HomeMy WebLinkAbout0018 FIRST AVENUE (HYANNIS) - Health rs Y
18-First''Ave �
West Hyannisport
A= 301-049
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L-0 M C kli ION S E G P• -R-M'1 T*N 0.:
VILLAGE .
1 !2ML 'S NAM & DRESS
B UfLDE R OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
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LO,C AT ION SEWAGE PERMIT NO.Aj� ly-p
VILLAGE
I N S T A LLE AM & DDR SS
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B UtLDE R OR OWNER
DATE PERMIT ISSUED ^7o
DATE COMPLIANCE ISSUED
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THE�COMAO �C NWEALTHOFUASSA;HUSETTS
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Appltrtttion -fur 43W.V sal Works C omitrurttntt Puna t
Application is hereby made for a Permit to Construct ( ) or Repair ( ) Individual Sewage Disposal
System at:-----L2.....................A-7 ........ ...... ----------
C�
Locat. - rs or Lot No.
Owne Address
a � ...._ . .... ----------------------------------------
In Ile; Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
dOther fixtures --------------------------------------------------------------------------------------- ---------------------------------------------
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
9 Septic Tank—Liquid capacity------------gallons Length................ Width................ Diameter-----........... Depth---------------
xDisposal 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.,l----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water.........------------_-
�14 Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water.-.;..-..------.--.-----
-•----------•--------------•------•----------------••----•-- --•--r......._....-•-•--------•-•---........................•...........................................
O Description of Soil_ �!, =----------� l
` w
W
...
U Na e of Re rs Al ations 'i�sw it pplicable.-._-
----- -- -,,--,-- `
p
------- -- -�C3—
AIQ�..CT.... .. E. .- t �( �/ ---------- ------- -- �f
ement:
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 furtl er agrees not to place the system in
operation until a Certificate of Compliance has en 'ssued the boar of e t P.
Signe -- ----D----_�---••.. [ !�
/ Date
Application Approved BY . - --- ---_ --- -----
Application Disapproved for the following reasons:.......................................
...... .......................................Date•-.-•••-------
---------•--------------•-------------------------------------------......--------------------------•---••-•--••---.....-••...---•-•••-••-••---•••.........•---------------------...•--•••------------•.
Date
PermitNo......................................................... Issued........................................................
Date
y� Fmic
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF H L -.,
AVVIiration -fur UWVviitt1 Murky Tottotrurtiutt Vrruiit
Application is hereby made for a Permit to Construct ( ) or Repair ( '-)�an Individual Sewage Disposal
System at:14?
Locati -A dr.ss or Lot No.
-................. = . _„�� .------------------
// ownerf, Address
� In tgller Address
UType of Building Size Lot............----------------Sq. feet
Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
P.,., Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
dOther 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. fi.
z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by------- ----------------------•---•--••-•-••••••••••---••--••----•--•---• Date---------------------------------------
,a Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water--------.--------------.
rZ Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water--.-----------------.--.
9 •--•---- --- --- --•-- -- ---.-•..................••• .......................................... --
O Description of Soll /rye'✓ �i�.� L �' t��* 7 -- ��l ;a ,s;
---•---•---••'--"" -- =-'`"----,. '�.--'`'�.'"1_- -------- �zl- l � ff r_ •�%� 1'e_x�:L"7�L,=f-— -�•'iF -- 1 f��f: -. .------- - -
W
------------
x - ---- ----i-- -- _.
U Na e of Pep! Irs e Alte atlons—" Answ t' ppllcable. ...-�� � Y �-
•----- --
Agreement.
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article NI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has ben issued by the boar of Welt
Signedf = r - -- ----------------------------- ---------------- _-_26
�i J,f / Date
Application Approved By------ r����`, �....• s < /. t.--.G�� { ��-- ./.---
Date
V y
Application Disapproved for the following reasons-.......................................
•.. ...............................................................
...................................................... --------------•-•-----•------•------•-•-----------------------------------•--------------------------.------------------------------••----••----
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD Pig HEALTH
iffirate
OF...... y ....1 .' _...:......................................
irr-
of fU'uutpliaurr
THIS ISq=„Q CAR" Y, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by...----...a. ... r = - ----- '------------------------------------------------------------------ ----------- -- -------
InstaVler / /��
has been installed in accordance with the provisions of Arof The tate Sanitary Code as describ rythe
application for Disposal Works Construction Permit No.'_.--....•.__....���-�------ dated-.-../.��..- _/-�-----_-._--G...-•.-••.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE-------------------------------------------------------------- ............ Inspector............ ------------------------------•--------•-• - -----------------
THE CO""bNWEALTH OF MASSACHUSETTS
BOARD O HEALTH
....1y...... ...........OF......-.. . >.1�- ........ �—"-
No......................... FEE........................
�i��u,�tti nrk� � �t,�trttrtiutt rrutit
Permission is hereby grante _- -•% V. �.
to Construct]( ) or Rep : (! an Individual ewage Disposal�,�yy te
`
m ��
Street
as shown on the application for Disposal Works Construction Per itr o------- ------
_ DT ed- ----/_ .- :.•.-••--
- -
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DATEC! _ 7 hoard of Health
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
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