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Home My WebLink About0122 FIRST AVENUE (HYANNIS) - Health (2) 2�2- Ave IVe ® www.myuniversalop.com phone: 1-866-756-4676 UNV12305 MADE IN CHINA F � c M No...�1' 7........ �� Ft T — o? F>cx... _... .::...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �® ......... / [,✓..7 I-..........OF...........-.l ............................. Appliration for Bifi anal Works Cons rurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( 44ran Individual Sewage Disposal Systemat. �. .... ----------------------------•-• ----•--- •... -------------••-••-••-------•-------. ------.-- --..... ..........)............. Location-Address /`o�r.,,Lot Npr Owner Addre W .. . ... ? . ate. _�. a+ ...._ . ----- Installer Address Q Type of Building Size Lot......................Sq. feet Dwelling 1 No. of Bedrooms.......................... .Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Pa 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........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (�-4 Test Pit No. 2................minutes per inch Depth of Test P,it_. ...._.____.__.f'Depth to ground water........................ Q+' .................................................... t 1 Description of Soil..................�1" •---s •-29--rua,-2--.... . ..v V •--••-......••---•--••....................•---•--•--•-••-•••-•••-•......•...........-•••-•-- --®' `r ............... --.......................................................-•----------- 9 ----------- '----------- _------------- _ V Nature of Repairs or Alterations—Answer when applicable----------------- A�✓ __ .._1 - ,f�, ----------------------------------------------------------------•---•-----------------......------•-•--........--------------------------------------......................... �l Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been 'ssued by the board of health ,s Signed....... lZ � ✓;ri° ........... ._. .... .........' --•j----- • ........... .. __••.�_- Apphcation Approved By... �-, _...�----_ (j = /. -�f Daa Application Disapproved for the following reasons:•`..........................................--••••-••-•--••�•�••••---•-•-•......-••-••............-•-- ...........................•..... �$! 7, ..— Date Permit No......................................................... ' -. Issued._. . :. ........................................ Date No...V.7........ FER 21----—----- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -- OF-........ 6 / ....�t...................... --7_,okmvq........... Appliration for Bhqpoval Works Tonotrurtion ramit Application is hereby made for a Permit to Construct or Repair ( an Individual Sewage Disposal System at: A • ............... ............................... .......................................................................... ..................... Location-Address Lot N 41 ...... ................ ............... Addre Owner ........... -------------------------------------------------------------------------------------------------- Installer Address Type of Building µ Size Lot............................Sq. feet U Dwelling,�Ko. of Bedrooms............................................Expansion Attic Garbage ( )Garb �4 1 �_� P-1 Other,—Type of-rBuilding ............................ No. of persons..--........----............ Showers Cafeteria ( ) Other' fixtures .................. ........................I......7.......I-----------------------------------------------*------------------------------- Design Flow............................................gallons per person per`day. T ot6Ldaily' flow,..._.- gallons. P4 Septic Tank—Liquid capacity............gallons Length................ Width-------..------- Diameter....--.......... Depth............._-. Disposal Trench—No.................._ Width.................... Total Length.................... Total leaching area.. sq. ft. Z ........7--------- Seepage Pit No..................... Diameter...--------.--.----- Depth below inlet........._...._.... Total leaching area..................sq. ft. I- Z Other Distribution box ( ) Dosing tank Percolation Test Results Performed rformed by.................. ............. Date........................................ --------------------------------------7�� 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........................ P4 -------------------------------------------------------------------------------------------------"-----------------"...........**----------------------------- 0 Description of Soil........................................................................................................................................................................ U ........................................................................................................................................................................................................ .........................................................................................................................A.........f--------------------------.......4-------------I... ... U Nature of Repairs or Alterations—Answer when applicable............... Vpaz.44 ....# ... - ....... ...............................................................................................................................................................................a- -------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance b d b the board of health, has.../en..;slie, y .......... Signed.. "'C'W .0 ........ Da e ApplicationApproved By................................................................................................. ..... ate Application Disapproved for the following reasons:.......................................... ..................................................................• ----------------------------------------------------------......."7...................................................................................................................................... Date .....Permit No............................................. ........ issued.... ..... ........................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF.......... ................ Wrtif irate of Tomptiatta IS I T,67CERTIFY, ThaVthe Ind* idu*�Isewage Disposal System constructed or Repaired , q .......... a er y . ..... --------------------- .0 ..L........... In t11 4r at - -------------_has been ins Red in accordance with the provisions. of Article XI of The State S ta Vry Code as escribed in the ---------------- application for Disposal Works Construction Permit No.__._6----------�1.47.............. dated-4---�L_ ........... TkEASSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.._... ........................................................ Inspector.... ......................... ........................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD /9 F HEALTH . ............ OF ....... .. ..... ......T&ZrIn No.. .4......... . ........ FEE.-;................ ........................Permission is hereby ranted... ...0.. ....... ............... to Construct o( or Re *r. an Individual 59w Dis osal Sy em 0, at No....- . ..... ....... . ...... ............................ Street as shown on the application for Disposal Works Construction Ppr%it N .. ............ Dated.._,_ __.`_... ........ .... ... ...... ................ .......... Boar of Healt DATE./ .........O�YAY�................................... FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS