HomeMy WebLinkAbout0262 FULLER ROAD - Health 262 FULLER ROAD
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH r
TOWN OF BARNSTABLE I P l 0�o r (9
1
Appliratinn for Eliipmal lgorko Tonolrnr#inn Vamit
Application is hereby made for a Permit to Construct ( ) or Repair (�an Individual Sewage Disposal
System at:
................. .................. ;------..-------..-..-----------
oc do -�f ddjjre s or Lot No.
_ ... See .... _ I _.......................
' _ --------------------------------------------
p Ad ress
i
w �' P_ L►4A�?V.... �.Qr_.j5b�---..4.r4 .......d.�1?F. t.
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bed rooms._......._............................Expansion Attic ( ) Garbage Grinder ( )
04 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
P., OtheX—fixtures ---------------•--•---•--------- .
W Design Flow.......... ....................gallons per person Vakday. Total daily flow................ __ ..................gallons.
WSeptic Tank 4 Liquid capacityt.CDOgallons Length.... .'........ Width. ....... Diameter________________ Depth.........:......
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No....../--------.... Diameter.___1.0. .... 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........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
t� ----------------------------------••-----------------------•-----•----------------------•--•---•-•-'.........................................................
0 Description of Soil........................................................................................................................................................................
x
c., ------
W ----------••----------------•-----••-----•--•---•---------•----------------------------------------------••--•-----------•------------ 1--- ---------------------------
UNature of Re airs or Alterations—Answer whe ap livable____ �.-1-__..__�_� ._&VI.��...
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 i ued by�theard of ea r-
Signe - ........ ----------- ....... 1
Dace
ApplicationApproved By ........... 4.4 --------------------------------------------------------------------- ---- { % p
1 Dace
Application Disapproved for the following reasons: ....................-----------------. -----------....-------- ------------- --- ------------.------------------- ......
.............------------------------------------------------------- --I --------.....---- ---.. ------ ------...------------------. ------ ----------....---------- -----................. ----------------------------------------
Permit No. ..... { ---------------- --------- Issued ...------------------------------ ---- ---...----..Da a
_.. ---...
Dace
No-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE ' � �J-
go ,-
'00
Appliratiun for Disposal Works Tonstrurtlun rrrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( Lam)an Individual Sewage Disposal
System at:
................_c ,�,,. ��-� �.��v' 1�.�`� ----.....------�-..'l�l C �' �'l I�t. 1 \,�
Location-Address y`-•^ ` r �T'rY W� (S,yAY^' 1 T or Lot No.
Owner
..-•-------------------••-.............._..... ................................
... .._......... __........._ ss..... ...........4
I . Addre .!.. _._
s ,
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of-Bedrooms__=.._?....................................Expansion Attic ( ) Garbage Grinder ( )
'4 Other—T e of Building No. of persons............................ Showers — Cafeteria
04 Other, fixtures --------------- --------------------------------------
W Design Flow.........: __ .. _---:-__gallons per person per day. Total daily flow___-._.. ..................gallons.
WSeptic Tank 1 Liquid capacityR Ckle a&lons Length___- ....... Width...N---....... Diameter________________ Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No._.._.I............ Diameter..../. ..... Depth below inlet....Z,_�........ Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by------------------------------------
•---------•--•-•-----•--------------- Date........................................
aTest 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........................
�+ ------------------------------"--••------------•-••----•--....--•-•---------------------------•---................................................
•---------
ODescription of Soil...............................................•----•---•-------....-------•--••----------------•--•--•-------------._.......
x
V .---------------------------------------------------------------------------------•-----------•------....----------------------------------------.....---...-----•----•-----...-•---••-------------------
W -•----------------------------------------------------------------------------------------------------------------------------------------
UNature of Repairs or Alterations—Answer when applicable.____ N/C—T A 1�._.._►.1) ._C�..---- --_------_
Agreement: s t
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;;7
*Si�. ..........................................� ... Date
Application Approved By ...--- . - �. q, .. ��.>-.� :.: S",--
Vf Date
Application Disapproved for the following'rearonr: ...... ;--------------------------........................................................................I.-------------- ------.
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------
Da
Permit No. ........ ..-... Issued
J Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
vlertifirate .off C�IImyXianre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (by - ..... -...................... ....��. r r gin.... rl\Y----------------------..........----•..----.........--------- ------------------------.------- .--
- Installer
^�.
......... _.�.. .........�-1,e�.... .�-................774-----------------------�'"" v..-....... ----------- ................................
has been installed in accordance with the provisions of TITLE 5��ff,,The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ......-T .-..... . ,�-.--.. dated ................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..... 5�
.......................................... Inspector �--r.-....G ........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
q TOWN OF BARNSTABLE
No..../f- l G�o. , FEE.... .� ....
Disposal �/�urku Tuntrudiun %"U;Vprrit `\
Permission is hereby granted.... _.4 r-_____I::�N._�..: ���-..
to Construct ( ) or Repair ( ) an lndivi�ual Sewage Disposal System
Street
as shown on the application for Disposal Works Construction Permit No`p\\ Dated..........................................
............................. Board of Health
.h-r. .-z_......................................................
._
DATE. .' C �•---
r
FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS
TOWN OF BARNSTABLE
LOCATION Fulle- SEWAGE # ��•—lG��
VILLAGE CeN� c u c ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY t U o ocl a 1 'ruh k
LEACHING FACILITY:(type) P f (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
H@ OR OWNER m S`
DATE PERMIT ISSUED: {'" `^ �
DATE COMPLIANCE ISSUED: �`IS�' L r
VARIANCE GRANTED: Yes No
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