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Home My WebLink About0862 MAIN STREET (HYANNIS) - Health F6c Ina 3 frfct 1 7-o ,"*71-7 i I �I W M E A D EPING YOU ORGA0P No. 10334 2-153L MADE IN USA GET ORGANIZED AT SMEAD.COM E5�oa //7- o7l LGO CATION ST'�, SEWAGE PERMIT NO. ll VILLAGE ig s r v I plc I N S T A LLER'S NAME & ADDRESS JOHN A. AN-TO BACKS :fir S,-R -CC West Barnstable, Mass. 02668 R U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED Y- 'V ems-. ® /, // ASSESSORS MAP NO: l 1:Z Pg� PARCEL NO.: n 77-� No... ! F� _............... THE COMMONWEALTH' OF MASSACHUSETTS BOARD OF HEALTH ..................................OF......................................................................................... Appliration for Mipaiittl Workii Tomitrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair `/) an Individual Sewage Disposal System at ................_. -...•--...... ..............._...._ Location-Address or Lot No. •------••--•-----............-- C�.Y�h....... ... . ......._.��_. STv f B ! �ai�......� ...�� Owner Address .c�.h.. :1.....o... Inst ller Address Type of Building C P_ Size Lot.................... .....Sq. feet V Dwelling—No. of Bedrooms.......................:........ Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers — Cafeteria Q' 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........................................ a a Test Pit No. I................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........................ DDescription of Soil----------- ` -"`----------------------------------------------------•------••-•---•--••---... -••.....----•--....................................... x U W VNature of Repairs Alterations—Answer en applicable........ .............. 0 Agi eement: IVVJ The undersigned undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with the provisions of TITA IE 5 of the State Sanitary Code The undersigned further agrees not to place the system in operation until a Certificate of Compliance has n ' sued b the oard of health. Signed•••. ............ S i g�6 --------- -------- ------------------- D A lication Approved B Q....... .._21_ I.. . ....... PP PP Y--•.......•.- D e Application Disapproved for the following r sons:.............................................................................................................. -•---•..:........................•--------------------------------------------------•----•-•--------------•••-------•-•-----•••-----••-••••••-----•-•--•-•••---••••-----•••--••-•.........••-•-...--•--- Date PermitNo......................................................... Issued-....................................................... Date ............................................................................................................................... C THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................................1.........OF....................... (9rdifirate of Tuutpliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal S stem constructed ( ) or Repaired (X) by-- •-----;-------_... - Q ---...-- } ........................................................ Installer Iat---....•••.................. � '-----------_ . been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as de cribed in the application for Disposal Works Construction Permit No........ ....... dated------- .�,Z 1... ___$�................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANT E THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ - Inspector.................................................................................... No.....�6_—:,f_ v'7-'7 Fas ��_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................:........................OF.......................................................................................... Appliration for Disposal Works Tonstrurtion Frrmit Application is hereby made for a Permit to Construct ( ) or Repair `�4 an Individual Sewage Disposal System at: OS T ................----•---_.......... •-----. _............... ...--••----------•-•----.._....._•---....... .............................-_-_-•.=- Loc tion-Addr s Q ` or Lot N. ............................. .,. c�. .�.....��. �.. ! .._ . ......._..t. _sTvr•6f Dt,,E...-•- R=----�'s �E,e�1f)Q .. Ower Address ------------------------------- - .� .n.....--, 1°► 1 a----------------- .........----------- Installer Address Type of Building 66wv1N Size Lot................ Sq. feet �. Dwelling—No. of Bedrooms.......................:....................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type e of Building .............. No, of ersons.................. .. Showers — G.I YP g .............. P ( ) Cafeteria ( ) Q' 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.................... .._. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9+ ................. ._. ......•---•...................•-••--•-------•-.......--.... 0 Description of Soil........... . V ------------ ------- ----- --------- ---------------------- --------------------- ---------------------------- ---------------------------- -------•----------•----------•-.--------•------ W U Nature of Repairs o Alterations—Answer en applicable..____.--= a� �?✓,,,,,,,-,,,•. b A eement: The undersigned agrees to install the aforedescribed 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 sued b the and of health at g Signed...: ..•. ..... -•-••••• • -•--• ........ .................... '3 Application Approved By................................ . '" --. D .._.... ._. D e Application Disapproved for the following r ons:....................................`....................................................................--- --•--------------------------•...••--•--•-•••-----......•----•-•--..........-----•----.....-••...._.................................................................................................. Date ro PermitNo...................................................---. Issued.................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF............... .................................................................... Trr#ifiratr of Tomplinurr THIS IS TO CERTIFY, That the Individual Sg�wage Disposal S-stem onnsstructed ( ) or Repaired ( ) h fi. by ..................... U....vl................. ...... - ................................ ... ._ Installer �- at............................... .....---==fi-'............ c 't (ZJ I �'- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code de ribed in the application for Disposal Works Construction Permit No---------- Q...... dated.._..._ . ... __ 4............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANT E THAT THE�;, SYSTEM WILL FUNCTION SATISFACTORY. DATE................•-•-•-•---..............----------..............--••--........._ . Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS 4r0t'%g1V%j(VV1 j BOARD OF HEALTH LL t�rc,ll4j0S 1114-+ ane�fi E.�.. ...........................................OF.................................................................`�h-t........ ace No.... .. •----• A f fi ova i . Fn....:.............. Disposal Works ottstgwlloln Vrrmif f-1 h L ��►N 4'F Permissioq:is hereby granted.............................. to Construct ( y ) or Repair (�4) an Individual Sewage Disposal System ' " 4� 5` at No...:................ h� O . :.... ?ill►1. - - Street as shown on the application for Disposal Works Construction Permit No.g4--no.. Dad .::.s �?'.. �j.................. r ; _ ----------------- ------------- . DATE.............. 2 _].`. ..!......................................... Boar of Health FORM 1255 A. M.-StKIN, INC., BOSTON, r �` E � a S 1 I � � t 1( '`".:, s ;;•h i �t6{ erg.• I + t ex 5 JvG i v�JaS1-r - Rin_ i R OL c t' • i rL*E ' C_V\CRM Pi�-TcH t t t ,1 t s i W N ' I --ffair -- ' , �O � 1 1 AiL REN0VCL� w .e gw 'Fat �` OF g\ j . _CCU e I . e ck t P' I __ .: _ .. ._., - I r l:.. - . . 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