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HomeMy WebLinkAbout0020 TUCKER ROAD - Health 20 TUCKER ROAD HYANNIS A= 309 - 153 TOWN OF BARNSTABLE Y LOCATION VILLAGE ASSESSOR'S MAP & LOT 4 INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (Size) D NO. OF BEDROOMS_ OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COZIPLIANCE ISSUED: VARIANCE GRANTED No i i A 'b~l ' a� No.... ..250 Fss....................... THE COMMONWEALTH OF MASSACHUSETTS BOARD. HEALTH .W.. a..........OF........." �� .................... Applira#ion for Dispntial Works Tonstrnrtion ramit Application is hereby made for a Permit to Construct ( ) 'or Repair (> an Individual Sewage Disposal System at: 1 9, ... .o.. .. .......... 1--5-- ------•-••...................•-----•---•-------...... --------...•-•--•------............•----- !� • Lo ter s or Lot No. dress - a ...... 9 sQ ,... . Installer Address Type of Building Size Lot 3 C., .. .....Sq. feet Dwelling�"No. of Bedrooms..��..............:......................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) � Other fixtures . = ------------•-------------------•--------------------- --------••----------•-----------•-..------------------------- wDesign Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—,Liquid'capacity/ 00.kallons Length................ Width................ Diameter................ Depth................ xDisposal Trench—No...................... Widtth...---- Total Length_.__......1._._-..__ Total leaching area....................sq. ft. Seepage Pit No.__.. --------_------- Diameter....46............ Depth below inlet..6.............. Total leaching area..................sq. ft. z Other Distribution box,(/i) . ' Dosing tank ( ) p, aPercolation Test Results - ' Performed b ................................................. .•.. Dat Q_�.3 ` o Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -----=----- ----------------------------- ODescription of Soil.....---- - ----- - ---. :------------------------------------------------------------------------------------------------------- x U .......----•--•-•--••-••-------------------•-••-•-•----.-----•------------....----•-----.................-----•--•-----•------•------•-------••-•-----•----------•--•----•----------•----•-------------- w UNature of Re airs or Ale tions—Answer when applicable._. -•----------V- Ems`=---•.: ` la" Agreement: /� 2 /lucj�zs, - ©r— n`-TcoAj E_ The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'Mi 11, 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 y the boar o health. . --- ----------•----•-----.. &-31-S Application Approved BY--•-•• a 0-37a�,7 a . -----•---•---•.................................. Date Application Disapproved for the following reasons:................................................................................................................. -----------•---•----------------------------------•---------------------------•-------••----------...--...__....--------------••--•-----•--•---•---.................................................... �-7r Date PermitNo.................. -.-I..................... Issued.. .... ......... .... .................. Date d No. -- FEE. : ............. THE COMMONWEALTH OF MASSACHUSETTS ,,.�-- ---J OAR® OF HEALTH ApplirFa#ion for Dispog al Works Tomitrurtion Vanfit Application is hereby made for a Permit to Construct ( ) or Repair (X an Individual Sewage Disposal System at: ......... ..'..... — .... -r ...... --• ..........:..................•----•--•-----•---------------••-----•-•----•-----.......------------ '. Locati -Address or Lot No. r_'a �. f -- �........_... Address1 ., ... Installer � � Address d Type of Building Size Lot. %_ t_ _ __..Sq. feet U -, Dwelling—No. of Bedrooms---___........................._............Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures .........................................••......--•--•-----•-•-•--•----............................................................................ Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. Septic Tank—Liquid capacity/_l.'O_;gallons Length................ Width________________ Diameter---------------- Depth................ W Disposal Trench—No..................... Width_r.................... 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:��___-•___ -I-...._---�--�--. Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ rX, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W x Description of Soil-----_ _d.. `"yam n c --------•---•------------------------------------------------------------------------------------------- U •--•---••---------------••----••------•-••---•-•--...-----•--••-------------.._....-----•---•-----•--•----------------------•------ ------------• -•-------------------------------•---•--•-•-•-.......•-------------•-----.................................. ._..---•----- •• "-----------. =-------------- --- U Nature of Repairs or Alterations Answer when applicable ✓ io -"� _ __.. 1_._____._.l � .............." --�_.._y �� ` .. __._....__________. _______________________________________________________._...__.._.____.________.....__. Agreement: Y The undersigned agrees to install the aforedeseribed Individual Sewage Disposal System in accordance with the provisions of TITLE 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 y the board.of health. ...x 1 ..� .. ----•-•--- Date ,� Application Approved By...... 4 ( _:e% --•-----...---- - Date Application Disapproved for the following reasons:................................•-•----------------•-----••---.................................................. --------•-•-•--------••--•-•-----•--•--•--•___...-•----•-------•---•-------•-------•-•-------••---•------------------------•_.._-•------•--•--- ^•� �, Date Permit No. �..... 1----------•--•-------- Issued_.. ............................ --•--•------------ Date ;,,//a THE COMMONWEALTH OF MASSACHUSETTS tti�� ,; . �- ''' BOAR OF HEALTH � �.c:.................. VTOrrtifirab of ToutpliFana THIS' S�TO—E -'sTIFY; Th t the Individual Sewage Disposal System constructed ( ) or Repaired ) by-----------------------�------•-•• ....... ="-1G� Installer at.......... JC.............................................. \---•--••....• r •.-.-..-•--------•------•----•-•------------------••-----------------------•-------•----- has been installed in accordance with the provisions T TIE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.......cc*_").! ---- _ _ __. dated.... ______________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL F NC IIO��'•N�jSATISFACTORY. DATE...... _.. ..-�•• _-`.....--••........................... Inspect- - -� Zl THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ,. OF. ..................................................•----- ............. No.....................:: PEE........................ Dispoll 1 irk laa� ra irrat rraati# Permissionis hereby granted ----=-•-------•---•-•---•-------------------------------------------------------------•-----_....----------..._•••---•----•........ to Construct ( ) or Repair '('�'' ) an Indiv�ual Sewage Disposal System at No.._ %---------- ` C J a r 4 Street r _.. ` as shown on the application for Disposal Works Construction Permit No. `_�__-''Dated.__! ��................... -. / � � Board of Health DATE ------------------------`-----------•---•-•-.._.._.. FORM 1255 HOBBS & WARREN, INC., PUBLISHERS P%