HomeMy WebLinkAbout0037 FOURTH AVENUE (HYANNIS) - Health 3TFOURTH AVENUE
-- -- Hyannis
- A= 246 122
AsBuilt Page 1 of 1
LOCATION /- SE1NAPERMIT N0.
22� -
VILLAGE
INSTALLER'S NAME i ADDRESS
R -.. �NF OWNER
DATE PERMIT ISSUED /7 S6
DATE COMPLIANCE ISSUED
T
eJ
http://issgl2/intranet/propdata/prebuilt.aspx?mappar=246122&seq=1 7/6/2018
CATION ` SEWA PERMIT NO.
.VILLAGE
INST LLER'S:z NAME i ADDRESS
N - �WF OWNER
i
ZK7 es �c
DATE %-PERMIT ISSUED /; y
DATE COMPLIANCE ISSUED �z�s�
I
m
No........`.3s...... FiKE.... . ...............
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF
��e2-�Z
:...........................................0F.� --....---- ------.................._........
Appliration for Uiipuuttly urku Tonstrnrtiun Permit
Applicatiori is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
�1 System at: ,
._ ......--- __...........%�.... ................. ................ . ....... ......... ....
ocati fi Add ress or Lot No.
-.- f e...............................: ..................................................................................................
.. /-,I � Owner -•..............................Address
a :._.. ......:.....d0.��_@rt....... ....... ... -----•-•--•----------•-.......
Instalj�� j/ Address
g (� Sq. feet
Type of Building "' Size Lot___________________________
U
�..� Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
`cl'q'' ' Other—T e of Building No. of persons............................ Showers — Cafeteria
04
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 ( . )
aPercolation Test Results Performed by---------------------•---•--- -•-••-------•--------------=••----•----- Date.....................................
Test Pit No. 1................minutes per inch Depth of Test Pit..................... Depth to ground water........................
fi Test Pit No. 2................minutes per inch. Depth of Test Pit.................... Depth to ground water........................
P4 •--•--••••---•••--------------•-------------•---------------=------••-•--•------••--••••......••••••......................................:..................
ODescription of Soil.114:2--C--'. ..GZ...... :......... . .!k!? ..............................................................................................
V •-••------------------------------ --- ...................................
----••-------------------------------------------------------------------------------------------------•-------•---------------------------. .... -- ----•-------•---
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 TITI.i;, 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 the board of health.
Sign .................. .... _........ .....
Date
ApplicationApproved BY..............................................................................•--------...__--•-
Date
Application Disapproved for the following reasons----------------------••-----•-----•......---•-----------------•--------------------------------------.......••--
................•---....:-------- 1 . .....----------.......--•-----,.._...............---------------------------�--------------•---•--------------------..........
Permit NO......�.............•• •••--.... Issued..................................'2'-...... ....Date
Date
No.............. ....... FRic�� ........ ....
;M..0
'±':'TRE'oCOMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALT
..............OF..Z52�,�............................. ........................................................................................
Appliration for Dhipaoal Works Tomitrurtion 1hrmit
Application is hereby made for a Permit to.Construct or Repair an Individual Sewage Disposal
System at:
............. .......... .... . ........................... ..... .................................................................
catI Add ss or Lot No.
.......... .......... ............................... ...................................................................................... ......
Owner..
6
.i. ---------- --------------------------------------------Address
............ ---------------------------i....................
n Address
Type of Building Size Lot..............!..............Sq. feet
U
Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder ( )
�_l
PL4 Other—Type of Building ............................. No. of persons............................ Showers Cafeteria ( )
P4
< Other fixtures ......................................................................................................................................................
Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
04 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........................................
1.4
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 Pit______.......____... Depth to ground water..__._.......-_.....___.
Pd ........................................... ................................................................................................
............
0 Description of Soil. . . . . ....... ......44�a_4_�_ -- -----------------------------------------------------------------------............--
V.........................................................................................................................
--------------------------------------------------------------*------
................................................................................................................................................ ......................... -Ar-------------------
�4 4, M!,
U Nature of Repairs or Alterations.—Answer when applicable..... e_ ...... .........
................................................................................................................................... ..................1(Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of T I T LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has beep issued the board of health.
Sine ... ...........A--
................... ....................................
Date
ApplicationApproved By................................................................................................. ........................................
Date
Application Disapproved for the following reasons:...............................................................................................................
.......................................a-
.............................................................................................................................................................
Date
PermitNo ...........S..re............ Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
11
...............0 F... ............... . ........
.................................. ..........
Trrtffiratr of Tomplianu
H •-----........
S TO CFIRTIFY That the Individual Sewage Disposal System constructed or R epaired
b ....... � ..............................
M; i�a.-------
at..... ...........!�........... "L-1-------------------2E........................ . ..... ... ......... ......................................................
has been installed in accordance with the provisions of IR-6E 5 of -he State Sanitary Code as de��ribed in the
application for Disposal Works Construction Permit N . .. - �Z — 7 1 -6T
A..........4:4......... dated__. .7_:�t . ................
THE ISSUANCE OF THIS CERTIFICATE'SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.............. A0 V4&tor... ..............................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALT
A.. �.. �
......... ......................
..........................................OF....
N ......................... Fu........................
Rapas "onstrtwti.ott "parmit
.Zo
Permission is hereby grante ............. .....................................................7.................. .......................................
to Construrt C ) or Repair Individual Sem/a e - pos y em
...................................I............................. ........I........................ ....
at No....... C
Street as shown on the application for Disposal Works Construction Permit o..................... Dated.._... ...........
.......................................................................................................
a Board of Health
DATE.................................................................................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS