Loading...
HomeMy WebLinkAbout0017 SIXTH AVENUE (HYANNIS) - Health (2) &enm 14� ASSESSORS MAP NO: 02 r `` PARCEL NO: l_ No...l `zjl ._ - Fizz.... !...00._ �• THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE � App iration for Uwvaaai lVorkriCann r r iun rani I Application is hereby made for a Permit to Construct ( ) or Repair (/,-)-<Individual. Sewage Disposal System at: 17 ... :....... =. .....- ........ •...................... ...-----------.. .. ............................................................... ocation-Address or Lot No. - -...................................... --•--•-- ... O ner Add ess Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms........-3------------------------------Expansion Attic Garbage Grinder ( ) '4 Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures --------------------------------• - W Design Flow.... .............................gallons per person per day. Total daily flow............ .0_.......................gallons. 1:4 Septic Tank—Liquid capacity.J&06.gallons Length................ Width................ Diameter................ Depth................ W Disposal Trench—No..................... Width................ Total Length......��...... Total leaching area....................sq. ft. x !J Seepage Pit No.-..---j....._..... Diameter.----1 .e...-- Depth below inlet...... ............ Total leaching area�le..q j��sq. ft. Z Other Distribution box ( ) Dosing tank ( ) PercolationTest 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........................ � - -- 10 Description of Soil.... _ . _ 14_.__ _.....__-____ ___ _____ x W UNature of Re airs or Alterations—Answer when applicable.....��— -------a la.-_1 ' 1---------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been niissued �by the boar4 of health. / Signed ----------------------------- -�---­- ' . ..... ....../ 1 f Application Approved BY C ' V -t, ,ems, ---- ------------ ................................................ ------------ -------------- ------------ ------` A?..... . Dace Application Disapproved for the following reafonf- -------------------- --------------------------------------- --------------------------------- --------------------------------- .........................................--------------------------------------------------------------------------------------------------------------------------------- -----.......................... ....-................................... q / Dare PermitNo. ..........f. ---e� ----------_--- -------- Issued -------------------------------------------------------------------- Dace No.... FES ��8.l.. .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 97-- ` TOWN OF BARNSTABLE �ell Appliratiou for �t n 1 ,ark C��at r r ' n- Trutit Application is hereby made for a Permit to Construct ( ) or Repair (Individual Sewage Disposal System a,Lt�17 r•- .................... .............. / �} Location-Address or Lot No. ......----•............................. ...........`... .`�. - ..................................... r �O n� •- Add�ess '?'?.._._.. ..... •••. ...Installer �? r��Q............. dre"s'...._�._.................................. � � Installer Address d Type of Building Size Lot..........}................Sq. feet U Dwelling—No. of Bedrooms........__.............................Expansion Attic F---� Garbage Grinder ( ) Other—T e of Buildin rsnns �laowers- — Cafeteria C4 YP g ----•---•------------------- o--Qf-Fe ) ( ) 0.1 Other fixtures--_..'. _ .----- W Design Flow----- ............................gallons pe person per day. Total daily flow.........._ 3a......_................gallons. � Septic Tank—Liquid capacity__ _. _gallo ngth------.._---- Width---------------- Diameter__.__-_-____-_- Depth................ Disposal Trench—No................. . > _� ...... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.......I........... Diameter.....!?_._..... Depth below inlet.....---....... Total leaching area.,94.q_!�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------------------------- Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -------- ------------ - .................................................................................................................... O Description of Soil-----;r -�f=���_ -x W x -------•----•----• -------------•---- -----------------------•-•----------....--•--------•-----•-•-- ••------------------------- ---------------------o-------------------------------------•------- U Nature of Repairs or Alteratiions—Answer when applicable.....VI.4.112,4.r C........ .................................. ------------------ _0 .!t. rC .................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental 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 -- " V _ _.`..'__` f /�� - ' --- Application Approved By ---------------- . . 2.� � ..... -------- ----- '1 Application Disapproved for the following reasons- .........................................................----------------------------------------------------- ---- ---- --- --- ....................................................--------------------------------- ------------------ -------------------------------- ---------------- ---------- ------------------- ---------------------------------------- qDate PermitNo. ............ f ............................ Issued ----------------------...---........--------- ------- ........ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Gelr#tftett#e of Torapttanre THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired (max) by------------------------M...c_e-,l��........ ------------------------------------------------------------------------------------------------------------------------------------------------------------- / Installer at --------------J ----------I-• '- --------........... ` -%�*r R. ' has been installed in accordance with the provisions�6 TITLE 5 o The State Environmental Code as described in the application for Disposal Works Construction Permit No. ......... .-/.�.-- C-------------- dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE------% L /.p. r �1 Inspectr' ... / ........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH q� TOWN OF BARNSTABLE .......0.... FEE. __............. Otaposat Works Togotrurtion famit Permission is hereby granted...........1.2......: .._., _.......1��1............ -� . to Construct ( ) or Repair ( ) an Individual Sewage Disposal System (/ atNo.............•--•••-•---•----•------••----...------------........-----...-•------•------...-•--.-------•--•-•-----------------------•-•--•-••-•--- ............................................ Street > as shown on the'application for Disposal Works Construction Permit No._-/`1�-_\Dated.......................................... -•----•-•-------------------------•-- )�---------••------------•••-----•----•--------- - / r ll _ oard of Health DATE................/... ... ............................... ` � FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS \� 1 , - - \ - .�. ;y ram. '� �/�//Z� ��--- �� � � '�� `, �� o © a