HomeMy WebLinkAbout0062 SAINT JOSEPH STREET - Health r 62 Saint Joseph Street
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Hyannis
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TOWN OF BARNSTABLE
LOCATION SEWAGE#
VILLAGE ASSESSOR'S MAP&PARCEL I' a
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY. (type) (size)
NO. OF BEDROOMS ;
OWNER
PERMIT DATE: l / COMPLIANCE DATE:
Separation Distance Between the: E
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY
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Commonwealth of Massachusetts Form 4--System Pumping Record
Massachusetts
System Pumping Record
System Owner System Location
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�ya�,n;s Ma aa60
Type: Emergent Routine
Cesspool: No Yes Septic Tank: No Yes=
j Date of Pumping: �' 13 Quantity Pumped: Gallons
System Pumped By: Wind River Environmental,LLC Permit#:
Contents Transferred to:
Contents Disposed at:
Date: �'� Pumper Signature: '
Condition of System/Other Comments
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Printed on recycled paper Dep Approved Form-12/07/95
No...... 4 _.. Fiz:c...�.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALTH
as1 .. ---.OF....... ........ ..... . ..... . .
_� �! .�...................
" Appliratinn -fur Di-qvatittl Morkii Towitrixrtion Vautit
Application is hereby made for a Permit to Cons uct ( ) or Repair ( ) an Individual Sewage Disposal
yA
Lo tion-Address �� _ f ---" Lot No.
_____ ________ ___________ _ _._ .......... ....._..._._--- __ _ __________ ___ _______________________________-
W Owner - Address
.--------------------------- -----------
Installer Address
QType of Build ix}g� Size Lot----------------------------Sq. feet
U Dwelling L No. of Bedrooms___________ __________________Expansion Attic ( ) Garbage Grinder ( )
per-, Other—Type of Building ___-_---------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
a' Other fist res _
d -------------------------------------------------------------------------------------------------
W Design Flow ________________ ____�--- Mons per person per day. Total daily flow.•....__.____.� :•...._._ _--.--gallons.
W Septic Tank Liquid capacity_ �d- 'lops Length--------------- Width- ......
Di --.. Depth.-..,------.---.
x Disposal Trench—N ._ Widtli_ ____________ _ g'h___.____ ____ each' --------sq. ft.
3 Seepage Pit No____ _______________ Diameter- b ea..____.----------sq. ft.
z Other Distribution box ( ) Dosing tank ( ) /7�Percolation Test Results Performed by__________________________________________________________________________ ae---__------------- ------_----_----
,� Test Pit No. 1................minutes per mch De of "Pest Pit-------------------- Depth to ground water------------------------
f� Test Pit No. 2................minutes per inch pt of Test Pit.------________-____ Depth to ground water........................
------------•-------- ------------- --- ------------•------ •-------------•-----•------------------------------------------------------------
Descriptionof Soil --------------------------------------------------------------------------------------
U ------------------ -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
W
--------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
V Nature of IPepairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------
------------------------------------
1
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanit• ode— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance h s b issued e and o h alth.
Signe . __ _ _
. -•.----•--
� Date
Application Approved By_ ,,1 --- --
Date
Application Disapproved for the following reasons__________________________________________ _______________________________________________ ___________________
..--•----------------------------------------------------------------------------------------••-----•__...._.-------------------------------------------------------------------------------------------
Date
Permit No...............................--•-...................... Issued......
. �,5 ��
Date
No.._. .....................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
!
*- _r...Zi/1�'►........_.OF......IC��L'.iA-+-�.....Wit.:...�.._..... ...................------
Appliration fur :41-4poiial Workii C owitriartion Vrrmil
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System ate
Location-Address f / ' 4/or
Lot No.
Owner Address
......••.
Installer Address
Q Type of Building,./ Size Lot............................Sq. feet
U Dwelling`No. of Bedrooms.--------------
------------- Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ____________________________ No. of persons-..-_.__--__--__________-___ Showers ( ) — Cafeteria ( )
0.1 Other fixtures ------------------------------
d ---- ----------------------------------
Design Flow. .............. —r�.__...______ Mons er person per da Total dail flow__._______-_-. .---!J'---r -_-. Mons.
f g P P P Y Y g
WSeptic Tattk!—Liquid capacity/6_6 allons Length................ Width.--_---_----._ Diameter..........------ Depth---_-__--._-_.
x Disposal Trench—No..................... Width____------____ -___ TotaVL-ength ____ __.. Total1eaching tCrea----. -._ . --. -sq. ft.
_--___ Diameter....�!-�. . %Depth bel wf nlet ,�r T tal leacluug area------------------sq. tt.
Seepage Pit No.__.,•�_.____ -
z Other Distribution box ( ) Dosmg tank ( ) /r� j /� r" ��'� �/ J/
W 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 Dept of Test Pit-------------------- Depth to ground water------------------------
.--------------
D Description of Soil--------- ------------------------••••. ''�< ''-:! t-f/
x �_„„ , �y c.j-------------
U --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
W
VNature 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 Tithe board of-h'ealth.
Signed.:��u ,mil---'-- `
Date
Application Approved By_y__-------- � ,4.....................�"__"'/.__f-*_ L ►------- -------•- Date
Application Disapproved for the following reasons:-------•------------------------••----.....j..................................................................
--••---••••••••-••-•-•----------••-••-••-•--••------•----••--------------•---••--•••---•----•-•-------•--••--••--•••--••-•------••-••----•-----•-••-----•••-•--•---------------------.....-------••••-.
Date
PermitNo-----------_--------------- ...................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
-........"'"................0F........,_ •-+'�a z—...-:...................
.........
Trr#ifiratr of 10.11,11mliftaurr
TH IS, TO CE `y" FY, h t the,Individual Sewage Disposal System constructed ( ) or Repaired ( )
/ Installer"'
` \ - -
at .._.-.� r7 -.r--•--------•----••-•--••---7- -__.----_�i/�-------
r -----. ----•--•-ram:_.�-�•-�----._.,. i r y�
has been installed in accordance with the provisions of Article XI of The State Sanitary Code asjdescribed/in the
application for Disposal Works Construction Permit No-------- .. . ................. dated..... rj/... 2/.
THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL CTIO SATISFACTORY.
DATE `J .. 7 Inspector11 �..........j'......... --------•-------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF) HEALTH
......... OF......... — � ..� _ r
yFEE •.................
V.an,
rk,g maPispo7sal
rtion Vrrmit
Permission is�lieieb ranted-- fry !y'?- = '` -
Ygto Construct (/) or Repair/( ) Individual ewageSysteem��
at N o..:!`�. `._....�'/' ........t '.. / ' " '
Street
Y ...
r � �._
shown on the application for Disposal Works Construction Permit-No___________________ Dated__-.__ -------------------------
as
------------ -------------'----. ----------
DATE�� /�_. Board of Health ~'
------�
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 11
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