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Home My WebLink About0065 FOURTH AVENUE (HYANNIS) - Health � �� fur • P � 7r 0 0 o n c v e ° e O 0 0 v o ° v o � v L17ar-, T ION � bEUW�A G E PERMIT ND. VIILLLAGE ?` INSTA LLER'S NAME i ADDRESS T p? 122l'irn/ -,Y 0UItDER OR OWNER DATE PERMIT ISSUED , -� DATE COMPLIANCE ISSUED ' o ' 0 U } p J TOWN OF BARNSTABLE LOCATION . ' /Yv � SEWAGE # �170 VILLAGE i.y� ASSESSOR'S MAP LO INSTALLER'S NAME 6z PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO. OF BEDROOMS' PRIVATE WELL OR UBL_C WATER BUILDER OR OWNER �" ''rrryr^ yy C DATE PERMIT ISSUED: W�_� 1XV-7,iPA1jsXoA"I, A? 55` DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes , No I2f1/) SbAdT—0 iu o�uc2 n -� �. � . � , ' ' � i �� Qom_ m� '' � � ,1v y Y. I /�� ♦ 1 k '� J No........................ Fi s('3.�..4-90...... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ................PW*09........OF... .Y] , ------_--_----------_----- Appliration for Disp gal Works Tonstrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (M an Individual Sewage Disposal System at: . �_.. ��r .. -------------------------------------------- do -Address or Lot No. O ner ddres..s ................... Installer Address- Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( ) 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. 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......................... f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ .......... ----- •; ....••••...----. 0 Description of Soil lr-_•�-11 . .�{ Q L1 J--------------------------•---------------------- ----...... .--------- ------------------. x V ••-••••-------••-••--------•-••••--••••--•-•-•--•••-•••-••-•----••-•-••••••-••••••••..............................••--•-••-•••••••••••••••••=.......................................................... ------------------------------------------------------------------------------------------------------------------------------------------•••......•.-- •------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable_.... 7,1 _911Q �,1... ................... ...-------•----------------•--•----------••----•--------------------------•---------...........-•-•-----------•------------------------------------------------------------------------................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of L ITI L 5 of the State Sanitary Coie—The undersigned further'agrees not to place the system in operation until a Certificate of Compliance has be n i sued by the bard Wlth. --•-•• °_G 9 Signed_._.. _.. .a.-c�-•a -------:_ ...----•------•----- -•----�--�_.---f--- Date ApplicationApproved By---•--•---•••--•--•-••••••••••••-•-•--•••...••-•-•-•••••••-••-•--•----••-•.............•-••••--- Date Application Disapproved for the following reasons-----------......................I.---------------------------................................................... ..•••-••-•-•-.......-••••---•---••••••-••••••--•-•--•-•••••••--•••-•••-•-•••-•••---•.......•----•..............•----•--••--•• •••••-••-•-••-•----•-•-••••••••-••--••-•-•-•••••-••-•---••--•............. Date PermitNo......................................................... Issued_.1 ..-� ..._......... Date r < OF- No........................ FzeB�:..J ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF r HEALTH 2.)EALJTH 07U) .......OF... �-� ?l..0.. 0 , f ................................ Appliratiun for DiipuuFal Workii ToniArnrtiun Permit Application is hereby made for a Permit to Construct ( ) or Repair (Y.) an Individual Sewage Disposal System at: ----------------•---------------------------•-------............................................ too Address .. or Lot o W P� Otivne� `� ddress Installer Address U 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 QI 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. I................minutes per inch Depth of Test Pit.................... Depth to ground water......................... (T4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --- O Description of Soil - .. J W -••-•-•--•---•....-•-----------•---•-•-•-----•••-•------------••••------•-------------•------------------•-•-••---•--••-----•---------•-- ---- UNature of Repairs or Alterations—Answer when applicable....../_.11�.e�.,.6)...._. :. _/./`��... -P.1 ................... --------------- ••-•---•---•-••-----•------••-••-------•----•----•-•------•-•--•-••-•--••-......•---------------------------------------••--••---•--••-------•-•-••--•---••--•--------------•--••---•...............-••- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI u 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 bo :d o lth. Signed-------- ..... -----• 4ti ............x �f " ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons:.............................................................................................................. ................•---------...--------................--------...-•-------••--------------•-•----•---.....••-•-•-----•-------•-----•-------------------•-----•-----••-•-----••---•-•-----••------•------- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH JAP44��...........OF..... ........................... Tler#if iratr of Tom plianre T S 0 CERTIFY, That the n''Lvidual S z e Disposal System constructed ( ) or Repaired �) --�.SS �jj by..... ,... Installer has been installed in accordance with the provisions of T eTlLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..L/.........__,.2.f........ dated d:tted................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......u-.. ... ..... �T..........................• Inspector �' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HALT •c�.�.-.�f.. «� ................. n..OF....&*'Pjtj24_c!. Q° ............................ �— go......................... FE ✓.._ ....... Diupow-al ,,yy�rku �onu rnr#io rrmil Permission is herebyranted.j_ ��l � � fj........�.11 " ...................................... g ,/�"� to Cons uct ( ) Repair., Y) a ndividual S w ge D's osal System at Na . ..�.._..�U ......if ...., `w ..�_/_1..L al ......................................................•-••-••- ll�s as shown on the application for Disposal Works Constructions-Permit No ................. Da�e�d ......_......_........ j^ - — C ✓� `"�" •-•�/-•--L-,:.- Boa-- %'a ------------ --••----------•------------ _ c�,e?� �Iti e J DATE. ..S__..... Z.................................................. / FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS