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Home My WebLink About0106 THIRD AVENUE (HYANNIS) - Health �4lv �trd �(�°, f��Y'lIS �- TOWN OF BARNSTABIE LOCATION SEWAGE # 'VILLAGEI ASSESSOR'S MAP Cz LOT INSTALLER'S NAME PHONE NO. 1-4 - 7S'— SEPTIC TANK CAPACITY /) ,. LEACHING FACILITY:(typeY 157 6 o 6 2i nj e- (size) - )t NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATERA- BUILDER OR OWNER IV" ' DATE PERMIT ISSUED: r , DATE COMPLIANCE ISSUED Zz'— 2- VARIANCE GRANTED: Yes No �C; r , .J (. . .. ' _ 1 ,'. ` '# .; mil 1 x� ®,+ C �[ ...vg-`q `1� �, �- �, �$ti> [rGp �, �� +T V" r � / . `ti.. � l\ i. �� rw. e=� i� e� 7 �� g � ASSESSORS MAP NO, a AREEL KO.: No... ..........I.... Fiz$....a0•..' .:..._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........c+..n... ..............oF....tSc¢ens ............................................................. Appliratinn for Dhipati al 10orkii Tomitrurtuan firrmit Application is hereby made for a Permit ,o Construct ( ) or Repair (4..) an Individual Sewage Disposal System at Location-Address Lot No Owner ? A`}dress I L� --�-A--�-�snco--------------------usta---lier %--------- s Address Iess QType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.................: ..........Yj---_____--_-_-Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ................................: . W Design Flow............................................gallons per person per day. Total daily flow......................................._----gallons. 04 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1................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............................................................................................--------------------------------------------------------------------------- x U ---------------------------------------------------------------------------------------------------------------- - ------ ............................................--...... Nature of Repairs or Alterations—Answer , hen a lica.ble._�n r_��__ _ t 0... +a__.__.__ U P PP � - --- ------ - -- - Agreement: !� The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the rov isions of i I I' .: p 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 of health. Signed---...0.�?roJ4.0 �u/1. •---•---------------------- ..... Application Approved BY Ce�rilf .8�? 0 /v at Date Application Disapproved for the following Irens:----•--•------------•--•------------------------•....•--•---------•----------•--------------•-------.........._ ----------------•--••---...... -----•---•-----------•------------------.....----------•--•------------------------------------------ --•-----•-------•-------•------------=---------------------••. Date Permit No..........^............................................../yZ Issued-....................................................... Date r � 7 No..L....... THE'COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - I-Qwrti-.. OF...fJcv.._nsccpl ......... Appliratinn for Uiiipuuttl Works Tnnitrnrtinn Prrntit Application is hereby made for a Permit to Construct ( ) or Repair O an Individual Sewage Disposal Systems at: t ,IG� Thtrr ... uE+ ��, su�an,•„_<,e+l Location-Address t • or Lot 1, N!},Anl,__t rora�a 5---------------------•--•---...... l+d i lfr er t r•e e k`act Abe {t rs w. 0/4 .............. _...._.._..-__..-....-.._ __..... .___._........._.._..._._...Y.............................................. Owner Address ............... A`� R ra�t ........ ................ -------- -••------------ Installer Address V Type of Building �/ Size Lot............................Sq. feet Dwelling—No. of Bedrooms................. ..........7__.............Expansion Attic ( ) Garbage Grinder ( ) p`•4 Other—Type of Building ............................ No. of persons____-___-______-____-_______ Showers ( ) — Cafeteria ( ) Q' Other fixtures ........................................... W Design Flow............................................gallons per person per day. Total daily 'low.............................................gallons. 1:4 Septic Tank—Liquid*capacity............gallons Length................ Width................ Diameter__--_-___--____- Depth................ xDisposal Trench—NTo..................... 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 ( ) aPercolation Test Results Performed by--•------------•---------------•--......._....-----------•-------------- Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water_-___---_______________. G14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •--•----•-------------------•-•--•--••-•---•-••--••-•-•---------............._......-------••---•---........................................................ 0 Description of Soil.................................................................................-----------•---------------------------------------------•-•-•-•------•-••-••-•-•••--- V --------------------------•--------------------------------------------•---•--------••-•-------....--•--------------•-----------------------•----•--•--------•-----._....._-•--•-••--------•----- W •••-------------------------•------•-----•--•-••-••-----------.....•---•--•----...-----•----•--•-...---------•-••-••••---•-•••-•---=•-•-•--•-•--•---------------------•-----------------•-......-•_--•-- VNature of Repairs or Alterations—Answer when applicableA` 'kt.0.__ 600 ae-d �_�'p__4.5'vt!r-'7 ?•k_____________ _-.lanx--••••4 n�' -ti^ro P---tO,-�_eh._t0rf-----`-'---S4 ---- ca 5 F c�C f�-rr --.......0 Agreement: The undersigned agrees to install the afor.edescribed Individual Sewage Disposal System in accordance with the provisions of T •= ..E �of the State Sanitary Code—The undersigned further agrees not to piace the system in operation,until a Certificate of Compliance has been.issued by the board of/health. Signed..... . /0.22•S(. Date Application Approved By-••------•.�...---'-:_ call• j f t. r Z . r� ...-- Date Application Disapproved for the following reasons_________________________________________________________________________ ......•----•-----.. ............_ ...........................................--------•----•--•-----------------------------•---------------•-•--......-•-•-••-----••-------------•---------•-•-----••---•••-......-------•--••----------- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �..... �'a.. ...................oF....E`irer...... c,.l?1e ........................•----........................... Trrtif iratr of Tomplittnre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (4K } b .......... - ...........................---•----------•---•--------•---------------•--------------•-----------......_ . , Installer has been installed in accordance with the provisions of Ti T'IE] j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No� _.._..�.1_.-ID................ dated-----'. ..... _ -_---___________- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YNE SYSTEM WILL FUNCTION SATISFACTORY. /f Inspector...l `'.DATE.............. -- •----...•........................................................... T COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH t 'v .....................................OF..................................................................................... �� (NO. _�_._ FEE_,),..................... Disposal Wor ,s Tons rnriinn anti Permission`is hereby granted------------!Imo.....\-- ..........('.f X ............................................................................. to Construct ( ) or Repair (f ) an Individual Sewage Disposal System atNo...............................................................................................•••----••-•--------•••---•-•---•-------.......•••-•-•---••-•-•••---•--............••.._......... Street as shown on the application for Disposal Works Construction Permit No...`'_..(_t_"7__ Dated__!_� ____._L. G . , , . t _ .......................•------_ --------•---------•--------------•-•------. Board of Health DATE.......... -- _-----•Z....---------------•••••---........----............ FORM 1255 HOBBS & WARREN, INC., PUBLISHERS