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Home My WebLink About0074 CAP'N JAC'S ROAD - Health 7q cCI PT cen,f,L-rvfj&- 1 qq- oC-z /// S M E A D KEEPING YOU ORGANIZED No. 12534 2-153LOR SUSTAINABLE FOREM MIN.RECYCLED INITIATIVE CONTENT 10% Certified Fiber Sourcing POST-CONSUMER® www.sflprogramorg SR01290 MADE W USA GET ORGANIZED AT SMFARCOU -z LOCATION OA9T-T'-6�'- gEWAGE PERMIT NQ. LOT4 a6' VILLAGE ��1�-7—F� !�✓c,c.t� lJ �oG I N S T A LLER'S NAME & ADDRESS fd B U I L D E R OR OWNER iM lF14 DATE PERMIT ISSUED DATE COMPLIANCE ISSUED +_ �O "��i flE 4K OF H a Boird 66,ealth Town of Barnstable No.. P.O. Box 534 THE &&MMi&VWMF1CbM,%X§S(kZWSETTS BOARD _QF HEALT H L ----------------------- .....OF.. Appliration for Mupviial Marks Tomitrurtion ramit Application is hereby N me.- for a Permit to Construct 44or Repair an Individual Sewage Disposal rt System at I V,j E-- ........................................... L"on-A, ress .......... .................... .... .. . '-Ie�'.................................... caner Address .......... ...................... Installer Address Type of Building Size U —No. of Bedrooms.........J ....Sq. f t Dwelling ...............................Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons----------------_---------- Showers Cafeteria Pr Other Pxtures ...................................................................................................... ..................................... Design Flow.........../Z.62......................gallons per person per day. Total daily flow----�AAV..........................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width...___._.__...._ Diameter._..___..__..... Depth._..._.._....... Disposal Trench—No..................... Width..__......._._._._.. Total Length.._....__._.____..._ Total.leaching area....................sq. f t. Seepage Pit No_____________________ Diameter.._.........._...... Depth below inlet___....._.._________ Total leaching area..................sq. f t. Z Other Distribution box Dosing tar ( Percolation Test Results Performed by.......AC24 ...... ...... ................ Date.... . Test Pit No. I................minutesperinch Depth z Test Pit� ' 1 .................... Depth to ground water...___.____._____.__.... 44 Test Pit No. 2................minutes per inch Depth of Test Pit......_._..._._____. Depth to ground water...._.........__.__..... 04 ...................... ............... ....... ................................................................................... 0 Description of Soil...._. ...... ......... .................................................................................... . ........................................ .. . .. ..... ......................................................................................... U W %X '10......... ��4 ....................................... . .... L. . ................... ........ -----------------------------------------------------------................. U Nature of Repairs or Alterations—Answer when applicable........_._ _.............................................................................. ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with L i the provisions of'1 , '11 5 of the State Sanitary Code—The undersigned further agrees not to place the system in opera nt' a Cotifi ance has been issued by the board of lYtdth. a ed. ;2- .. .. . ............ ......... . ................ ................ ....... Date plicapli tion Approved By.....-- --......---•.. ...(:LDX..It,........................... .......... ......... ---t:e... Date Application Disapproved for the following reasons:................................................................................................................ ......................................................................................................................................................................................................... Date Permit No.__..524-ft5....... ..................... Issued.........3.h te ------------------------------------- ----------------- ------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......OF t- ......... M x AVVliration for Disposal Works Tonstrnr#inn rumit Application is hereby ma for a Permit to Construct (44"or Repair ( ) an Individual Sewage Disposal $ 'stern:at- _ �; f ofi tit at&l. iQ+I ,. f... (�✓,rl .