HomeMy WebLinkAbout0118 INWOOD LANE - Health 118 Inwood Lane ,..
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
......................Town..........OF...........Barnstable
........................................................................
-A* A liration for Disposal larks Tons rurtion ami#
I V�UVaad �,�
Applica(ion is hereby made for a Permit to Construct ( ) or Repair (x) an Individual Sewage Disposal
System at:
...... ----------•-• ..........................................
or------_Ro..........................................
Location-Address or Lot No.
............................................................... ..I=ing.AYrea-►...West.Hyaz�n�. po .,...M�......-------•---
o'ner Address
.. &_.B__Cess�oo .s �i:ce.................•------•-•-•-•-------- --..1.2$...� k�o�s_�exx r R.Xaxinlo.,..M .......-•--•--•---
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms.................4........................Expansion Attic ( ) Garbage Grinder ( )
04 Other—Type of Building ............................ No. of persons............------------- Showers ( ) — Cafeteria ( )
PL4 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 ( )
aPercolation 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----....................
----------------------------------------------•-•------------------••-•-•-------..I..............---.........................................................
0 Description of Soil..-•---Sand......---- •--•-----•----------------------------------------------------------------•------------.................--•---..............-•-•-----------
x
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UNature of Repairs or Alterations—Answer when applicable---inatallati on---o.£--a..1.5?QQ..galJ Qn---pxe-QMt,
stQoe..p.ackaed..lea h-Pit Qjrer '1 A ----------------------------------------------------------------................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of ITTLE 5 of the State Sanitary Code—The undersigned furti�,,er agrees not to place the system in
operation until a Certificate of Compliance has been 'slue by the ealth.
Signed.. . = '
Application Approved By---•--------•-•-----------------• ---------•--•---•--•-- ........ �2.37 -------------
Date
Application Disapproved for the following reasons-------------------------------------•------------------•------------------------•-------------------------------
...........................•---•-•-•----....------•--•-•-•-•-•--•-•------------------------•---•--------.---•-•--•----•--•-•---------•-----•••--•---------------------------•-------•----------••--•----
Date
Permit No.......................... 1-. Issued_ 10_3181
Date
�Itiuu fi l I vi vioo -vie- /-C 9y
SEWAGE E PERMIT NO.
LOCATION
VILLAGE
I N S T A LI, ER'S NAME i ADDRESS��
BUILDER OR 9
DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED,� ���
C r
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Application is hereby made for a Permit to Construct or Repair (X) an Individual Sewage Disposal
System at:
Location-Address or Lot No.
Owner Address
Installer Address
'w Other fixtures
~� ------_'_--_.__---____--_.--.__'__—''--_-__'-'_--_-______--
Design F�n�-----___'___-__--g��ne per person per day. Totalda�v 8nvv_----__-__..__—
Septic Tank—Liquid Loocth----'-. Diameter................ Depth................
Disposal Trench--No. .................... Width.................... Total Total ft.
Seepage Pit No-_----' Diameter-----.............. Depth below inlet.................... Total area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
'- Percolation Test Results Performed by.......................................................................... Date........................................
1.4
Test Pit No. l................minutes per inch l]cptb of Test I,it--------' Depth to ground water........................
PLI Test Pit No. 3.......... .....minutes per inch Depth of Test Pic--.-----_ Depth toground water.......................
�
— �a��[—'----'--'---------'-----------'---'--'--'-'-'--'-----------'----------
�� on ofSo�___-____-___'------'-------'---------------.--------------------------------'--
----'-----`--'---------`-------------------`----------`---------------``----`-----`-----
_—'---.----.---_----_---'-----.--___-_--_---_---_____'-----_-----_--'--'--'---_
U Nature of Repairs or Alterations -' ...._IuOOO. ,
.__'_-------------.-----_—_________________________
Agreement:` _
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of rLZ= 5of the State Sanitary Cod The undersigned further agrees not to place the system in �
| operation ���000no�laC�c� of Compliance has� ^
� S6/oe ---------- ....... 4/23/81
___Application Approved ___
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