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Home My WebLink About0011 GOOSE POINT ROAD - Health 47 T1GOOSEPOINT-ROAD 3 s , A 252 . , Hyannis" ,.:. 084 LO CATION SE o� E PERMIT NO. G D o SQL /00/4 T ?B VILLAGE I N S T A LLER'S NAME & ADDRESS -� VF M/f IA-0 I IZa5 r� �- B U I L D E R OR. OWNER C�20 C f(�2 DATE PERMIT ISSUED n- �(t DAT E COMPLIANCE ISSUED w c s cA o li1 c� �oo Tn y N h a� Fps.... ......... THE COMMONWEALTH OF MASSACHUSETTS OF HEALTH ..........................OF.......................................................................................... Apli r a#ion for 1hopos al Warks Tonstrur#ion thrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at .:........... ......�r� oOS ...i°D%d�l�......lc ......... - 1« ---------...-------=-----.............._. Location-Address or Lot No. ........ -..... /l............................. ........... -.._.....------•--•--...-----------------......-...--- Owner Address_ -•-••---•-•-••---_---•--•••---•. Installer Address QType of Building Size Lot............................Sq. feet Dwelling—O(No. of Bedrooms__.___ Expansion Attic ( ) Garbage Grinder ( ) Pk Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures -----------------••---••-•-•-••. - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W Septic 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 ( ) ~' Percolation Test Results Performed by........................................................................... Date........................................ aTest 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........................ a --•-•---------------•-••••-•--•-••------------------------------....----------------•----........_.......••••---•-•-•••••••----•••••----......._.-••---____-- 0 Description of Soil-•-----------------------------------------------•---•---------------------•------------------------------------------------------------•-----.._._..-•-._..........._.. x W ••-•-----------------------•-----------------------•-••••••--------------•-•--...••-••----•---•--•-----•-•-••-•------ ----------------••---••----•------•-------••--•---•------............. VNature of Repairs or/'Alterations—Answer when applicable.......... � _-----.�-, "l�L�Ti! .___� .t` .y --•---------------• ='-----•,/• ��`� (..........5.�"o ...•--1�'11�1fr ..........e0'T.------••---•-----•--••-•-•--•---•-•--------------•-•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL U 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issu�hoarOf health.Signed----•-••-(4- ---- . -----•••--.....----------------•- ................................ Q Date / Application Approved By.. -- ---..__ �,�..................... 9/-Date Application Disapproved for the following reasons:........................................................................................................ ----------------------------•-----------...__._......-------..__...---........q--•--•---------------...----------•----..._..------•••-•--•••----•--•--••--••---•--•-•-••-•-•---••---------••------------ Date PermitNo-------'------ ......... Issued....................................................... Date No -G 5_q 2 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............................................ ApplirFation for Disposal Works Toustrnrtion Vrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ............�'� .. oOS�' P..o(`` .................. ............ :. t o...... :.- ......... or Location-Addresses gE'I Fes. r?_�if,�( 1............... .......................................... .........----------.........---•--••---- .N... ._......._..... W Owner Address a .................. tiG 0----ri``............... Installer Address Type of Building Size Lot............................Sq. feet 1-1 Dwelling-kNo. of Bedrooms....._�..............................Expansion Attic ( ) Garbage Grinder ( ) a Other—Type of Building ............................ No. of persons............--.............. Showers ( ) — Cafeteria ( ) 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 are a....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) `-� Percolation Test Results Performed by••••-•••••......••--••-••••-••-•••....•................................ Date........................................ .a Test Pit No. I................minutes per inch Depth of Test Pit.--................. Depth to ground water.......---.............. LX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.....---............---. 04 -•••••-•-•-•••••.........•••••••-••-••••-•--••••••-••••---.......•--••....-••---•----•......•................................................................ 0 Description of Soil........................................................................................................................................................................ x U ...........•...........................................................................----••••-••.......---••••••••••••----••-•-....--•••--••••••-••••••••-••-••••••-•••---•------•----•-•-••--•....... w x ••--•••--------------------------••••... ••-•••••••••••••••-••••---••-•••••••-••-•-•-•---••-•-•-•••-•................. -------------------------------- •-----••---------------- •------------..... Nature of Repairs or Alterations—Answer when applicable...---.... .� -- .---../ - X{' T/�LG� y S/�1 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 b th boar_d of 4ealth. Signed............ .... ........ - - Application Approved 9/..Da �cSZs Date Application Disapproved for the following-reasons:••-•-••.....•••-•••---••-•-•-••-•••--•••••••••••••--•-••••---•-••--•--•••••-•-•••••..............••-•-........ --•-•-.........-•-••---••-----••-------•••-••.....•-•••••.....-•-•--•......•--•••••--•---•---•••---•-----.•••----•-•---•••••-•••••---••••-•-••-•-••--•••••••---••-....................................... Date Permit No..... �'...-�...-��...-�-----•--. Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........OF.............. ...................................L. ....... 01rdif irFate of TompliFanre - THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( Ll or Repaired ( ) by.........:U "-c- n.�... -------------------------------------------------------------------------------------------------------------------------------------- Installer has been installed in accordance th the provisions of TITLE, 5 of The State Sanitary Code as escribed in the application for Disposal Works Construction Permit ........ dated............. . l��......{P-........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTIZU D AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION`-S,ATISFACTORY. DATE................ .. ... ..l.I... .................... Inspector..........------ -.---�-�•------•-----••-•--•---------------------.-.--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r__ �l... .� .. ...........1..CJ..........OF............. 1v 1 L .....o� r ..... ................ No. 2......f..-�� . FEE........................ Disposal r. �o�.,rks Tonutrnrtion hermit Permission is eby granted...........V.4L� f_e.n.. ......--................ . to Construct ( or-Repair ( ) an I�nSvidual Sewage, isposal System atNo...- ^��3 .............,�c n ...................... .... ✓i _ ............. Street as shown on the application for Disposal Works Construction Permit ND.�.'......,5 ........... Dated........ V! _... F�' .................................................... C� Board of Health DATE-----_-_--- ._--====-_=9r ........------.1--l FORM 1255 A. M. SULKIN, INC.. BOSTON r �i -1