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LOCATION SAGE PRMIT N0.
VILLAGE
N S T A L L E R'S N A M E & A D D RfE S S J. CRAIG MEDEIROS
'rucking & T allda{iq
142 orporatloh eet
Hyannis, Mass_ .77'5.0828,
B elvvew OR- OWN ER 4
DATE PERMIT ISSUED
7-�
DATE COMPLIANCE ISSUED' ZIP
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No ! a Fus.._ .......
THE-COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
--__` . ...............0F ne- -
-••------_---- --------•--......._......._.
Appliratiou for Uhipaaal Works (�>a� rin� rr�ti#
Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal
System-at:
............ �- .... ............ �' ................M � s
Locatt !`7—dcd'ress, `{�` or Yt No./�
l''!�_a_ :'_0 S $��..Y. /.�"L �a.�y„v sA���ti. . .. t�b�
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms......_.....................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e 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............- --•- P g q
____._ Diameter_______________ Depth below inlet_____.._..__._______ Total leaching area________.._.__...s 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......................
Li, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a •-•---•-----••---•--•••---•--•---••-•--•-----•-•--•-•••----•-•-....•---------------------------••--.._..__.....•-••-••--••......----------.._.._..•••--_---•-
0 Description of Soil_______________ _______________ __
U
W ---•--------•----•------------------------------------ ........................................................... g /
x Yam- -- G�- �t�i- p.�_g.! '.U N e ¢f. a1rS or Alterations—Answer when applicable_.__
// .. (0•-- n d ... -Vt'e--- �r ol •------___----
Agreement.
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of.TcITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b n iss d by the board of health.
Of
... ............. ..... ......................................................... .1 10- Date
Application Approved•By. �-
Date
Application Disapproved f 0110 ing reasons-------------------------------------------------------.........................................................
---•--------•-•------•-------•-------•-••----....--•••• -----•-•---•-••-•--•-•-•-----•--•-••••--•-----...............................................................................................
Date
PermitNo......................................................... Issued.......................................................
Date
y .0 �-
No._.............- ,� � Fps... .... ......_
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
Apphrtttiun for Uiipusttl Works Tunitrur#iun Prratit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
...............� ....----•-- ---....--•-----............... .. ...--• ------------•--•-•-----
Locale ddres C�+� or Lot No y�
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.. ....
7 Ow er y� Address Y
�}
-q S 1�°8 l Z'" t„««�a�J J'ii G.� �' 1 j t T ".! 144-D (},�• A J
� Installer Address
Type of Building Size Lot----------------------------Sq. feet
U Dwelling—No. of Bedrooms................................ --_•Expansion Attic ( ) Garbage Grinder ( )U
`4 Other—T e of Building ........ No. of persons............................ Showers — Cafeteria
a' Other fixtures ......................... ......
W Design Flow............................................gallons per person per day. Total daily flow.............................................gallons.
Gd 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........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
•----------•-------------- ---------•----.........-•---•--------..........._•-•••-----•-••-•----••------•...-•------•--••-------.....:..
x Description of Soil..........___....____ . _
U --------------------••----------•---•-•-••---- •--•-•---••--•---•.....----•-•-•---•-•------------••-•..............................................s:_
W -----
UNate e �pairS or Alterations—Answer when applicable_ .......} 7 -
......'`--.. -0-v-.,r �. �— ...... %}`� .- �
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TT T ALE: 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has en iss `d by the board of health. ;
eDate
Application Approved By--.
........................................
Date
Application Disapproved e f of wing reasons---------------------------------------------------------------------------------------------------------•-_._...
....................••---••-----•-------....... .... ----------••---•-•-----•-••--......... -•----....---•---•--•---•------------------•----•-•-----•-•..................................
Date
PermitNo......................................................... Issued_.......................................................
Date
„ THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
... ............O F.....................................................................................
�rrifirtt#r of fl�untlittnrr
THIS IS TCPCERTIFY Tliat tot Individual S , ge Disposal System constructed ( ) or Repaired ( )
b - ter . ` L.�. .� ',
y ----•• ........................................•-•--...-•---•----•---
.r.."" ` IAS all
has been installed in accordance with the provisions of i5�e€_The State Sanitary Code as described in the
application for Disposal Works Construction Permit No"t"�''--_.�.-_-.
-------------------------- dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS UARANTEE THAT THE
SYSTEM f WI ' F NOTION SATISFACTORY. ;
DATE.... _._Y ..
..............................•..._......_._........... Inspector....,............. .... ........................................................
1
THE COMMONWEALTH OF MASSACHUSETTS
_ �F HEALTH
............ (/
B AR
O......................... FEE.. ...................
�i��u� I k� duns Tun �ruti#
Permission is hereby granted..:-.--} "-"''t- -----•---- --
.......................................................
to Construct (5,,}.,or ai�r�(W'') ail' ndiv' u ewage<ns)),o st
Street
as shown on t e a lication for Disposal Works Construction Permit ~'`r~____---• Dated..........................................
'`
................... --•--------------------•------------------------------•-•----•--•---••-•-----..
Z- � / Board of Health
DATE..........'---•-•-------••---------•---•--•--•-••...:............•-•-----.......
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS "