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HomeMy WebLinkAbout0078 FOURTH AVENUE (HYANNIS) - Health Ave gj&m� s p O c o o o � I v _ o ' o o p o o c O e e o o v n , C, �c,� TOWN OF BARNSTABLE OV" g/I61� LOCATION SEWAGE # VILLAGE � V�S PQ�"'� ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. Q n i,,/l L 4C_a u SEPTIC TANK CAPACITY / 00Q 6 4•L ! LEACHING FACILITY:(type) ip (size) NO. OF BEDROOMS � PRIVATE WELL OR UBLIC�ATRR," BUILDER OR OWNER ( t DATE PERMIT ISSUED: z Zi DATE COMPLIANCE ISSUED: L/ VARIANCE GRANTED: Yes No LZ C 1 Ficic THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .........76- :0..............OF......�.fH�!!��A���.......................................... Appliration for Bioposal Works Tonotrnrtion Permit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: - - .. .... ............ i- s � ' -Address t 7 ^� Owner Add ess . ....61, ck-x ,1- -----------------------•-----------•------------- D... , I!I f �. /I'l tt ............................................ Installer Address e d Type of Building Size Lot.....t Q ....Sq. feet U Dwelling—No. of Bedrooms---- ..............................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type T e of Building No. of persons............................ Showers a YP g -------•-------•------------ P ( ) — Cafeteria ( ) a' Other fixtures .. .... ----------------------------------------------------------------------------------------------------------- d W Design Flow........................_..._...._.._gallons per person per day. Total daily flow........................ _Q......gallons. WSeptic Tank—Liquid'capacity_'fIXVgallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No...:................. Width.................... Total Length..........._.T.... Total leaching area....................sq. ft. Seepage Pit No.-------------____-- ameter-----------JAQ_. Depth below inlet.........- ?..... Total leaching area_Z.&. .sq. ft. Z Other Distribution box.( ° Dosing tank ( ) /04 Percolation Test Results Performed by......... ABC. 4 _...._J�•.�(�__l���....__.... Date........ .`AJ:4- ...... a Test Pit No. 1__._.._Zfninutes per inch Depth of Test Pit._____..17:.... Depth to ground water...:..................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground.,,water........................ a .................................. O Description of Soil.....................' z....... ••-•------•.......... ...... .. :sa W i�nze - V Nature of Repairs or Alterations—Answer when applica�-� e............................................................................................... ••-------------------------------•-------------------------•---•-----------•--•---------------------------------------------------------------------------------------------------------...........----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code e undersigned further agrees not to place the system in operation until a Certificate of Compliance ha e —ued by the board of health. Signed .............. ....................................... ................. 1 Dace �/e Application Approved By .. ............ �� .............. . .............:.............................. �'--. .r��.L... Dare Application Disapproved for the following reasons: ....................................................................................................................................... ............................................................................................................................................................................................................... ............ ..........Date Permit No. ..... ............................................ Issued ..... .. Dare No................--....... Fxs............._............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............. — .................... ........:r. .............. ---........................................... Appliratilan for Uiipn,ia1 Vorkg Towitrnrfinn rrmi# Application is hereby made for a Permit to Construct (�or Repair ( } an Individual Sewage Disposal System at: / A ............ - - - ar !- '�� i( lit. 1'�..-� :�.:. '>.....f!4...2�.1 Location-Address or Lot No. ......................_.......................................................................... ..........--................................. ............................................... Add Owner ress _') a �#..........•p�......_�\„ 1..r' GL:.................•-----..............__.......... ......--= .......................t -'-._ �t _--- ... ._______....._..................._._____ Installer Address Type of Building Size Lot....1 2� L?a.....Sq. feet Dwelling—No. of Bedrooms............. .............