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Home My WebLink About0216 SIXTH AVENUE (HYANNIS) - Health 216'SIXTH AVENUE A = 245 - 103 ' Hyannis l? ': e 0 s TOWN OF BARNSTABLE LOCATION �16 SEWAGE # VILLAGE e0414 (,(6t Lr ASSESSOR'S MAP & LOT V,5- /0;3 INSTALLER'S NAME & PHONE NO. 4)4,<-) �4 g/o&'# fl <9 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) ,Cc.�e,� 0i,--P 050 (Size) NO. OF BEDROOMS PRIVATE WELL PUB IL C WATER BUILDER OR.OWNER P8 DATE PERMIT ISSUED: I a DATE COLIPLIANCE ISSUED: VARIANCE GRANTED: Yes No -� �, �, I ` i 0 `� r 1. �.� ti� i �. THE COMMONWEALTH OF MASSACHUSETTS 7J 103 BOAR® OF- HEALTH a / ................................ Applira#iuu for Disposal Works Tayns rurtinu Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (Individual Sewage Disposal System at, ......,�............ .. . ..21._. -----•-----••--•-------------- -------------------------------------- •------------------•----.._..--••-----•-- �+ Location-.Address or Lot No. � .It/4... ..�a_l_.......�� .................................. _ --•................................................. Owner Address Installer Address/ U Type of Building Size L�t..G �_�-`.Sq. feet Dwelling No. of Bedrooms..........- Expansion Attic ( ) g Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ................................. WDesign Flow......` 5............................gallons per person per day. Total daily flow............................................gallons. / •- W Septic Tank—Liquid capacity._ allons Length��.-'4:Width.,57`'57.7. Diameter................ Depthy5.P--- x Disposal Trench—No..../............ Width...-;?�............ Total Length...r3i5e........Total leaching area..5a_ -----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........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-------................ --••---------------------------------•--....................--------..........................------......................................................... 0 Description of Soil........................................................................................................................................................................ W ----•-----------------------••----•---------•---......--------•-•-......•--••••..... ......-------•--•---------••-••-•-•-•------•----••••--•--------------••--•--------••......•---•-•-----•---•---•--- UNature of Repairs or Alterations—Answer when applicable. . .............. /®bt-C Agreement: . The undersigned agrees to install the aforedescribed Individual Sewage.Disposal System in accordance with the provisions of iIT1Z 5 of the State Sanit —The undersigned further agrees not to place the system in operation until a Certificate of Compliance s een iss d by and . I y. Date II Application Approved BY-----------•- -� - -----•---...--•-••-• .................................................. ...... . Date Application Disapproved for the following reasons----------------------------•---•-----------------------------•------------------------.....--••-•-•------------ .................•-.........----•-------•-•--------•-----•-•............•------------------•---•-----•---------•------------•-------------•-•---••-••••--......---------------••--------•---•-••--•-•--- Date Permit No.....................................-�`�---�--•--.-. Issued-.------•1--��•------••---•-----------••--- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH %orrtifiratr of Tompliaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( �r Repaired by--- ............ ........ --------------------------------------------------------------------------------•......----------- • Installer Ci .......!'Co2........-•--------------------------------------------------------------------- has been installed in accordance with the provisions of TITIF 5 of The State Sanitary Code as described 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. o eC DATE... i ysy, Inspector �� -- ............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Z/ .........OF..... �............ FEE. 8 Permission is hereby granted--�- ....e�.--.--•. �' ......................................... to Constru ( ) or Repair an Individual Sewage Disposal System atNo.... .5 ill ............ .........................•--------------------•----•-••--........ Street e� as shown on the application for Disposal Works Construction. Permit No.:5:.€?..7 Dated.....T'V..tefAtz— .... . Board of Health DATE.......... ------------------------------------------•-------•----------- FORM 1255 A. M. SULKIN, INC., BOSTON '7 � No.. ..............._2>4Y F E... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �QG........................ % .................................... Appfiration for Disposal Works Tonstrartion Prrutit Application is hereby made for a Permit to Construct or Repair (-7-a-n-oIndividual Sewage Disposal. System at ................................................ .................................................................................................. 14. e J Location-Address or Lot No. ........... ................................................................................................ .............................. ....................................................... Address slefj�Z .... ................................................ ." . ......... ... ........... .......... ......... ..... ..... . ............................ Installer Adc Type of Building Size Ei�......Z Ac.,---Sq. feet ................. Dwelling—No. of Bedro'oms.........�/...........................Expansion Attic Garbage Grinder PL4 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria PL4Other fi tures ..................................................................................................................................................... < , - Design Flow........:......... ........................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity/ gallons Jength/ ... Width_. `s'. Diameter................ D e p t h6e_ ....... Disposal Trench—No. ..V............ Width_.'............... Total Length_..J......... Total leaching area.-6- s-5......sq. ft. Seepage Pit No..................... Diameter.........__..._..._. Depth below inlet..............._.... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 0-4 Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water.._..._............____. �_4 r%4 Test Pit No. 2................minutes per inch Depth of Test Pit,•.................. Depth to ground water_._______-_-___---_-___. a ..........I.................................................................................................................................................1. 0 Description of Soil......................................................................................................................................................................... W U ......................................................................................................................................................................................................... ........................................................................................................................................................................................................ U Nature of Repairs or Alterations—Ajjswer whe applicable.-19,...6.1......................... .......................................... e-4-, L.......................... ..........................................................................................................1:.................................... Agreement: The undersigned agrees to install the aforedescribed individual Sewage Disposal System in accordance with the provisions of TITI1 5 of the State San*�re"is ' The undersigned further agrees not to place the system in bo a y operation until a Certificate of Compliance as , en s - e �2��h. gnu ............. ---Z.. .......................... Date Application Approved By......................41 ......................................................................... Date Application Disapproved for the following reasons:............................................................................................:_................. ......................................................................................................................................................................................................... -73 nase 4.................i........ ...... Permit No............................... Issued........... ........... .......... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......................................... .................................... Tntifirate of Tomptiaurr I I, TO CER_TIFY,ghVe Individual Sewage Disposal System' constructed or Repaired bj ............................ ... . ..........Z��-------- ..........................................7............................................................................ In at...... ............................................................................................................................................................................................. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described 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...... ....... ................ Inspector............ ......................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 70® -J ., No... .. FEE........................ Disposal Works Tons ion rruti Permission is hereby granted....P...:�l. ....................19.::�........ .........5.;..................................................... to Const5p or Repai an Individual Sewage PIValSystem at No. ... .......... .......0.................. -77-�----------------------(-" Street z,- .............../....2.../.../...1_'(M;=" as shown on the application for Disposal Works Construction Permit No..................... Dated.._...._____........_............_........ ........................................................................................................ DATE. ............................... ................................................ Board of Health ... FORM 1255 A. M. SULKIN, INC.. BOSTON