HomeMy WebLinkAbout0161 THIRD AVENUE (HYANNIS) - Health Aird Rvt., T
by
TOWN OF BARNSTABLE
LOCATION ~ ��/ I�II�O �U� SEWAGE #
V'-LLAGE �1�15 ASSESSOR'S MAP & LOT
t4- _
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY IO0 9
LEACHING FACILITY: (type) .? �l`�5 (size)
NO. OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 f of le Ching faci ' Feet
Furnished by
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_ SEW-pf�E_ PERMIT. -1.10._
INSTALLER 5 U&& AE ADDRESS _
_ BUILDER-5- ►J.&MF— _�- ADDREESS_
In-
. .Dts,TE PERKA T 155UEDi l%7 - — — — —
D ATE COMPLI &MCE ISSUED : — `
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No.—Ir?....... Fwic At*
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THE COMMONWEALTF
F MASTS
BOARD/
, HEALTH
,...--.OF.... .......................................
Appliration lor Dhipviial or s Tutuarurtion Vrruid
Application is hereby made for a P;rmit to Construct A�®rRepair an Individual Sewage Disposal
,
System at: 0
611_�
.. ........ ... ...... . ------ ..................
1 4 ------i��j ----- ...... ----------------------
Loc on- ddr
. ........... . ... ...... - ------T_ .................... Y
Owner Afddres,
----------------------------- ...................................................................................................
Installer Address
Type of Buildi Size Lot----------------------------Sq. feet
Dwelling=No. of Bedrooms--s-----------------------------------Expansion Attic Garbage Grinder ( )
Other—Type of Building ---------------------------- No. of persons-._--___----______----___.-_ Showers Cafeteria ( )
04 Other fixtu es
Design Flow------------- ---- gallons--- ---- ---p--e-r---p--e-r--s--o-n----p-e--i--d-ay--------T---o-t a--I----daily-- -----fl--0---w-------------------- -g--a--1-1-o---n-s-
WSeptic Tank A-Liquid capacity-1 _
. gallons Length________________ Width- ....... Diameter-_----_ Depth----------------
Disposal Trench—No------------------ Widtli]/e.) .... ....... .
Total Length.....-------------- Total leaching area.._ ._.___.____._sq. f t.
Seepage Pit No_____________________ Diameter_________-__-_-_-.__ Depth_4 below inlet-- Total le4oing area---------------_sq. f t.
Z Other Distribution box 2
Dosing t k
' a id.
Percolation Test Results Performed by.........f-M-C.01,09--—--------------------------------------------- Date---------------------------------------
Test Pit No. l................minutes per inch Depth of Test Pit-.-_-_____________-- Depth to ground water....... ------------
G14 Test Pit No. 2--------_------n1inutesper inch Depth of Test Pit._._._.._..____._.._ Depth to ground water.........______.__......
-- --------------------------
0 Description of Soil--- . ------/---------
�4 -------------------------------------------------------------------------------------------------------------------------I................................. ....................(------------------------
U
------------------------------------ ----------------- ----------------------------------------------------------------------------------------------------------------------------------------
U Nature of Repairs or Alterations—Answer when applicable.--!t------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system III
operation until a Certificate of Compliance has be ssued by t4e board of he-alt
—ka -7d—
.. .... .. - - ------------------- -- - - - ---------------
Date
Application Approved By..*-')9........... ... ... . --- ............. -----
Date
Compliance as ssu by board of 1, Ith,. . . .........
SSi
. .. ....... ...
Application Disapproved for the following reasons:.............................. .....................................................................
.........................................................................................................I-----------------------------------------------------------------------------------------------
Date
PermitNo........................................................ Issued.......................................................
Date
-----------
No._-........t -----• FE$...., ....r....
THE�COOMAO�N®ALT OF ALTH MASSACHUSETTS
® PP''11 ii�Z i-
(fit ----------OF..... a'.......................
Appliration -for Uii uiittl Workii Towitrurtion Vamil
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at• !D ! f
=:.. � ----- -'- - ! ° �,� � .--�:�c..�J. f' -------•- ---•---•--•-- --
`�� � Locj�_tion-Addr s � J( 771
f o�Lot�l�.• }f I
"� :_..�d vJ-�!v i fl —-S ............. ........ri .......�r a
{ y • y
(/ Owner Address f
W
Installer Address
Type of BuildiV Size Lot----------------------------Sq. feet
U Dwelling—No. of Bedrooms._. ._-_-_-____••._---.-_-.. -Expansion Attic ( ) Garbage Grinder ( )
p., Other—Type of Building ______________________ _____ -No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Q' Other fixtures ------------------------------ --------------------
W Design Flow.............. _r�_______________•__,gallons per person per day. Total daily flow.............. S_rJ'? _-_-._..---gallons.
* Septic Tank t Liquid capacity ..........gallons/ ����Length________________ Width------.......... Diameter__---_.-.------ Depth---------------.
xDisposal Trench—No..................... Width_l L__._--_-_- Total Length....! 6.:---- Total leaching area--------_-----------sq. ft.
Seepage Pit No--------------------- Diameter_____________.---.-_ Depth below inlet-__ ___-_-_-_-____ Total leaching area.;--.-.---_-__---sq. ft.
__�G�
Z Other Distribution box ( ) Dosing tank
'~ Percolation Test Results Performed by------- ---___________________________________••---------- Date----•---•.--_---__--_-__--_-______------
aa Test Pit No. 1..._------------minutes per inch Depth of Test Pit.................... Depth to ground water.._._-__-.---.--_-_.----
�Tq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_..---_-___--_--____---.
a r �~f __ _ _ _ _ __
i _________________________________________'___`_•______-___-._-•-•_--•.-______-_-_4_,f;.___- J i y` _________________._--..
f 1 _f_____________________O Description of Soil.----- - ` ---r---.....1�i_-.� .' .r t ----------_-a,_,t__._._�.__:_ y - ".�?`.------•------
U •----.------••---•---------
W ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------..........
UNature of Repairs or Alterations—Answer when applicable.._n-------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI 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. ,
� r
ed
Al 11114, Date 7
Application Approved B -.__.-.
Date
Application Disapproved for the following reasons:_.......---•-----••---••--•-.V-•----------------------------------------•--------•-----------....--------•------
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOAR
/D ,OF HEALTH
. •:.&r ...........OF. Gc�t- - ...... .............................................
QrWrtif r atr of T1,Tllaphaurp o
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( )
by......................................................
f( Installer
at.....................(,1 ------ i -"'" =` r- -••---------------...........••-•-•-------------------------•----•-------•------------------••--•----------...
--has been installed in accordance 2Jith the provisions of _ tick XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit N _!_; r_-- ------------- dated...__-__ Z_ !_:._?.. _
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD QF HEALTH
S ......r! OF..... ....................................
FEE: .:..................
Dispaiittl Workii Tomitrurtioaa Vamit
Permission"hereby granted..............................................................................................................................................
to Constguct (�t ) or e t ( )ar Individual Sewage�6isposlal System
at No. .�d --------.----- - ... = G-_2' t ✓'=
as shown on the application for Disposal Works Construction Pert No.. .___.._ Datedn�._- ._..�
Board of Health
DATE-------------------------------------------------------------------------------•
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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