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ....__..... No. of persons............................ Showers a g ---•------------- P ( ) — Cafeteria ( ) dOther fixtures ----------•.••. •••.............•-•------•---••--•--••••---------••-----•••-•••--•--..----------------------•----•- ------- W Design Flow____________________ _..... per person per day. Total daily flow.......................... - ©......gallons. WSeptic Tank—Liquid"capacity__/gallons Length_.............. Width................ Diameter................ Depth................ x Disposal Trench—No/ Width.................... Total Length............_l__... Total leaching area....................sq. ft. Seepage Pit NO__..__..�___.._ Iameter...........��Q__ Depth below inlet.......... Total leaching area_1.h_e-Psq. ft. Z Other Distribution box ( � Dosing tank ( ) 0 4 Percolation Test Results Performed by.-__--___?�' l ''; pr1...__._ ._.__t?�j____/(�_...___.... Date_....._ �� " 1.4 Test Pit No. 1......��-_-"'minutes per inch Depth of Test Pit.......f�-_..._ Depth to ground water_.__"""" ........__. 4A Test Pit No. 2.:..............minutes per inch Depth of Test Pit................. Depth to ground water........................ D Description of Soil---------------------- '----Z------•-• ----------------------------- v t UNature of Repairs or Alterations—Answer when applicile............................................................................................... --------•-------------------•---------------------------•--•------•--------------•--...........---------•-------------------------------------------------------------------------.......---------•-•... Agreement: 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,,beeee'n"issued by the board of health. Signed ................� «'' ` ......................................................"-- '-----------.... ----_--------- p---............i Dace Application Approved BY '.... ..... .... .... ..........................".......... ..............-------- --....--------........---- ----- ------ ...-------.... —-------------- - Dare Application Disapproved for the following reasons- ---------------------------------------------------------------------------------------------------------------------------------------- Dace Permit No. ..................... --------------------------------- Issued Dace THE COMMONWEALTH OF MASSACHUSETTS BOARDOF HEALTH ................... 4J . 17nt - ,7 &5- a OF -- Ce>rtifirate of C11uxttylinu e THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by--------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Installer at ....................................' .--...-- ----.... .. ... --.---------------- '- ........................... ---- '---'--...---. ....------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ............................................_ dated --.-----..----------..--_-.--_-_--------- 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 F HEALTH 1. ?..0 . ...OF........ : ............................ No......If._.D+ Jo<-- FEE.......1 Disposal nrkii Tnntr inn amit Permissionis hereby granted.............................................................................................................................................. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo............................................................................................................................................................................................... Street as shown on the application for Disposal Works Construction Pe�r-m-iit� No....................%i Dated.......................................... V .. .. _Board of Heatth DATE '; ------•--•-------------------- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS 51146-4-E FAMIL-( 3 13E-VWnDt✓4' �a GA¢F3Ac�E GRIIJnET� � ; � � . • ! I �: � r•.{� ' i � � :i A ( Fix( 3)�110 - 3 v l�+r"L• L.i. . . •� T, _! 1 . ':- •., ,E 1 c TANS 9S d,; ; �1�0 w �� {h: ..i-..,�•. 1 { &j U�F 1000 DISPOSAL- PIT. 1- IUDIDG,4L�2�5TV46: Z . p -; ! 51Dcw/ll _ F ISM 5F X 'L�S�1d Gi'U, . '::� •�! .-'���:►•eI:�L': ..,�� _ -i- -_ { TorAl. 'DAILY Mr! = 330 �Pb ;,oY p�-°P.• 1- - 1 11MA9 0 T�E2ca(.A-not-4• ¢ATE _ '' I:I° rub er• 1 ' - '° 2 MIN 1 L.�fs ! I. ! ...�. .I _�I ,� :j•. 2�d U ' OF ��° PETER _F_ OF RKIARD o SULLIVAN A. ca I aAstEq No. 2y133 pp 41 i Al .• C..mot,' r 'P sz c G- 4 14- . !-i i s :a` i T o, / r -b k� /,J� � g6•L ho 1000 BOX fi;� NL 1ti/t'j� JG AI7 N _ z - _ WA69 : A� SntucT�QEs sTo''aE' MoPF T114N 4 'DEEP 1 !st4ALL •SE 4-Zo I I 1 SA ! . C3ZI-IIE� PL1�N 'L�/E!.v;�c� T�2oFll1=-- :: ; : ! � :. ; i. _.i_.�..,. .,: _,.... 1.--;--•--, . . 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