HomeMy WebLinkAbout0168 MELBOURNE ROAD - Health 168 MELBOURNE ROAD
Hyannis
A= 267- 157
- t
TOWN OF BARNST ABLE
LOCATION lbY ,0c l ,wc, 1111 SEWAGE i#
VILLAGE ASSESSOR'S MAP Cz LOT
INSTALLER'S NAME & PHONE NO. (S Cam_-o -77 6,�6q
SEPTIC TANK CAPACITY /(� c-�,
LEACHING FACILITY:(t i pe) 2,)4 (size) /4iz!:)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER� iC•c .
BUILDER OR OWNER Fr—.d 64g�rJ -
DATE PERMIT ISSUED: 7
DATE COUPLIANCE ISSUED:
VARIANCE GRANTED: Yes No �/�
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No..r -•2.- ----------- Hyannis, Massachusetts 02601 Fxs.....�
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF l-iEALTH
4C?.ltm.................OF...?9i.�F�s 0L.......--------------------•-----.._....----------------
ApplirFation for Uispvii al lVorks Tomilrnrtion Vamit
Application is hereby made for a Permit to Construct ( ) or Repair (*) an Individual Sewage Disposal
System at:
.�68 11'I�I ttal�ttte .. .._ n «------------------------------
Location• ddress or t No.
Owne n,I Address 'I
W — ��" ovr,pr� Sa �( rn...s.. s�: ir. '!ote.`ti�.r
,1 ---..... r
Installer Address
dType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type 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---_------------------------••--•---
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_-_-_----_---_-.......
Test Pit No. 2................minutes per inch Depth of Test Pit-_--_____••-___--- Depth to ground water-._____----____. -...._
..........................................................>......------•---•-------------------------------------------•-----...-•----•.
ODescription of Soil.........................................................................................................................................................................
x
U
W ---------------------------------------------------------------------------------------------------------- ---------------- ------------------ - - ---- ------------------n-----
U Nature of Re airs or Alterations—Answer when applicable_____�»10�_xito_�nSr__.I_W..?J �C ?_�)t _tt-� s,
lx�_�_71uw_� n i- clip c�-----------•---------------------------------------------------------------
Agreement: U
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TA!t!L- 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 jb the board of health.
Dalw _
Application Approved B ...............................Z
-----------------•- ......................... ---------.i----fit......
Date
Application Disapproved for the following reasons:..............................................................................................................
•-----•-------------•-•-•--------•-•--•-----••--------•---•-----------•--------•••-..........•----------.._.....•-••-•-------•--------•-•------------•-••---•------•-------• ............................
Date
Permit No.............. Issued...............................
Date
FEic
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
....... ......... .................OF.... ....................................................
�.>.,.
Appliration for Digpuiittl Warks Towitrurtion Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair (*) an Individual Sewage Disposal
System at:
r
If,o 1! _Ik"',
.............—....................................................... ------•-- -----•--------.....--------".............---•------------------------------...-•""----------"-----
Location-Address - or Lot No.
..................... ,::..- .............."---..."••-......---"---••--_----- ..................................
_ _ Address
WW `�-i� `.. c���cx c:�.r n� ........... .. ................_.....`.E� .. {._... ."r`- . .........--------•---....
... .. ...
Installer Address
Type of Building - Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
pa,, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Pa 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........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
(14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
Ix ..................••-------"------"•-----•"-"-"-....----•"•••-••""""-"....-••-•"•-•"......_..................................................................
ODescription of Soil.......................................................................................................................................------.............•-•-"•"•"•-•-
U --------"-"-----""------------------------------•---••----------------"--"-"---•---•-----._...•--------------•-----"""----"-----"----------"-----"----------...........................................
W
UNature of Repairs or Alterations-1 Answer when applicable__��f._::.:�._. _-4'::r_`_!��.'�.f___._� _'f-_::-_'...:.�___ �.�
i
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
T�'14•�
the provisions of 'I'1 T: ,.�• 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has�een_issued by the board of health. ��
Signed.._:_ _
. . 7.` k ._._ .Application Approved By"•"-"-"--- — ... D
' Date
Application Disapproved for the following reasons:...................................................... •---..........................
-----•-"--------""--"---"•""-----------"--------------------------------•---"--"-•----.......--"----"-"--.•-••-•----•-"-••-•---•--••------_..__ ...---••--•"-----""----":.-•••""----------••••"•---"----
Date
Permit No --•--- - ---------- Issued--f..........
Date
�r
;1 THE COMMONWEALTH OF MASSACHUSETTS
i` BOARD OF HEALTH
!................................OF _}7 .......:..!....t ...........................
...........................
(Intifirtttie of (to nt�liattrr
THIS ISrTO-CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (V-,)
by-------•-------•--• t�I� ..:I•-----�-"3 n�!� -_ ------ -- "---•---..... ..--•-"-•---------•---•---....--"..................................."----------"--
•--
.- � r { Insta ler
L� �vJ!rpm 1 4.Xi `a
has been installed in accordance with the provisions of TITLE 5 of jThe jtate Sanitary Code as described i the
1 I i,`--- �s�'1
application for Disposal Works Construction Permit No........... ..:...........::........... dated_...._.__.7__-:._
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS,A GUARANTEE THAT THE
SYSTEM WILL FUNCTION S,"FACTORY. -
DATE............:.........2.. ....:.° ........................................ Inspector........................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�, :....................... �...--- ..... r.• ...............................................r. ....... \,}
No.•--•.................... FEE........................
Permission is hereby granted...............��-LDr,- ,-•--------------------------------------------------------
---................
---------
to Constru t.( ) or a rp�( ) ap,4pdividualSee`aDisoxsetn5
at No. 1 Vim" J� ,�,
•-"-•.....--•••--"--"-•"••- •----"--"--""•--•--"---•••-•---------------•.......-"-- •"••--... -- ! 1
Street �� `, t 7'1
as shown on the application for Disposal Works Construction Permit No.-' :_'_:-:r:"-d ----ated __•--.-__-------------
---•-•--""••"-"-"--•---...-•----•"-"-----f r,------""----"---•----......•••-"•-•-"•--•••-••-""--••-••""......
- 2 �� c}� .,Board of Health.
DATE--------------------....•.
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
1