f .: `3 "1 t a �_ \� � �� 'S No..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiolt for Diopoittl lVark.6 Tontitrnrtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( x) an Individual Sewage Disposal System at: .......1.1.9__5th___Ave_.W•-•--Hyannisport-- •------------------------•--•---•--------------•--...._..--------•-------•--•----......---------• Location-Address or Lot No. Andre Chambre Owner Address a W.E. Robinson Septic Service P.O. Box 1089 Centerville Installer Address UType of Building 2 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. 3 Seepage Pit No-------- ---------- Diameter-----------.-------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed -by........................................................................... Date........................................ Test Pit No. I................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........................ P+ -------------- -- ----------------•---------------•----••--------••------••---------•---•--••--••••......................................................... 0 Description of Soil--------sand ---------------------------------------------------------•---••-•--------•---- x w UNature of Repairs or Alterations—Answer when applicable.-instal_l__ a___1 r 000 gal tank,_ d-box and precast leachpit with aft of stone ............................................................... ........................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE S of the State Environmental Code—The undersigned further agrees not to place the system,in operation until a Certificate of Compliance has b i ued by the b erd of health. Signed /J- ----- --------------------- ---------------------------------- - / ----- Date Application.Approved.By ................. sa-u-1111-161,11^--11�-------------------------------------------------------------------- Dace Application Disapproved for the following e'afonf: .................................................................. ..........-----------------------....................................-------------------------------------------------...----------------------------------------------------------...--- ----------..._------------------------ Dace PermitNo. ........... 6-.- ------------ Issued ............................ . . . ...... -- Due No.. � -- � Fimis THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diripoottl Mirkii Tomitrurtiou runfit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual .Sewage Disposal System at: 119 5th Ave W. Hyannisport ..............•--------...............---•-•------.-.-._.....----------•--••--------•---•---...... -----••-------•----•----•-----••-----•--------•--•--•----•--••---..-...•--..-..-••••----...•-••-•- Location-Address or Lot No. Andre Chambre ......................-.......................................................................... -•••--••-•---------••--••----•-••--•••.....•-••-•--•-•-...•--•••---.....--•-•-••-•-•-••----•-•---- Owner Address W.E. Robinson Septic Service P.O. Box 1059 Centerville Installer Address Type of Building 2 Size Lot............................Sq. feet ,., Dwelling— No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit__...._.--___-__.___ Depth to ground water..................... GL4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------- 9 ....-•-•---------------------------------••••-•.•.......••-••--•----•-•-••--•---•---.._.....•••-----......................................................... rO Description of Soil---•••••sand•---------------------------------•------•--------------._.------------------------....--------------------------------------------.-....--•-•-•... x w ----------------------------------------------------------------------------------------------------------------------- -------------•---- ------------------------•------•-•-•••••••-•••-•-•--------••- U Nature of Repairs or Alterations—Answer when applicable_---- 11 a 1 ,000 qal tank, d—box and precast leachpit with 3ftoof stone ....................... Agreement. r The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with ` the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place•the system in operation until a Certificate of Compliance has been imed by the board of health. / n Signed _..� .�' J. ........`^ -' --------------------------------- .:. -- --- - Datr Alication Approved B --- ------- ^ - .?,.. ..�.<,-~z .----------------------------------- ----- -- .------- PP PP Y U J �; Date 5 Application Disapproved for the following reasons: ............. ...... ... ..............._.... .................................. -'.. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ' ........................... � Date Permit No. ............,/f'...... ... ............. Issued ..--------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 0-ler#ifi ate of C�omplianee THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( x) by .........W W.E.E------ Septic....Serv--.ce--- -----------------------.._.-------------------------------------..__.------------------------------------------------- ..Robinsonn ._. . lastallrr 119 5th Ave W. Hyannisport --------------------- -- ---..___- ----------- has been installed in accordance with the provisions of TITLE 5 o.f The State Environmental Code as described in the application for Disposal Works Construction Permit No. -----e,?�..-... .......... dated ......3...- .r��..'..`� -... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE J'...� ...`...--. .'"'+ .... Inspector -- - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE , No........---�- - �(ji � FEE---30......-•.o0............ �to�oottl orko �o�totr�rtuan �rrmit W.E. Robinson Septic Service__•_•____.._•_..____•__------ Permtssion is hereby granted ---------------- --------------•....-- •- ---•••...•••--.....------.. to Construct ( ) or Repair (x) an Individual Sewage Disposal System at No.....1-1-g.... trh Ave-•W-'--•Hya. l«j, no t ----------------------------------------------- Street as shown on the application for Disposal Works Construction Permit No./... .J_ Dated....... Board of Health DATE .............. --- ......-G FORM 36508 HOBBS Q WARREN.INC..PUBLISHERS