HomeMy WebLinkAbout0056 GOSNOLD STREET - Health S6 Gosnold St. (Hyannis)
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LOCATION SEWAGE PERMIT NO. `
VILLAGE
INST L ER'S NAME i ADDRESS
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8UILDEIII OR OWNER
DATE PERMIT I SUED
12
DAT E COMPLIANCE , ISSUED
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LOCATION SEWAGE PERMIT NO.
VILLAGE
I N STrLi ER'S NAME i ADDRESS
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BUILDER OR OWNER
DATE PERMIT I SUED
DAT E COMPLIANCE ISSUED 9/Zv/ter
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THE COMMONWEALTH OF MASSACHUSETTS
i BOARD OF HEALTH
..............................I............OF......................................
Applira#ion for Dhpui al WorkB Tnntrnrtion Famit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
pcation-Address or 1-ot No.
_L :..------�-•S•S••••-•...............••_:...........-•-•--••- --•�-?-'---- °�w-°-ZQ--.....__:_. ` ...... - .......
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Owner Address
Installer Address
d Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms______________ _ .......................Expansion Attic (Vo,) Garbage Grinder (Ao)
Other—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.
3 Seepage.Pit No....................• Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by........................................................................... Date.......................................
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........................
x -•----•----•._...••-••••-•-••----------•---•••-•----•-•-----•-•--•--..._...-•-----------------------.........................................................
0 Description of Soil........................................................................................................................................................................
x
U ............................................................... •--•-•-••--••••--•••-•-------------._.._..-•-•-•-•-•-••-----••-------•---•----...•-•••---------------------------••-•-•••----••-•-•-•--•.
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UNature of Repairs or Alterations—Answer when applicable.--.---:.../Q_0067 e.........��_?°ETC._-_. "_ ________________
--/oo�--......�........A. T-_._../ .-�- �� .l:....Dr1r--------
Agreement:
��%��
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TLILHE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance h s been •ss , d t oa of health.
Sign l' — `-`�••
ApplicationApproved JB =--• •- •-•--•-•--•--------------------------••----•--•--•----•---•--...._...__ ..- - l ! ...----••---
�� Date'
ApplicationDisapp va following reasons:---•-----••----------------•-------•---•••-------••-----•--•--•-•------•-•------•-----•------••---••-.._._._..-----•----------- ---------•••---------------••----•-••---•---•---•---•----------------•-•-•-----------.••-----•---------------------•-----•---•-----•••--=-----••-•-----•--••-..--- --••-----._.....
Date
PermitNo........................................................ Issued.................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...........................................OF.........................................................................................
Appliration for Diipooal Works Tontrnrtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
..... ...
Jcation Address r t No.
y . ...__ ....... �.s. ... - ._ o ...D...., .......
.�f� M:�:................
Owner Address
.......bt{.�!r!.!. Qr............................
ra !e ................................ ............... r c f3 �..�
Installer Address
dType of Building Size Lot............................Sq. feet
Dwelling No. of Bedrooms...............' Expansion Attic O> Garbage Grinder ( j1
Other—Type of Building No. of ersons......... ........... Showers —Cafeteria
a' Other fixtures --------------------------•-•..•. -
---•..................................................................
WDesign 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 ( )
'-. Percolation Test Results Performed by...... ......•••-••---•-••-••----••-----•••......-••----•••••............• Date........................................
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........................
R+ ---------------------------------
-.................................................................-•---....•--•••-----.........-•-•-----••-.•... .
ODescription of Soil...........................................................................................
x
U •••.....••-••••••••••--••-•••---••--•-•--••--•••----•--•••-•-•••...............................•••----•-•-••-••••-•-•••----•--•--•--••••••--•-••--•-•••-•-•--•-•••-•-•................................•.
W ••-•-••-••-••.............•••---•--••---••-•-•••-•-••-••••----•••••••••••••••--••-•••••----•-••-••=•--•-•-----•-•••--•-----......••••--••-,•••-••••-•••--•••-............-•;..A::--------------.......
UNature of Repairs or Alterations—Answer when applicable--__-__-- ,e `11 ........ �"`� ......e...°'../_f.........::...
good 7 � / `` � .T.. =r: '----•••. •••••• ••.. . .....
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with'
the provisions of TITTLE 5 of:the State Sanitar Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance.h s been -ss Led.. ' V. oa of health.
- Sg .......... �- ft.J�e .......
ApplicationApproved •--••-•-•--•-•-•• •---------------•-------..................---... .•.............Date
Application Disapp v or. e following reasons:..............................................................................................................
...................................•--••-•-•---••--••••----------••--•---••------------•----•---•-•••..............--••-------•-•-•-....._..
Date
PermitNo......................................................... Issued.........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOA OF HE LT
........!......w........................OF :........... ;2................................
(Irrtif irtttP of TwoanpliFanrr
IS CERTIFY, That the Individual Sewage Disposal System constructed (_ ) or Repaired (VOT10"
by ...... .....•• ..................................•---•........---
'
Instal ler
at.................. , !_ .11.......---5_1------------------------------- ._ -----
has been installed in accordance with the provisions of TITLE of e State Sanitary Cod as Scr'bed 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........................................ .�.1- .1.g ................... Inspector.............. .........................................
THE COMMONWEALTH OF MASSACHUSETTS
BOAR F T f
l/ / :......................OF..... ........ ..:::..
`
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FEs.......,
erk �onstrnrtion rranitPermission is eby granted .........•_--••-•• �....
to Constru to Repair ( ) an Indivi Sewage Disposal System
j. ..
at No.---. - -•----`---':��11f/ �4 " J� ...... ....
• � Street / �1
as shown on the application for Disposal Works Construction Permit No. r.. :��_. Dated...
.. .............
---.....--•----------------------------------•---------.....•-•-----•---•-••••-•••--••--•-•--••.....----
Board of Health
DATE....................
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS -