HomeMy WebLinkAbout0112 SIXTH AVENUE (HYANNIS) - Health ; 11 .2 Sixth .Ave u
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�� _ 'West HyannispbIl
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TOWN OF BARNSTABLE v
LOCATION , _ ,(� L SEWAGE #
VILLAGE Q %ASSESSOR'S MAP LOT
INSTALLER'S NAME & PHONE NO.
e
SEPTIC TANK CAPACITY Mdl
LEACHING FACILITY:(type) le5�01D (size)
NO. OF BEDROOMS PRIVATE WELL-OR PUBLIC WATER
BUILDER OR OWNER ,��
DATE PERMIT ISSUED: I f `j
DATE COMPLIANCE ISSUED: W ' /
VARIANCE GRANTED: Yes -No
3i
;Z 41 _
'RRCEL NO, e 9,7 No ;��6...10 99
---- — Fes- .
-
THEC COMMONWEALTH
ASSA;HUSETTS
BOARD OF HE
L _
�� ....-.....OF.... ..: . ....... . . .... -------------•----.-..-.-------.-- .
ApplirFation for Uh4po5tal Works Tomitrurtion Vautit
Applicati is hereby made or a Permit to C struct ( ) or Repair ( ) 4n Individual Sewage Disposal
System at: '
......... ........ .... ............... •-• '--- .............................. .
ddress or Lot o.
..............�` .... .... --•'--......•...................... .............................................
O .e Address
Instal le Address
UType of Buildin Size Lot............................Sq. feet
�. Dwelling—No. of Bedrooms......-.3--------.-_-.-_-.-__-___-__-Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons........................... Showers — Cafeteria
a' Other fixtures ..................................
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
9 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................
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 ( )
a Percolation Test Results Performed by----------------------------
----------•-•-------••-------•--------- Date.......................................
a Test Pit No. I----------_.....minutes per inch Depth of Test Pit.................... Depth to ground water_-___---_-_-_-____-_----
r3 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......------------------
— ..........................................
O 7-
Descriptionof Soil-------------•. < ---------------.......-----•-••---------------------------------------...--------••------------------------....----...----
U -•--------•----•--•---........................................................................---------------------------------------------- .........................................................
---- -------------------------------------------------------•-- ......----•-.... --
U
Nature of Repairs or Alterations—Answer when applicable._____ .!!._.....___..lf. '
-------- ......:......
-------------------------------------------------•--------•---------------•-••••-----------------------------•----•-•---••------------------•-•-------------•-------•-•--••-••---------••-----....--_..
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of i T'I is 5 of the State Sanitary Code— The un ersig furth agrees not to place the system in
operation until a Certificate of Compliance has be issued b oar
Sine ............ ....`_ ._... ......................... �.
Application Approved By........................ .--!I---------.................. --------•-•'---•-- ----....../... t �-------
Date
Application Disapproved for the following reasons:...............................--................................................................................
----------------------------------•---------•------...------------------......---------.........-•----•----•--•------•--------•-----------------------------•-------•--------••-------•---•-•-•...._..._
Date
Permit No..... ..-..1 `� --------------- Issued.......................................................
Date
� Mr
N ...:1< .� Fps
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HE T
-..AV_,�/�.........._OF.. ....:.... ....... • ----------- .._._...----••---........._......--
ApplirFation for Biiposal Workii Tomitrurtion Vrrmit
Applica 'o is hereby mad for a Permit to gpnstruct ( ) or Repair ( ) an Individual Sewage Disposal
System at•
........ ...... -- .. ............... ....-•--•---...-------•-'-•----•---•-_---_.. -----'---------.........................
-----
cat ddress / or Lot No.
.! .. -__ ..............•_______....___________..__.._..
� n -- -----------------------Address
I
lsl•• nst •--- -----•--...••-••••-•-
nstall
� -• ... ... .-••---------- Address
UType of Buildin Size Lot----------------------------Sq. feet
Dwelling No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Pa-, 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—NTo. .................... Wid1th.................... 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. I................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........................
P4 € "�:='--------- -----------------------------
-------•-------------•-•----------------
--------------•----------------- ...............
Descriptionof Soil------.... --F......................................•-------------------•------------------------••-------------------------...•••••--•••--.
x
W ------------------------------------------------------------------------.....................................
...
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 iI, :°.-.>_ ;of the State Sanitary Code—The u 'ersig d furti r agrees not to place the system in
operation until a Certificate of Compliance has be issued b t e boar f F
ate
Application Approved B ..........=............... r .�. � `�`�—•--
/
Date
Application Disapproved for the following reasons:_..----•-----------•------------------------------------------•-----------------____._..._.....____._..___.__._
---•..................................•-----•----------•-•--•--------------._.._......_..------.......---I•••--'-•-----•--•-----•-•--••••---•••••-•-------------•-------•-•-----••......•--•----...•-----
Date
PermitNo..---`-- r -- `_=`� ................. Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALT ,
,,Gl%. ....OF.. .... .. ... ....: .. .......1�......................................
Trrtifirat a of Toutph atta
TH' IS TO TIFY h ndividua Oe l SeDisposal System constructed ( ) or Repaired (�
by----'-
;�46,
Inst
---W-A- z. .
has been instailed in accordance with the provisions of TTTIE of The State Sanitary Code as des r bed in the
application for Disposal Works Construction Permit No._ (e... 0 _. .......... dated_-...___1_ �.�._ ......................
THE ISSUANCE OF TINS-CERTIFICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE
SYSTEM WILL FUNC ION SATISFACTORY.
DATE...................... 4_(_Oj�2.......................... Inspector....._... ..............................................................
THE COMMONWEALTH OF MASSACHUSETTS v�
BOARD OF HEALTH "
r ... rriy OF.........�</ �� . �%2 ......
NYO•--.••. ' �U � FEE.__......._.!........ .
ePermM
ission is hereby granted••. = . ---•••-•- ••-..... .__ ... ------•---'-•---.....--•-•••..........................
to Constr et ) orRep r ndivi ual Sewa at No.. t �l-_ ". •.._........ '.--_•--••....................."
i................
as shown on the application for Disposal Forks Construction Permit Street
No........1 y Dated .__. v l�1 �
a ...........................-
. Board of Health
DATE == - ! ? ......-------•_----
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS