HomeMy WebLinkAbout0148 THIRD AVENUE (HYANNIS) - Health (2) aoco ��
LOCATION SEWAGE PERMIT NO.
u
V"ILLAGE
p '
IN'ST A LL R'S NA E i ADDRESS
L � wf
d U 1,L D E R OR' OWN ER
DATE PERMIT ISSUED
9 '
t.=
DA'T Erg 0`MPLIANCE ISSUED ��-
' I
d-
No. 3 3 Fm3..... v..............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........ ...... _OF....... �, sr, .
Appliration for Uigpoottl Works Tnootrnr#inn Vanfit
Applicatio i Weby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at: 116
........ ....... ........... . ..--•.......................................
Location-Ad ress. - • or Lot No.
.......................... ....................... ...................................
�y Owner Address
tiWa UX4?&e....... _-j'.I-C��............................. ..........................................•--....-----......_..__..............-•---..............
Installer Address
dType of Building Size Lot.................... .....Sq. feet
U Dwelling—No. of Bedrooms________ __________________________________Expansion Attic ( ) Garbage Grinder ( )
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—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........................................
aTest 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 -----------------------------------------
__--------------------------------------------------------------
-___---•-------••--•-----------------------•----•--____--•----------------------•--•-•----------
W -------------------------------•-------------------------------------------------------•---------•••---------------------------'-----------------------------•--------------------------------
x �
V Nat e of Repairs or Alterations—Answer when ap licable_.____�SL�lC?...____ � ?�' . ______________
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITLZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been is ued by the board of Beal .
gned ....................... '''- l! •,/-
t
ApplicationApproved By.........-•-- --• --- .............:..........................•-•---•-•--••---.._.....--- -- z1 -?---•------
Date
Application Disapproved for he ollowing reasons:•-------------••-----------------•--•--....------------•--------•--•--------•---------•-•-'...._......-••--•-----
....................................................... ••--•-----•---•---•---------------.............--'--•-•--..._.__.....__._....-••-----••-•--•-••••-•--•••-••••••----••••-•-•-_ _..__......---
Date
PermitNo......................................................... Issued----------------- ---------------.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
d�G1ft1�/..0F....... / ��•'L': +.,I".1." ....'....................
Appliratiun for Di,ipuuttl Workii Ton' iArnrtiun Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair,( an Individual Sewage Disposal
System at:
l--:S'Q........ R........ r�:..,..._...... sr- ... �_. ................... .....................................................
Location Address or Lot No.
J°
Owner Address
-------------------------------------------------
Installer Address
dType of Building Size Lot........................:...Sq. feet
U Dwelling No. of Bedrooms__.._-_'�` Expansion Attic Garba a Grinder
aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures __________________________________ _____ _ ':
d .7..................................
Design Flow............................................gallons per person per day. Total daily flow____._._._.__.:__...._._.__._.._.__.__.._.__gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter.......:........ Depth................
x 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........................................
aTest 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.......................
0+ -•-•----------------••-•-•-••-•--•---•-•----•-•---...-••-•-----...------.._......_•••-...•-----------•--.....----••--•-•---------.....-•--------•--.........
0 Description of Soil........................................................................................................................................................................
x
U •--•---....•-•---••-----•-•---•-•--•-••----•••-----•----•---•-••....---•------•-...-•--•-------•-•--....----•-•------------••••---••-••--••--••-----••-•-•-•-----•------•-------••-•-•-•--•--•-•------•-
w
U Natuuje of Repairs or Alterations/" Answer when ap Iicable ��1j rlev. ��C. ' �C' .____..-.---'
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage"Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in.
operation until a Certificate of Compliance has been is ued by the board of heap .
�.
to
Application Approved BY 1 °.................................. ........... ...................... !' y!,"/j �' --••--•--
Date
Application Disapproved for he , flowing reasons:.......................
------------------•-------...._......--•----•-•••--- ••---•----------•----••---.._..._..------------_-- ------------•-•-----------------• -----•---••-•--•--••-•-----•-•...-••
Date
PermitNo......................................................... Issued..............
ate
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
................."/:4 ...OF...... .5.,t .!' j /` ...................
Tnrtif iratle of faontplittnrie .
THIS IS TO CER. IFY, That the Indywidual Sewage Di sal System constructed ( ) or Repaired ( C.)+''"""
by , v.e. °. G- l-w' �t_ari ..""''..._o...................................•-•-----.......-•---..._..-•------.....__...-----
A./ Installer ,�,�1'
at. }� �� !✓'�� '?'. -------- f"= �r --------- --•------•-•-•------------------
has been installed in accordance with the provisions of TITLE 5 of�The.State Sanitary Code as described in the
sx
application for Disposal Works Construction Permit No......................................... dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM W;
./kL F NCTION SATISFACTORY.
s
DATE._..J ....................................................... Inspector••-- --• •---••-----•••-......•--•-------•-••••--..........--•-••----.....--•-----
t -
s.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...... i3?..ew►."r..............OF.......... j t'i ,S~ iis±l i..r r......_.........
...✓..... ..........---•. FEE.
�iu�outtl ork$ �on�trttrtiun lerntit
Permission is hereby granted Ntry[ �. ��`'4°x' .r. ----------------•---•--•-----._..._.._...................._..
to Construct ( ) or Repair ,4-)�h Individual Sewage Disposal System
Street
or
as shown on the a icati � for Disposal Works Construction Permit N�o , __... � . Da fl'..-__..�?4�03 ......
. .......................... .___......__.____.____._
- Board of Health -'--
DATE.--�jC� -••- ...............................................
FORM 1255 A. M. SUL KIN, INC., BOSTON