The URL can be used to link to this page

Home My WebLink About0220 JAMES OTIS ROAD - Health 2.�20 -�otMPiT Q7fJ C24,re('v►11e 79 SMEAD KEEPING YOU ORGANIZED No. 12534 2-153LOR 0mra MIN.RECYCLED INITIATIVE CONTENT O% U=dFiberB .Wg POST.CONSUMER wwwafiproyamary sioipo MADE IN USA GET ORGANIZED AT SMEAA,com .t LNo .....&-70 Fxs.. ............. THE COMMONWEALTH OF MASSACHUSETTS c� BOARD OF HEALTH ApplirFatiou for Biiip o ii al nrkg Tonstrnrtiun Vamit is hereby made for a Permit to Construct ( tL-or._Repair ( ) an Individual Sewage Disposal -ystem at .. ....... .�� __. --------- --------------- - ... ... ----------- ------ Locatddres Lot NO— ......... ------- •. ........ ........................ a ner f. Address Installer Address Type of Building Size Lot......'15-ill,— feet Dwelling—No. of Bedrooms._..................................Expansion Attic ( V o Garbage Grinder ()tV 'd aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) dOther tur .................................................... -•----•-----.....------•-------•----•-•---•--.....---------------•--------•------••------•----- W Design Flow................... ......................gallons per person per day. Total daily flow.... .._.*.................gallons. Septic Tank—Liquid capacity. allons Length................ Width................ Diameter-_-_-.----_--_ Depth................ W Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--__-----..__-------sq. ft. Seepage Pit No... _ 4. Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a' Percolation Test Results Performed by------•-•---------------•-....-••••-•--•-•-••-•-----••-------•-•----•-••• Date........................................ W Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_-_-_-._•..-----_--__--. f.4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_-_.--_--_---__-----_--. ,:4 -----•--------------•--•--••---••••-•---•-.........•-------•---•-•------.........---.._..----•-•---•......................................................... 0 Description of Soil........................................................................................................................................................................ W U --••-----------•-------•---------------------------••-••-•--------•---------•------...--•---------•.......----•-•-••----•-•••--••----•--••-----••--------•-•---•-•--•--••----•--------••--•----•--...... W -------------- --------------- --------------------------------------------------------••---------•-----------•---------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable................................................................................................ --------------------------•-•--•-••••------•--------------•-•----•-•----•--...................••••--•--------•------•-----•-----------•---••-------•-•-•--•---•--••------••--••---...................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions ofTT.^IF 1 i::..r. 5 of the State Sanitary Code—The undersigne rther agrees not to place the system in operation until a ti ca.t f Complia has been i u by the board health. ! ...........................o—:5r..--•-•---. ..--- .......................... Application Approved By.............. ...............(ZI--..- --- ----.�..... .......... .. �l.�._.. . Date Application Disapproved for the following reasons------------------------•----...-•----------------------------....--------------------.......................... ...-----•---------------------------------•-------•--------------•-----•------...-----.......--------....._.....--•--------------•---------------------------------------------------------------...-•-•- Date Permit No.----< Issued_....................................................... Date Fms::..�._6�................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH A► ° ..... .= ............................. Appliratinn for Uiiipla.aal Workii Tanstrurtion ramit Applicati n is hereby made for a Permit to Construct (9-), or Repair ( ) an Individual Sewage Disposal r System at: ......... -----------•--------- --- . ---•........................ Loca n•^�dd^r`p or Lot Not .........%...; C.x._c............ ................................... .......... Y.,�:a'e::..: '....._:-:f ..'�..o�..............................._ ' Owner.-,) •- /� �, -Address af'-+i > tr,�.C!:`�" �--Z" ...... �._ � Aw 1=6:e= •------ s'.......................................... Installer Address d Type of Building t Size Lot---------'_ �_ " sq. feet 1l�)Dwelling—No. of Bedrooms........... ___________________________Expansion Attic ( Garbage Grinder (y!�`) ' 04 Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) al Other Mixtures ____________________________ _ W Design Flow.....________ :«*'....................gallons per person per day. Total daily flow... ..................gallons. 