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Home My WebLink About0035 MELBOURNE ROAD - Health 35 Melbourne Road Hyannis A= 268 —245 i a y 1 a ° e d ��~ TOWN OF BARNSTABLE "'� cip I& LOCATION SEWAGE # VILLAGE- ASSESSOR'S MAP & LOT �f INSTALLER'S NAME 6z PHONE NO. / G SEPTIC TANK CAPACITY LEACHING FACILITY:(type) raAsTi (size) NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: Zu VARIANCE GRANTED: Yes No CA o c 6 � ?1 � A Q i THE COMMONWEALTH OF MASSACHUSEETTS BOARD .`LIV, - O F..... Appfiration for Disposal Works Tonotrntion Pumit Application is hereby made for a Permit to Construct ( . ) or Repair ( ) an Individual Sewage Disposal syst y Address ' of N s .._..------ /y ' A � ......................... Comer dress a - --- --------- -' -- -•-••--••=-------------••--••------•-•-- -•- -•••••••-•••-- -------- . .._..._..-------- e M Installer Address sj6 � FY k, Q Type of Buildin "' Size Lot___�5_a1 �_____._.Sq. feet U Dwelling—No. of Bedrooms_______________ ________________.____Expansion Attic ( ) _Garbage Grinder ( ) `4 Other—T e of Building _____________ No. of persons._____.__.____________._____ Showers'( — Cafeteria Other fixtures - W Design Flow____________........... ____gallons per person per day. Total daily flow________.______-3_��_________gallons. WSeptic Tank Liquid capacity/__gallons Length................ Width................ Diameter---------------- Depth_-___________- x Disposal Trench-No_____________________ Width__._._.__ ._pp . Total Length___________ _ Total leaching area--------------------sq. ft. Seepage Pit No./................ Diameter �"____` Depth below inlet______ g . q.Total area.��_�'_s ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Result Performed by-------------+............................................................. Date------------...------------------------ ,a Test Pit No.'l............____minutes per inch Depth,of, Test Pit.................... Depth to ground water------------------------ 44 Test Pit No. 2................minutes per inch Depth of Test-Pit.................... Depth to ground water........................ P; ......... -- ---- O Description of Soil___________________ ___ _, t U ------------------------ --------....................................... -----------------------------------------------------------------------------------;::----------•----•••---••------- x ------------------------------------- ----------------------------------------------------------------------------------------------------------------------------= -------------------------------- 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 Article XI of the State Sanitary,.Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been 2iuAedlw the board health. S -- c ------- Dat Application Approved By---=J�,- P-----------•----------- ate Application Disapproved for the following reasons:. ----------- ------------------------------------•-----•-•--------._.:._•--------_.._..•••--•-•--•----•••-----•-----•------•-------•--•---•----•---•-----•---------------_--••---------•-••-•----•---•---...-------- Date Permit No. ......................... Date THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF H ALLTH ; ...........oF....: r .. . .:-. Appliration for Dipposai Worku Tonstrurtiou frrufit Application is hereby made for a Permit,,, o Construct ( ) or Repair ( ) an Individual Sewage Disposal System t� •9 AV7�10 ,on-Address r of Nop/ -- 414A -- --------------------------------------- Ib ` � �k A � - .......................... caner - dress . _____ Installer � •- Address Q Type of Buildind Size Lot___ q. feet Dwellin —No. of Bedrooms--------------- ----------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons............................. Showers ( ) — Cafeteria ( ) a' Other fixtures ....................\-... Design Flow......................._. ..._...._.gallons per person per day. Total daily flow......_......_. g W ____....._-gallons. WSeptic Tank—Liquid capacity' :_gallons Length................ Width---------- __-- Diameter---------------- Depth-_--___._---._. x Disposal Trench—No..................... Width..........___ 1___ Total Length._________ :_ Total leaching area----- _ ------------sq. ft. Seepage Pit No./-------------_- Diameters .... Depth below inlet.... ........ Total leaching area A-'__`__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-_--__----_-_-_-_-_.---- f3, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water----------------------- a �. -- -------------•-•------------------------------------------------------------------------------------------------------=------ O Description of Soil --------------------------------------------- x ---------------------------------------------------------------------------- U ----- w z -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 Article XI 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. fi Sig d---.- ........'� ' Date Application Approved By_ �� .�c ,°- • --------- �, � ate Application Disapproved for the following reasons------------------ --------------------------------------------------------------------------------------------- ............................................................................................................. Date Permit No......................................................... .......................... Issued.. -� Date THE COMMONWEALTH OF MASSACHUSETTS c BOARD OF HEALTH ...........OF.... W . r.:.. ..............•..................... T IS IS ' CERTI Y, at thl Individual Sewage Disposal System constructed ( ) or Repaired ( ) by .e -• . �. ?' staI r at.. _._ : �g ,Y -� -- has been installed in accordance with the provisions of Article XI of he Late Sani ary Code de gibed m e application for Disposal Works Construction Permit No..................... __ __ "_ dated_- __ .- � .- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL� FU�CTION SATISFACTORY. � DATE lCy -------- '-'--•--••''_. Inspector 1 P ... - ----- THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALT .... .. .OF.... . ..:: .... FEE ---------•---•--- Permission is hereby granted . -_. '- ._ ----------. to Const ct > ) or .Repai (,� ) `Individual Sews e Ibis o zl Skstem ....... Street as shown on the application for Disposal Works Construction N-_10V51._._. - Dated. _ ................. Board of Health DATE...j h_ _._ -•------------•--------•-------------•:--•-•-- � t _ 7 FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS • - -