HomeMy WebLinkAbout0013 FIRST AVENUE (HYANNIS) - Health / 3 First lave •, 14#A^v%a
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WCATION 25f � SEWAGE PERM 0•
VILLAGE
Li
INSTALLER'S NAME ` ADDRESS
d UILDE R OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
may.
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Coll
Yam,
-717
L.00it,", SEWAGE EVM T NO.
VILLAGE
I N S T A l l E R'S NAME i A D D R E S J. CRAG MEDEIROS
q ucTng 0 Bulldozing
orpo t
- Hyannis, Mass. 775-0828
BUILDER OR OWNS
DATE PERMIT ISSYED _�
DATE COMPLIANCE ISSUED ,� 7�
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A �.
No... ......... ......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD 0 H EA T
0 F. ........................
------------*r- ,
Appliration for Disposal Works Tonstrurtion rumit
Application is hereby made for a Permit, to Construct or Repair an Individual Sewage Disposal
System at:
.......... Z_L/4
................................................................................................................ .....
Lo flon•Address or No.
...........
Ow er
Address
.......................... ..................................................................................................
ainstaller Address
Type of Building Size Lot............................Sq, feet
_J)wellirW 2--No. of Bedrooms.._..... B..............................Expansion Attic Garbage Grinder We)
Other—Type of Building ..... No. of persons............................ Showers Cafeteria
Otherfixtures ..........................................................................
----------------------- ......."-------*.......... ......Design Flow....... _-T. ......................gallons per person per day. Total daily flow._._......_ .................gallons.
W IW Septic Tank Liquid capicity.l-..�!.��gallons Length________________ Width...__.._..._.... Diameter..._............ Depth_..___._..._....
—
Disposal Trench—No.----_------------- Width...... ............ Total Length.................._ Total leaching area...................sq. ft.
Seepage Pit No-----------t-------- Diameter......_.10 Depth below inlet.......(a......... Total leaching area..,-7(a'iC%...sq. f t.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by........................... .............................................. Date........................................
1.4
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..._....._.........._...
0 ---------
4�� — . ........1_2.......Description of Soil........ 7Y__ :�S-
W -------X- - -------------------
'*----------------*------------------------------------***-*-----------------------*1--------------------------------------------------------------------------"----------------------------------------
......................................................................................................................................................................................................
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 TLITLE 5 of the State Sanitary Code— The undersigned further agrees not to plate the system in
operation until a Certificate of Compliance has been issued by the board of health.
Sign(o
r % > W....... .. .. ..... ----------------------
----------------------------------------------------------
Date
Application Approved By - --------------------------------
Date
Application Disapproved for the following reasons:.................... ........................................................................................
............................................................................................................................................................ --------------------------------
—1 -( i1q, Date
PermitNo........................................................... Issued_----k.—.q...........................................
Date
��c� g -,
No........_ ..._ --- .
...................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O,F HEAL.,T
_ .. OF....` .- ...............
Applira#ion for Disposal Works Tonotrnrtiun Prrutit � _y
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
l............ 5. .�.....! ?�.t' 'a!�`�• ----------------------------- �f?� °'........ ..........................................................
Lo ation-Address or hqt No
Ow'er Address
-• ..................................................................................................
Installer Address
Type of Building Size Lot............................Sq. feet
l�ellin No. of Bedrooms....... ..............................Expansion Attic Garbage Grinder
p, Other—Type of Buildingi'_ !! c '__.... No. of persons____________________________ Showers ( ) — Cafeteria ( )
Q' Other fixtures .---- .•--...----•------------- .
W Design Flow______s�.e.-e_______________________gallons per person per day. Total daily flow.....:.__._! _ Q_:'_:__._____._____gallons.
WSeptic Tank L Liquid;capacity1_9' 'gallons Length................ Width................ Diameter................'Depth................
xDisposal Trench—No..................... Width_..___ . .......... Total Length....................`Total leaching area....................sq. ft.
Seepage Pit No..........I_........ Diameter....... '. '._. Depth below inlet...... _ __..__: Total leaching area..,r?00...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........................
Test Pit No. 2................minutes per inch Depth of Test fPit______....__________ Depth to ground water.....................
O - J �
j ..... :.
Description of Soil > _ ...... -•--•• -- `"..,j, -
V --------------••-------•--•-------•--•----•-------•---••......_------•--------........_--------••-•---••----------
W
UNature 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 LITLE 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.
Sign - �= ..............•-------•------------•----- ..........................-----
����s{�p a Date
Application Approved BY------ --- -- -- ----------= ••--- -����'� *� -----------•-----•--- --- �=--�".---
/� t DaApplication Disapproved for the following reasons---------------••--....Z.,
---------------•-------••-----------------------•------•---------•-•-•-•••---•--
.........................................................................................................................-----------•-------•-------•---•-------•-------------------------•-----..._.....
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEALTH
v ..OF........... .....................
(Intifiratr of Tnntplianrr
T IS TO CERTI , Thnt the Individual Sewage Disposal System constructed ( or Repaired ( )
by......� � �..._.. . ►Ia--------------------- -------..............=--=...........................,.._.............................................
Installer ,,
has been installed in accord e with the provisions of T ` of The State Sanitary C de as described in the
application for Disposal Works Construction Permit No..t`.. '............. dated_.. '-- -/V../'Co
#
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY._ FBI.
DATE..................... .............................................. Inspector..:.------------------------------... ...........................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............... _OF......... .................
N FEE....-_.----•-••-........
. �a liar pan irainn rraniix
Permission 's reby granted !� . . � �
��11!G_... ..__.__. G ...... ..........
to Construct (" ) or Repair ( ) an Individuaf Sewage Disposal System
atNo..._..........................................................................................................................................................................................
Stregt
J4
as shown on the application for Disposal Works Construction Per,• No.:_!°............h Dated___ _ _ "`___:...�i.•..........
DATE --------------------•--.._..-•-•...---•------- r oard of Health
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS
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