HomeMy WebLinkAbout0564 OLD FALMOUTH ROAD VA
1 1®6 �F�ROVED..............
THE COMMONWEALTH OF MASSACHUSETTS 18Con68Ne pep`
ftea t- C�A ,,, ,,,,,.,. BOARD OF HEALTH 9
TOWN OF BARNSTABLE
womiedep
03A0 , V trod tiolt for Bi-ti twial Worlai Towitrurt u t Vamit
Application is hereby made for a Permit to Construct ( ) or Repair (A) an Individual Sewage Disposal
S stern at:
rn. . ..... ......................•...--..••--...._---
cahmi-_\d rrs WOO?
or Lot No.
Owner A ress
Installer ---•- -•-----•-------
� Address
UType of Building Size Lot............................Sq. feet
.-� Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons-----..--------------------- Showers ( ) — Cafeteria ( )
dOther 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. I................minutes per inch Depth of Test Pit.........-.--..--.-- Depth to ground water....--..................
(Z4 Test Pit No. 2................minutes per inch Depth of Test Pit.--.........--...... Depth to ground water.....---................
j � . (} y►�
x Description of Soil... .. Q1�. [� 1 � N.5.1......�� .- 'N�...mix--,t--..15�....I
.......... Ty -- - - - -----• --------CUZ --- ------------------ ---------------------------------------------------------------------------------------------
V Nature of Repairs or Alterations—Answer when applicable-AK N. aP(M__- 0.:!T ...... -----------------
-----------------------------•---------...----------------------•-------••-••..._............
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Envi ental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Co lia e has be by the board of health.
Sigd --- ---- --- - .................................. .3)- ..�..)1�........
Date
Application Approved BY �J .... ----------------
..-- ...........
Application Disapproved for the following reasons- --------------------------------------------------------------------------------------------------------------------------------------
..................... ' .................... .................................. . ........... ' .... .. ... ................-''' ..... --------......--------------------------
` Da[e
Permit No. ! f'l = '��.�n-------------------------- Issued ---------------------- .........,.
....................
------------------
Dare
r.. Y THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWertifirate of N OF BARNSTABLE
omplianre
3IIIS IS TO<CERT.IFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by _._.r T .:.9 -.. - �-�..��.�.?.�'a.�1.`�..-?..4��------ ------�..`--...I .r.filler----
.-----
..-------
----------------
-
--------
.... ......................................
at . .----' :... .� Y `max 1`�' 0.-------- �. ...�i' � � t '111 �
has been installed in accordance with the provisions of TITLE 5 of The State Environmental.Code as described in
the application for Disposal Works Construction Permit No. ----(?-.v-- .../0--&- dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE...... - !�..' .� --��-1---_--- - ----------- --- --- -- Inspector - •�i, i
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
� /)/ TOWN OF BARNSTABLE
NO...�.../...../:�-(� FEE.,-.—:?(2)
Permission is hereby granted--- =...... C?cC' _ ?l>- --------------------------------------•---------•-----..........-----
to Construct ( ) or Repair ( )'an Individual Sewage Disposal System
at --------------'l_1� : - . ( �11 _, "7
; - a,
Street
as shown on the application for Disposal Works Construction Permit No._9_y��_b_ Dated........ -.�-,%-----
---•.....------•'---•----•--......- E-�•---• ------------------------
--••--•-----
Board of Health
� DATE............. ..................................................
FORM 38608 HOBBS&WARREN,INC.,PUBLISHERS
t
THE C"OPMMONWEALTH OF MASSACHUSETTS �/
BOARD OF HEALTH , � / 3 ���
y
TOWN OF BARNSTABLE
Appliration for Dhip 1 ial Workii Tomitrnrtion 1rrmit
Application is hereby made for a Permit to Construct ( ) or Repair O an Individual Sewage Disposal
System at:
L cation Address or Lot No.
~` tOwner._ � Adllress_......--
_...
-•--------•-----------------------w.. ..
- aM .�'a t.. ...� .,.. Y.....-•------
Installer Address
UType of Building Size Lot............................Sq. feet
.-, Dwelling—No. of Bedrooms----------------__________------------_-----Expansion Attic ( ) Garbage Grinder ( )
Pk Other—Type of Building ._..................._____ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
a' Other fixtures
IT, Design Flow--------------------------------------------gallons per person per day. Total daily flow............................................gallons.
Septic 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........................................
Test Pit No. 1................minutes per inch Depth of Test Pit-_-__-__-_--_____- Depth to ground water-.-_------_._--_._-.-.-.
4q Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
-------------------------------------------------------.................... -----------------•----------•.........,...............a
x Description of Soil....R_ 1�-nti...--. 'A! f----- �� L f _ 1_ � VY\R ...
1- :1 _ fit' a �,
U .........................................................................................................................................................•.---..............................._ --------
U Nature of Repairs or Alterations—Answer when applicable._1X_F-_.) Q_R(��__-_--_ ..._7T ..................
---------------------------------------------------------------------------------------•••-••-•••-•----•---••-------------------------------•-------••-----------------------•-------•--....--•-••--••--
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 Co 11
pliit e has been_issued y the board of health. f
Signed ....... ,� �� .-: ..�... .... - --- .--j..�... . Y .:......
i�r.?t-� Dare
A lication Approved B <.........:....
pP PP y .............. J...-. ... - .- ,��-� .--...--------------------------------- -�'..�-�ZDne` ..
Application Disapproved for the following reasons- ---------------------------------------------------------------------------------------------------....................................
----------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------- ........................................
// / Date
PermitNo. ......�Lf---'---6-- Issued ..................................................... ------------
Dare