HomeMy WebLinkAbout0688 SCUDDER AVENUE - Health 688 Scudder Ave
PV
287-007 Hyannis
i
j
{
i
�I
i
i
a
TOWN OF BARNSTABLE
LOCATION ��� ��s�'���®� � .SEWAGE #
VILLAGE ASSESSOR'S MAP & LOT g
INSTALLER'S NAME PHONE NO. �'t�� ,� ��
SEPTIC TANK CAPACITY R Z QQ mac.
LEACHING FACILITY:(type)
NO. OF BEDROOMS P OR PUBLIC WATER
ftiMMEROROWNER ,'
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No ��
LOT N0. : -ADDRESS: 6 $ �� ci c f d eA
014NERS NAME: C e - .
SEWAGE PERMIT NO..': NEW:� REPAIR:
DATE ISSUED: DATE INSTALLED:
INSTALLERS NAME: � n e_ �* i7`� C
I NSTALLATION OF:
WATER TABLE: FINAL INSPECTIONyBY:
DRAWING OF INSTALLATION .ON REVERSE SIDE:
t
C
`w i
Zh
Lf ,
o,
AISSESSORS MAP NO: ,-F 9 Z
-y 'SOEL N0,-- D'11 7 /
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratiun for Bi-tipuuttl Wurku Tomitrnrtiun Vamit
Application is hereby made for a Permit to Construct ( ) or Repair (�n Individual Sewage Disposal
System at:
�L.� �- — fe e�wi i el .
Locatiot Address or Lot No.
.� �: ... . .............................................. --------------5i4 .
Owner Address
a - ----------- � � . 4
Installer Address
UType of Building Size Lot............................Sq. feet
,., Dwelling—No. of Bedrooms-------- ------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons------------------------.--- Showers ( ) — Cafeteria ( )
a' Other fixtures ...............................................................
------------------------- ----------- -----------------------------------
------------
W Design Flow........ per person per day. Total daily flow.... -----------------------gallons.
WSeptic Tank/_Liquid capacit gallons Length--- ___ Width_._-_` . Diameter---------------- Depth................
W Disposal Trench—No.` __-'PF4 Width..__............ Total Length____i __.____ Total leaching area....................sq. ft.
�: Seepage Pit No---------_----------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
�_t Percolation Test Results Performed by-------------------------------------------------------------------------- Date........................................
W
Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
tit Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water......_.................
a -------------------------------------------------------------------•--------------------------••-•--.........................................................
0 Description of Soil.........................................................................................................................................................................
W
- ------------------------------------------------------------
U Nature of epairs or Alterations—Answer when applicable.,_'�.._5'7�� �t3�___SI �6-__. '
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 been ' ed b — d of
Signed Date
-----
Application Approved BY ........ ....................... ............ ... .. ------------------------------------ �''�.� ems% .....1
Date
Application Disapproved for the following reasons: ............... .........:..................................................................................................
.............................................................C-�--------................----....------.................----...............---...------------------------------------------------------------ ................. .........
Permit No. ----- f �'� `'� 7-
......�. Issued .....
`� Date i
007 -
__ �
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
,pphratilall for Uhlyinial Workri Tomitrurtiou Frrutit
Application is hereby made for a Permit to Construct ( ) or Repair ((,�an Individual Sewage Disposal
System at: /' c t
---------------••-----------------------------•------------------------------ y -----•-------------.....------- .....................
Locatioi�j..A�ddress or Lot No.
i- Cil 1'•c��;J .C/ s...Vjl-------- .e5/�•�`—--.----------------------•--------.-------..------------------
..............................................�_...
Owner ,r� Address /ffJ
a ( �A - ��---/J�!Yi%�r�.._._.C............. . ` ---•--.........
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 ( )
Other fixtures . f .?._... ---------------------------•------- ......
W Design Flow......J__,�..:...............��......``,gallons per person per day. Total daily.flow.....1!j��_....................__gallons.
9 Septic Tank�Liquid capacity�_<._+*gallons Length----;��----- Width---�._-------- Diameter_..-._......._. Depth................
Disposal Trench—No.`?_.T�s�._4J_Width-----9........... 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.J....................................................................... Date........................................
Test Pit No. 1................mmutes 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......_.................
> -
GY ...........................--------•----------------------------•------------------------------------------------------------•-----------.....••-•-------•-
0 Description of Soil....................................................................-...........................................................................................---•---
x
V ...................
W -------------------•------•------------------•--•-•--------._----- - ---------------------------------- ---------------••---- ---------------•--------------------------• ...............
U Nature of Repairs or Alterations—Answer when applicable.. J_57-9//.___
lrl...-•-----�-.- LL•( � Y_t
•+L�" - li/ 7�Jy `lJ f�t7
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 be�en,issued by.zhe board f, ealth. /
Signe�t�-.....�._.. ---------- ----------" ------------------------ ..../ter / ..........
f�
�.----� r Dare
Application Approved BY Ll�.�r..:T ;1 .....�✓ .. ............. ----------------------------------- r' f.... .-....1� /
. I
Application Disapproved for the following reasons: .................................. ......................................
--------------------*......--------------.....�.;.......
........................................................------------------------------..................----.----------........................................................----------.....---.. ............................:...........
Dace
Permit No. ----- f.-.' ... ..%.... !............. Issued .........lf�.- .� ........
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Tertifirate of Complianre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired
by ........................................................... ....�5- /.)T- i
---------------------------------------------------------------------------------------------------------
lase Jl�
-------------------- ----------------------------------------.......................
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. a... .el�.l... - ---- dated
. .
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE-----------------------I-------!�..7�5..........-------------------------------------- ---- ----------------------------------------------------------------------
-- Inspector ----0- -
---------- ---------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
No.........../........... FEE. .,.��
Disposal Workii Tonotrurtivit Vanfit
Permission is hereby granted----------------/-1 .,a L-,4,-L
4.......................... z J..(.....................................................
to Construct or Repair (,�),an-f�idividual ' i&age Disposal System
atNo---------------------------------------------------- ....... ------- ........... ........................
Street
as shown on the application for Disposal Works Construction Permit ...... -------------- ......
.............. --,z, - r1-9
......... ....DATE...../ ------- -.7....... .................. Boardof Health
FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS
g
X Q E 1-0
£ N N I £
I ££
-i �ryfii /1
-tot
N 'i 1 ----------
II I _ !�ilijl�Illjll
70 ----------------------
70
II ,
-u I
I I V
S II I
II I
------------ I � LL�
II
iw
II �
II
5 g•
II �
II
II
II
II t0;
11 DY
II
II
J
L�
® nx�
S