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Home My WebLink About0158 THIRD AVENUE (HYANNIS) - Health (2) 158' ��i rd i'�V�t�� n;S �' No::' •: --... ..................` THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA1 TH c!- 1r ............O F...j .. .... Appliratiun for Dispaii al Works Tonstrurtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ®�/ Lo ss or Lot No. • . ��-.�... ..... .. ....... ........................................... ..........••...............................-...............................................--..... ner Address Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms-_........ _________________________Expansion Attic ( ) Garbage Grinder ( ) Other—T a ype of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtu �- '---------------------------------------------------------------------------------------------------------•-------------•---------------••---•-------- 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......................................... 1 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Lrq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -----------------------------------------------------------------•---------.....••-••------..._............................................................. 0 Description of Soil........................................................................................................................................................................ x U ----•----•----------------------------•••••--------••-•--------.........----------...----•-------•--•----••-----------------------------•---------------•---------------•---------.......------•---••--- UNature'of Repairs or It tions—Answer when applicable---. X.J=-- OPl ° -=-- -----•---••-----------------------------------------------------------------•---------------------------------------...._.._.._--_--- Agreement: 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 beodNssued by the board of h/ "I 2— 6 � e h. - 4 .�. Signed._.- = �------�--•`-'-� . `. .. 7... F Date Application Approved By........ •-�C---------------•-----•••••••---------......_........_..••••-•••-••--•-----•- -----------�.�--7 7 Date Application Disapproved for t e following reasons:.............................................................................................................. -••----------------------------•-•-•----..._..._...----------...-•-•------------•--------------------------------------------------------•-----__------------------------------------------------------ Date PermitNo �-�................................._ Issued................................................-....... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH !�/iisr- /.�9-17 ol�csT/�fy[eo ............. ...........................OF................... ........................_...._............................_... I Tnr#ifirto of Tuntplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.................. ... 1 .._.� js.--••-_.. oQ.Q....A ............-----------•-----•---........................... .:........ .................................................�1 — Installer '�// at ....... J ------. -•--...--- `s fA 1--')`'t /S �'d / -- - ----•--------------•--••--•------------••-.....------------ has been installed in accordance with the provisions of TIT EE 5 of The State Sanitary Code as described in the ,application_for Disposal Works Construction Permit No.......... _ __________________ dated---------- _ .-__.?_- ...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector-•-•• _-..-.•----------•-•..._•---.....•------- No..:3..•�... ..... FEs.............................. THE COMMONWEALTH OF MASSACHUSETTS ' BOARD OF HE TH �'�''�"''�............O F... °'` q......... Applira#ioU for Disposal Works Tons rnrtion "anti# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal S yst a '-- Lo r ss or Lot No. . .+ ...... ............ ............ ................................ .......---------------.........----------• ----•--------•---•---.....................---- ` ner Address Installer u °. Address dType of Building Sie;,.Lot............................Sq. feet U >, Dwelling—No. of Bedrooms..._..... .........................Expansion Attic ( ) Garbage Grinder ( ) Other—Type e of Building No. of ersons.___._.__.r_._.: Showers — Cafeteria t� yP g -------------- P ( ) ( ) a Other flues' t . d ------------------------------ 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. .................. a Width.... ...._ .... Total Length___...::. _. Total . leaching*area.,... ..........sq. ft. Seepage Pit No_____________________ Diameter` Depth below inlet._._.._. Total leaching area.... .... sgaft. 5 z Other Distribution box '-' Percolation Test Results Performed by.................. .. .................. Date......................." Test Pit No. I................minutes per inch ,Depth of-Test Pit _._._._.__.______ Depth t`-ground water.._.....:... + .__. Test Pit No. 2................minutes per inch.,-.,Depth of Testi:P t_............._._... Depth to ground water........................ 7 --•-•---------------------•---•----------------------------------------- O Description of Soil.. •`=`•_..................................... UW ------ _...... .._.. ....ty 1 .... ..._. ..... .................... .--------------------------- ----•---. --_------------- . ----------------•------------- ............................................................ ................................... �__ -- .U Nat f Repairs or It tions—Answer when applicable__. .._. , � ...........tMA Agreement: f/ The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL% 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has issued- y the boa d of h h A « r� � , Signed- --•--''�?------- - - ---- ---•--... . �:..__� ._.._..... .......... --•-- ------------•�•- s"`'2.,, Date Application Approved By..... "j" _` . " 7.7._ . Date Application Disapproved for the following reasons-------------••--•-----•-------•------------•-•-••-----•---••• -------- •---------------•- �:. . , z� Date a; Permit No. .. Issued Date x 1`E'..COMMONWEALTH OF MASSACHUSETTS, `4` a BOARD OF HEALTH 7 4.tA1t1jL4 .................. OF..................... .. ............... .................................f.y...... (Pntfratr of TomptiFnrr +}q 4 constructed K r » THIS IS TO CERTIFY That the Individual Sewage Disposal Systemconst cted ( ) o Repaired by----------- --- �+ t *.._C G - ,&10 -` ' ------------•--------- Instal ler at............................................... 0 t J s^ d'a'f spt�/.f d � ' ------------ . has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in theme' ��k� hY application for Disposal WoXks oi�istruction Permit N� fi,._� "` k ,._________________ dated ___ _ __. __ ..... ' � r . THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION, SATISFACTORY. � k K b F DATE..... , y r-•- >. Inspector }}, .�a'cw...a...-tp_�. anvAk THE COMMONWEALTH OF MASSACHUSETTS BOARD OF It= 1LTH. �" _..._r... w ..- No ......................................OF. .......................... .. ..../._......... ,y� FEE............. Disposal orkii Tnnstrnrt' i`e rer�i� /�,,; ' Permission is hereby granted............ �t'-'�� ---•• ----------5----- ............................................-....................... to!Constr t (x ) or Repair ( ) an Individual S jwage isposal SystemL� y.. h W E d at No......f' C t---r�......_./t �!''r�c� �'�d.�__`..._ ..........................................1 - " to"fig; 7"? 7 Street as shown on the application for'Disposal Works Constructi6 Pe �itN Dated.. ................ .rr x� th rvs. { q' j -1 1- -- --------------- DATE ------•----.......................................... ' r FORM 1255 HOBBS &;WARREN, INC.. PUBLISHERS'�', • ,��,'.r �`'� r "•rt,--- .:4',i'' i.�.