HomeMy WebLinkAbout0247 STRAIGHTWAY - Health 247 Straightway
Hyannis
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L0CAT`t ". _ SEVAGE PERCIlT CJO.
VILLAGE
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I N S T A LLER' % AM 6 ADDRESS
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U U I L D E R OR r
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DATC PERG7IT ISSUED
DATE COMPLIANCE ISSUED ����
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�IAP•�.
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TO) .._....0F....... - ................1� g✓a
W
Appliratiou for Uhip ii al Works Ta nstrurtion Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
!Iy
stem at: ,....... 7
` r`�d"' 2'Y
.
L Address / r
, A
............ -------a� �..... Lot N
Owner eA ess
�v]w r�4 R � Mane Y. ....... ... ........ ..... -
Installer Address
d Type of Building Size Lot..//. Q._......Sq. feet
U Dwelling—No. of Bedrooms.......... .................. Expansion Attic ( ) Garbage Grinder (/VO)
per-, Other—Type of Building ............................ No. of persons-----------------_.......... Showers ( ) — Cafeteria ( )
a
Other fixtures ...............
el —W Design Flow..........s:i ....... ..................gallons per person per day. Total daily flow___..._ ........................gallons.
WSeptic Tank—Liquid capacity!'0._ gallons Length. '.46�.... Width.�1�..e�®.... Diameter_ llepth�_..�._..
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No......../--------- Diameter----__6_---------- Depth below inlet.._.(............. Total leaching area.at)!:�_..sq. ft.
Z Other Distribution box (A') Dosing tank ( )
'~ Percolation Test Results Performed by.. .......5.&_OWZ..o.................... D a f e -_---.----.
1_4 Test Pit No. L 4...4._.minutes per inch Depth of Test Pit____I A....._.. Depth to ground water---IV.10194__.
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_____-..__._-_----____-
•-------------------------••--•-------.._.._...-----•--•---------------:........--•-•---------..........------------------------------------------..----.
Description of Soil =a /� .r ..... s1.Q.�, ---------------•---------------------------------------------------
U ` j..... .j 4,..lr,c..... ✓9.............................................................
---------•------ ------------•-•--....----•-•--•-------------...------•-•-------•---••------•---------••----••-----....-•-••----....--•--------------•---•------••-•-•--•--•-•-----•-----..............
UNature of Repairs or Alterations—Answer when applicable...............................................................................................
..••----------•-----•-----•-----------•-------•------•---••--•-----•--------•----•-•----------------•---.-------•----•----•••••--•--------------••-----------•---------.--•------•------.•---....--.•---
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
f'tT 1:1�^
the provisions of i, : -- 5 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 f Health.
Date y
M Application Approved By-----... ....t�.
ae
Application Disapproved for the following reasons:.....................................................................•-_....................................._
--...---•-•----......•-----------------------------------------------------------•----......---------------•-•••----•-•-----------•--•-------•-------•-•--•--------------------------------------------
f�---!�--l ---- -� Date
PermitNo......................................................... Issued-....1-- - • -------------------
Date
No.P�. ..�.. .-, 'FE$: d....d"'�...:...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
?�_._....0F........ f-:r'........---
.klipfirativit for Biiqvoiia1 Work,5 (fontitrur#ion Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Syste at:
........... ................ ZZ .. _../
Location-Address or Lot No.
.... ...._._................. _..... , ..........•-------••------.....................................---•__________.._.._..._._.._____..
Owner j/ Address
(� e..... /t/'S
---- .�—=:-row,::--- .- - ----- -- , .=------------------------------------------------ =-----
Installer Address
Type of Building Size L'ot.
........... feet
.� Dwelling—No. of Bedrooms..........�3..............................Expansion Attic ( ) Garbage Grinder (!v)
P4 Other.—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
aOther fixtures ......................................................................................................................................................
Design Flow......_..'" .........................gallons per person per day. Total daily flow.......�t3o-------------------------gallons.
W Septic.Tank—Liquid capacityJa_qagallons Length Width..0�4___ Diameter_'V.'..6//. Depth+ .g/f.
x Disposal.Trench—No..................... Width.................... Total Length................. Total leaching area....................sq. ft.
Seepage Pit No--------/--------- Diameter......4. ......... Depth below inlet.._!�............. Total leaching area_.�'a.:..._..sq. ft.
Z Other Distribution box (P') Dosing tank ( )
~' Percolation Test Results Performed by `, l!`2? _._. �}��'.l......................... Date-.,1,/ ?..�'�:_":''......_.•.a
,.a Test Pit No. ___minutes per inch Depth of Test Pit....k�_........ Depth to ground water.._'?
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water______.._:_..__.--_____.
R+' ----------------------------------------- ---------------
•................
-...........
:-----------
Description of Soil_______________ _"a .�___._
x --••-•--•-•••••'•••••••--_•-- ...... .......... --•---•••------'--•-----•-•..............•--•--'-------•...---
1_... --
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 Ti'L y g g p y
S of the State Sanitary Code— The undersigned further gees not to lace the system in
operation until a Certificate of Compliance has been issued by the board of health.
- Sign d__
--•----------- .............................................................. -- -._._..__......................
Date
Application Approved By--••- d" - ------� % `� 6 ,r .... -I-----�-
Da e
Application Disapproved for the following reasons_______________________........_____________...................................................................
t;
4.A Date
PermitNo........................................----•--•----•--- Issued.......................................................
Date
A.
THE COMMONWEALTH OF MASSACHUSETTS
r
BOARD OF HEALTH
......./...Pik..,/.V..........OF......./ �/�1 � � �".......................
(9rdifiratr of Tantplitanrr
THIS IS TO CERTIFY, That the I dl idua't-Sewa e is sal System constructed (Z111or Repaired
..
A ' y� ler .
at. I �" _. 14�` -- --- -- .. ........ .......... .
has been-installed in accordancL ith the visions j of The ate-Sanitary Code as described in.the
application for Disposal Works Cnstruction Permit N '________________ da.ted_...rZ_ -.l''.r .Cl..._..________.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE®AS A GUARANTEE THAT THE
SYSTEM `16ViLL'FUNCT16N SATISFACTORY.
--•-----•---•.............................................•---••--__•-_. Inspector....................................................................................
THE COMMONWEALTH OF. MASSACHUSETTS
BOARD OF HEALTH
/� ,may/�/� -y^/� ,/i ,/ �•'
V �/ �' ✓�... /., G1 //..rt'..............OF......�v.✓.!7�2°.ffi-✓�4rY.. !.1 Jf..:se..............._.... F.E. r!.a. .
No.:.._.... l!
t :o� 1k Juan rrntit
Permission is reby granted............ .- ....
to Constr ) ofr/R&� (. . Individua ewage Dispp Syst
Street A...0.
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as shown on the application for Dispos �'�'orks Construction Per No. Q-�' . D ted--_-_ ..g�?_....._..
Board of Health
DATE ..............................................................
FORA 1255 HOBBS & WARREN. INC.. PUBLISHERS
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