HomeMy WebLinkAbout0352 MAIN STREET (HYANNIS) - Health 3sa main .
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TOWN OF BARNSTABLE
LOCATION SEWAGE # 2—
VILLAGE ( ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO. 114 ,4 C
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER 1 f
DATE PERMIT ISSUED:
DATE . COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No f/'
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ASSESSORS MAP NO:
PARCEL N0:
No.. �:.�.�. Fms....7.,.,., 7-..-
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
------- -------- -- -------------------OF..................................................................................
Appliration for Uiiipas al Vurkii Toustrurtion Vamit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
�
.- ..... r---------- ..................... ----------------------- ----------------------------------------•------
Location Address or Lot No.
...................(�l - .}........ .......---------.....------------.._ .......------......------------.._.....
r' l�wt0�r,.�er,,�Vy Address
a ----•............... --•---"''".a"c�"-""`----"`_•--F---_..........•................ ......--•--•---•----••----•-........-•-.----•-.................•..------..................---•----
Installer Address
Q Type of Building Size Lot............................Sq. feet
V Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Q' Other fixtures ------------------------------- - -
W Design Flow............................................gallons per person per day. Total daily flow............._...............................gallons.
1:4 Septic Tank—Liquid capacity............gallons Length---------------- Width---------------- Diameter---------------- Depth................
Disposal Trench—f\To_ __________________ 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 ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water.........................
r3, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P+ ...................•...............................................................
•----------------
--------------------------------------
•------------------
0 Description of Soil........................................................................................................................................................................
x
W
U Nature of Repairs or Alterations—Answer when applicable----------/Qd_Q__a4---_ c e.._. �rt*�__-__-•----••---•--_-.
• Agreement:
s The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iiTi 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 board of health.
Signed...................................................................................... ................................
Date
Application Approved By---••.......... -------•--------------------------------
v Date
Application Disapproved for the following reasons:..............................................................................................................
--.......-•---------•....................••--•--....---------....•--------------•••-•----
G _ Date
PermitNo.-- ..................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............... ..........-......O F...........................................................................................
Appliratinn for Bi-4posa1 Works Tonstrnrtiun rrntit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
................... 5 fi
(/S Location-Address J - or Lot No. -
.................'e ' ---_...---- - '-•-- -•-----'+.�r_e.._. :�ft9 ..._......_..........._._......................_......_._.._..........._._.__......_.......--^---
wner Address
a ... •+-.......• ............................ ......•-••--------------•-----•-•--•---------......_...._..._...-----•••••-•••-•-••---......----•-
444/// Installer Address
UType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms.............................................Expansion Attic ( ) Garbage Grinder ( )
`-4 Other—T e of Building No. of persons____________________________ Showers — Cafeteria
aI Other fixtures __________________________________
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
1:4 Septic Tank—Liquid capacity------------gallons Length................. Width................ Diameter................ Depth................
Disposal Trench—No_____________________ Width.................... Total Length----_............... Total-leaching area....................sq. ft.
3 Seepage Pit No----------_--------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. It.
Z Other Distribution box ( ) Dosing.tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
a
a Test Pit No. 1________________minutes per inch Depth of Test. Pit............_....... Depth to ground water........................
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a •••••-••-•••----------------•••••-•-••••-••••••••--••••---________--------._......----•-----•--•--'-.....
-----------------------•----------------------_--
0 Description of Soil......................................................................................................................................................••-••--------•-•-
x .
W
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
U Nature of Repairs or Alterations—Answer when applicable-_______p.'2 A__.e . ----- 3`---- _______________________
-••-----•-------------•------•••-••••••---••----•---•-••••••••••••••••••••-•---••-•••-••--------•---••-•---.....••-•••--------•-----••••---•-•-•••••••-------•••-••-•--•--•-•------•-•-•-•-----•----•••-
Agreement:
The:undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
TT•^lY
the-provisions of 11".._;^. 51 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.
Signed...................................................................................... ••-•••••••--••••••-•-••-•--
Application Approved By--••-•-••••• "�-- ' --------------------------- ---•-•-•-••••••••. Date••••••-•---
� ��^"q ....--- Date
Application Disapproved for the following reasons:-----•-••••••-••••••••--•••••-•••••-••-•-•-••••••-••--••---•••--••••••••••••••••'----••••-••••-•••••-•••-•-_..._
-----------------••---------••------•--------------•-----•--•-------------•---•-••---•-----._....•----....__....._....••..-------___-----•-•••--•••••••••-••:•••-•••••-•-•------••---•-•••-••---...--•---
Dat
Permit No..: e
...._.._.� a --_.... Issued---------------------------•--.._........._._.
_
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.......... ..........OF.......h', �c G.? ..........................................
Turrfif iratr of ToutpliFanrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (�,e)
by-------------------- � :--------�j-. --------------'-------------•----------------.................--------....----'-•----------------.......------------•----
I Installer
has been installed in accordance with the provisions of T i T E j of The State Sanitary Code as described in the
�`application for Disposal Works Construction Permit No.... _�_t:_ .:S:7S ._________ dated_..--------_....................................
_
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT HE
SYSTEM WILL FUNCTION SATISFACTORY. Q
DATE-------------------S--•-=`••--.1.0--- ................... Inspector......
......� ....................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........OF........
�
.. _. FEE..,,e..
Disposal Work
�onotrnrti.orn unfit
Permission is hereby granted__...-----.r -•--I---------; ,*r. ''
to Construct ( ) or Repair (K) an•individual Sewage Disposal System
atNo.___. `"=1 .-••--•.....•.. _ l ___________________________________________________________________________________
Street
as shown on the application for Disposal Works Construction Permit Dated..........................................
••...............................•-•-----------------•._--•----•---•-------•••••••••_______.__----••••-
Board of Health
DATE................................................................................
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS