The URL can be used to link to this page

Home My WebLink About0069 WASHINGTON AVENUE - Health (2) 69 Washington Avenue Hyannis A - 287 a ASSESSORS rva 11u; � PARCEL NO: P Fims.......ao........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH iota-1----------------OF....�J�ta"►� ....................................................... Aplifir.ation for Uispviia1 Workii Tomtrnrtivit Vamit Application is hereby made for a Permit to Construct ( ) or Repair (4) an Individual Sewage Disposal n System at: ... Mar- .�?4a!?.!!!�n.�.�jp4> _.Nue�,...�ns :-.........• ............................................................... ovation-A ddress vv r Lot No. //�� ,1 7�0 / �At�� o;!AJ cr a ..._ l:Qr110r-----� ��.i.:Fly.Q.IX!�9.�!!� .. �... -- �{ �_ gv._ Owner ddress w A Cry: ... ----------------- Sa=f ir►.. l�:f_ ru- ...------------ --. Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms...................................._-------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons..................._'-------- Showers ( ) — Cafeteria ( ) GL Other fixtures -------------------------------- w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ 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 Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ G14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water____-_-___•--__---______ 9 --------•-----------•-----------•---•••.....-•••------------------•-•----•-----------------•--------......................................................... 0 Description of Soil......................................................................................................................................................................... w ----------- U Nature of Repairs or Alterations—Answer when applicable_ lQ...►.�?_. G.G!GsQ._...d..= �Fi.�.-ih,..sttA -----------------------------------------------------------------------------------•--•-•------•-------••----•------------......------------------------------------------------------------------...---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TILE-, 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/by� the board of h lth..-•-------••------------- ----- /0 7......---Signed Date Application Approved By------ ...` ',,.",'"", ........................................ Date Application Disapproved for the following reasons--------------------------------•-----------------------•----------------------------------.•--•------•-----•-. -•------------------------------------•---------------•------------------....--------------•----------•------------------•----•-•-••-•-----•-•----.................................................... Date Permit No......6 k:.......................... Issued--•------•---•------------ -------•------- Date Flcs.... '............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................................................•-•- Appliratiun for Disposal Works Toustratrtiun nutit Application is hereby made for a Permit to Construct ( ) or Repair (J ) an Individual Sewage Disposal System at: -4 (ar ---J--n?�af� S ..TUr*�it,� ..1...rkf�.4.................................................................................................. +Location-?address( or Lot 1 o., t_-GYriOr IvS irlG� r�, sr i...... +iri UE' f�tf�i3(AISfJlf +� n P Owrer Address / 1 t/+ W,• k 1 A y1re') _�Sa dO1.-t 'S ��• jtte-S 49rxe&eft -••-----------------------------------•-••------•------•-.....-•-..••••-••••.....••-•--•••. •-----...............---•..:::-. •• •---_. ..----/---- ._ ........•--••....•... Installer tAddress 4I } Type of Building Size Lot............................Sq. feet t-1 Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria (. ) Otherfixtures ................................................-•-----•----------------••-•-------=----------------•----------•--•-------......................_... W DesikR Flow.................................:..........gallons per person per day. Total daily flow............................................gallons. � Septic Tank—Liquid capacity ------------gallons Length................ Width................ Diameter__-__-_.._____ Depth................ Disposal Trench—NTo. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage tit 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. I................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........................ Pi 0 Description of Soil........................................................................................................................................................................ w UNature of Repairs or Alterations—Answer when applicable 1)e__.tY?_._a r,rre G a ^4 ..e i1 I sTt n c r,*�to , V e i" 1 -------------------------------------------•-------------------._...-----------------•--•-•-........------------•-------•-----------•----------------------------------------------------•----...._..... Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'IT"LE, 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 by the board of health. Signed--•- f ''�P� . ......................... Application Approved B Date Date Application Disapproved for the following reasons:--------------------------------•-----------................................................................ -••-•-----•----------------------•-•------•-----....----------------------...---------•--......---------•---•-----------------•-------------------•--•-•-•---•-------••••----------------------•-------- Date PermitNo.---•.6-2••_-2.k...................•--•-. Issued-....................................................... Date j THE COMMONWEALTH OF MASSACHUSETTS it BOARD OF HEALTH . 71,1� OF...Ta:;r.r /1.4�iG� IC? ... ....... .. T-pr ifiratr of ToutpliFatt THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired •(•K ). bY.....................A.,---1--......C.= ......................................................................................--............................................ Installer has been installed in accordance with the provisions of T TT E 5 of The State Sanitary'Code as described in the application for Disposal Works Construction Permit THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. .DATE.......................—.._:-L.J s� Inspector__..: r,-� ---- ............................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �i `"�r?!....!.........................OF...6f,Fn . c. ..� FEE..-'-.`............... Disposal Works Tunutrurtiott vrrmit Permission is hereby granted........A.,a----- ._ to Construct ( ) or Repair ( ) an Individual SewageSewage Disposal System Street as shown on the application for Disposal Works Construction Permit NoV:!�XZR�_.. Dated.......................................... ---------------•----------------------------------------- Board of Health , DATE.....------------------•---------•-•------------•--••-.... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS v "' ••. J