-'� � :C:'__.,.e! ........................................... Location-A dress ' k o, O wrier rW-a / G...YA � Address 1:. Installer......... ..e.••�.... ......... ----•---------••--- Address Type of Building Size Lotd-/.`/`&..,.....Sq. feet � Dwelling—No. of Bedrooms.........A f............................Expansion Attic )t)d) Garbage Grinder V(a aOther —Type of Building ............................ No; of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures ................................................... W Design Flow..........M2.......................gallons per person per day. Total daily flow.._ V..____..___...._._______._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 ta5�-: '-' Percolation Test Results Performed by.._... > i` Tr.� -�•�!:_L..t.. ........ Date........ -�_ Test Pit No. I................minutes per inch Depth of Test Pit-------------mot__ Depth to ground water.___....._....._.._____. 1s;4 Test Pit No. 2................minutes per inch Depth_ of Test Pit.................... Depth to ground water........................ D Description of Soil.....2•n--.-� -�'�� -c! .>o ..... _ ..... x , r ------•--•••-----•-----------•-----------•-•----•-•--------•-------•---•- (,) .......................---.......................................................... ----------------------------------- i ------- �' // � .... - --------•-----------------------------------................................. U Nature of Repairs or Alterations—Answer when applicable---------6/------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------•---........-----------------------------------------•--------....-----------•------•••-••••-----....._....-----• Agreement: 33 The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with 3 the provisions of TITIZ' 5 of the State Sanitary Code— The undersigned further agrees not to place the system in opera oiazn 1 a C rtifi t pliance has been issued by the board of health f Date opplication Approved By_____="`------- ..._ ._------ ..,.. s -* A Date Application Disapproved for the following reasons:__...---••-•------------•------•--------•-----•--•••-•----•--•------ ----------------.......................... .----.....-•----....-•---------------------------._ Date Permit -- Issued-...---- ' ate THE COMMONWEALTH OF MASSACHUSETTS BOAR6 OF HEALTH .. �.. �. -........OF.. j:� � ` u.. ......................CAP D? �. Tntifirtt.e' of TontpliFanrr `s THIS IS TO CERTIFY, That the Ind viduaL Sewage Disposal System constructed (_-)`o'r Repaired ( ) by .i{.f �L�... '' ....Insta er at.. ------ 1/... .....---........ ......................... <%.....--•---'-.- has been installed in accordance with the provisions of TITLE, 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No---- d-ated_. _ . THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GBJARANTEE THAT THE SYSTEM WILL UN TION SATISFACTORY. DATE............. Inspector--_...-- ----•- -„---_--- THE COMMONWEALTH OF MASSACHUSETTS 4E BOARD OF HEALTH .......................... FEE ? Disposal 9tjks Tonotrudion "permit Permission is reby granted ------•---------------•--------------------•---------------•--•--------------•----- to Constr�uctt (`I oer Repairs/( ) an Individual Sewage Disposal System at No....=� = .... !ra + -- /ter!/L-tom'---- `Street as shown on the application for Disposal Works Construction Permit _ Dated « � v Board of Health DATE -: ...............-••........................................ FORM 1255 A. M. SULKIN, INC., BOSTON /�/6LE FA /L Y ^' 3 BE0.2oOw1 I ._ /DD •DO Alo GQi2BA45E — OA/L Y --'4o W - //O X& = -700 G.PO. SEPT/C T,4Nk:� = 33aX/Soo =5�9f'G.Po I 2 / /G/ '46' .S/O1'W,QLG A,e-E Q /SO - B 'r:',�"�V.O Z�,C & s �.. �Ny .. o,e PLAN Ofev'MqS OF s PETER �� ;. �� V1?/✓63�, 1bG'7' . P o "ULLlVAN `a`' WILLIAM r 7.//. I . No. 297D No 19334 STS t lee r' Rv. o..sr,GaC.c--�a AZr-,,e . . 7- G'E,2T/F/EO �G OT P4A41 it /b No rY•�T�� c>7'' 2 '37- 4/1 r' e5. yE.�Eav GOMPGY.s W/1�/TiyE S/OE'.t,�//E B.4X7�,2€�t/YE /.ciC. 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