04 Septic Tank—Liquid capacity '�-_''_gallons Length................ Width................ Diameter----------..... Depth................ W Disposal Trench—No_ .................... Wid1th.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit Diameter____________________ Depth below inlet.................... Total leaching area_.................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ W Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ fs. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' ----•--•-•••----------------------------------------•••--.......-••-----.....-••------•-•-••--•--•..._...-•••---••-••••----•-•-•-••-----•--•---••------....•. ODescription of Soil........................................................................................................................................................................ x U .................. •--•--•-••----•••---•--••-•-----•••--•••-•-••--••-•••--•-•-•------••••••••-•-•----•••-••••-•--•••••--•-•-•--•--••--•••••-•--•••-•-----•--••--•-••-•--••-•-•••------------- W ----•--------------------------------------•----------------------------------.----------------------------------------._...--------------------------------------------------------------...-•--•••••. U Nature of Repairs or Alterations—Answer when applicable...................................................._........................................... •---------------------------------------------------------------------------------------•---------•----•---••-------------------------------------------------•--------•--•-----•--••-••---•--•......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i i=:_:� �of the State Sanitary Code—The undersignerfurther agrees not to place the system in operation until a tinca of Compii�n e has been issued by the boardof health. - �.Signed."__-...... ':{... .... ................. Application Approved By _' ate Application Disapproved for the following reasons---------------------------------------------------------------•-----------..................................... ..-•-•-•••-•••••••••••-•••••-••••----•--••••••-••--••--------•----•••-••-----•--•--•---•-•-•--••----••••.-----••--•-•••--•-••-••---•----•-•-----•-••--••••-----•---•--••--•--••-----••••••••--•••--•-•-- <C �' -�� Date PermitNo---------------��...-------�=---•--•�-----.. Issued_.----...-------------------------•--------..__.._...--- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Z. 7.. ........OF..... ........................................ 01rdifiratr of Toutplianrr TH-S"IS TO ERTIFY, T at h _Individual Sewage Disposal System constructed ( ) or Repaired ( ) ` Installer J�-- t C1 ( .ate ti -(�r"� --�. ..at. ---------•----•---•-------- C --------•--•---------•----- has been insmiled in accordance with the provisions of T I T IE jco The State Sanitary Code. s descr•"lped in the application for Disposal Works Construction Permit No._�K'�._____. � --?D r dated ��' -------•-------••-•- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU ® AS A GUARANTEE THAT !WE SYSTEM WILL JFUNCTION SATISFACTORY. DATE......---_-••--- ..... ' Inspector.............. .........•-•-••----.......••••-•--•....._..__...------......_..•--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1p. .......................OF................_.._ .. l''.._ ` -�•�._....._...._...._.__......... �^ l��Y................. FEE._ f_ ............. �i��rrr,>��1 ��k� ��an��rttr#Uan rrbti� Permission is hereby granted__��'--.0 � -Z to Constrict ( ) or Repair ( ) an Individual Sewage Disposal System Z < c --= Street - as shown on the application for Disposal Works Construction Permit Now-.6._�'___%ated.__ . • ':� - ------------------- Board of Health DATE....•--•- •........ �'•..... FORM i255 H 11131 & ARREN, INC., PUBLISHERS f" WAS ■Eiir��®■■j■®! r • ®■■■■e■■moose a ■■a ■ ■■■■a■■wl■n •• r'] _'I�rp�1�r�Jfif� �- off• � ;, , '11tiEWE 'man 0 r�. V.Vp�y IC�iI sfiaa r V r ` IRMO nil �m�r®15/It�®■IABY■ ■ r - e ■■Emmons so EEE■■E l� Li ■■��■■ sir`.,\Ifl\ :�■�� sun f 1■��®��®on to Nis , 11■Mani®N1 711: �s• a If■r■o6■I A IB■ ■■1/Ig�I 'H1 E 11■ ■■I®f� Ilan■■■I■■I ti 1%�i■INN If■ 1■!rl _y� � . . j i■■■ �15ir rsM=M Mp a IIEE! El:aaaaaar•�r�a �INem 6/�:■®111 r Nis trE�,lnm MUNMlr■! •.Vil�0"e 'HeAllno a gl.�■Irk r MAlil®iAl1�� i®®IMRiff ■®am 11111,11il ■� I� r■■■■■1pU11■ ■■■®ts.►'.OI _.r- Jam, ._r.�.� it • � • ®iiii®is■■s® • r. r an am ■ r E ` TOWN OF BARNSTABLE LOCATIOA-C7'/:3 ' %4A i eS 2�rl.S `� SEWAGE " VILLAGE OfIV-Y-<I/,de, ASSESSOR'S MAP & LOTr�O INSTALLER'S NAME & PHONE NO.'j-;,7'j. C� SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO. OF BEDROOMS_ PRIVATE WELL OR PII"LIC ATER l QBUILDER OR OWNER DATE PERMIT ISSUED: a DATE C011PLIANCE ISSUED- VARIANCE GRANTED: Yes No � ss