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Home My WebLink About0045 PARK AVENUE - Health i■■■■■■■■■■■■■■ ■■■■MEN■■■ (■■■■■■■■■■■■ ■ ■■■■■■■■■■■■■■■■■■■■■��■E■EM■■■I MENNEN ■■■■■■■■■■■■■■■■■■■■■■■■O■■■■■■■MEN ■■��■■�■�■■� ■ENEM�■■■■■■■■■■ ■�■■■■■■■■■■■■■�■■■■■■■■■■■■■1 ��■■��■■■■■■■■■■■■:�V� L%i" ■■■■■■■■■■ommmummmu1 Qommmmmmmmmnmnm gee®ee®ee®®e®®e®ease®e®®®ee®e■e®®®■®■■■■■s■■®®®e ■■■■■■■■■ ■��■■■■ ■■■■■■■■■■■■■■L■■■■■■■■■■■■■■l IMMENSE I�■■■■■■ ■■■■■■■■■■■■��■■■■■■■■��■■■■�■■■�■■■■l TOWN OF BARNSTABL-E LOCATION c:j�j �� /gcs SEVIAGE h glj VILLAGE—Ce-r)tQrj o � _ t.SSESSOR'S biAP &LOT INSTALLER'S NAME-& PHONE NO Qgk_q_ ,, SEPTIC TANK CAPACITY` j(2!)(Qd LEACHING FACILITY-.(type) Le-acJ- ®�� (size) G*A _ p w NO. OIL BEDROOMS, PRIVATE WELL OR PUBLIC WATER 2f&!!d /,�: BUILDER OR OWNER �` p � C, yfl r DATE PERMIT ISSUED:_. � DATE COLIPLIANCE ISSUED: -U ��.__�r�_:�___. VAR"IANCE GRANTED: Yes No 2t, No. _17..3... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...........0 F........ . :........................................ Appliratiou for Uigpnual Worko Towitrur#inn ranfit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at ys /04r/,V l.je fV ocat n-Address ......................�.....................-'---.... .................... ......................................... ,y ( v4i... Own / / J A/Y�s a I.... /fe ....J ...._��.� ............. a Installer Address Q Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' 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 ( ) Percolation Test Results Performed bY.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-.._--.-.----.---..----- li, Test Pit No. 2................minutes per inch Depth of Test Pit...--.........--.... Depth to ground water...---.--.-.-----_---. -...�- ----------..............................................................:..__...------•----......-------------•---•----•---••-•-- 0 Description of Soil..................... x 7•----- ------ --•- - -•-•----••-----------------------------•------- -----------------•----------•----------•--•------------- U --•-•-----•---•--------•.......-•-•---•-•--•-•••--•-•---••-----•------•--------••---'-------------------------•------•-----------•---'--'-----•---•----••-••........----'.............----............. -------------------------------------------------------------------------------------------------------------------- -------------•-------------------- U Nature of Repairs or Alterations—Answer w hen pLpplicable..- h- --_4- --..-. 0�.e--....5 --.'_�_.. "fr.-4.............. --------- .Pea .... 'f /.....`�j�slo`'�' �?r�o� c� c Ps � L----------------••-'----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI..i� 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issue by thheeboard of heal . Signed----'---- •-•'----...... L� // S- ----•-..........'-"------------------•--•- Date Application Approved B Jf- Date Application Disapproved for the following reasons---------------•-------------•-------•-------------- ............................................................ ------------------ ---------- --------------- •------------------------------------ ---.------------- ---------------------------------------------------------------------------- Date Permit No....... --------------------- Issued...--•-----•------- -- Date THE COMMONWEALTH OF MASSACHUSETTS �* BOARD OF HEALTH Z' �i...----.....OF........�.�'�.-....,.........% Appliration for Disposal Works Ton.5- trurtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair an 'Individual Sewage Disposal System at: 4S /ai/Y ly-_vf COh�Il�lii r�✓ ............................................... ........._......_._....___.._.........._....._................._............._.................... -Address o LoL�To. - kJ'------------------------------------------ --------------------•-------------_._...... .._.. rOwJnetAddre-s.........................•--...........__.. (� �(7 H f7 /'G�/Yo ...._�S v ... / S� �.. �Y/, Installer Address Type of Building Size Lot...........................Sq. feet Dwelling_ No. of Bedrooms............. ---------_---------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ------------------•--...-------------------------------•-••---------•-••--•-••----•---- ------------....-------------------•--...----•-•.......--••-• 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........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.----__-___-_-_-----___. D Description of Soil..................... ....................... -.........-..............................................................: ......................................................... x -- -- -- ----- ------ ------------------------------------------- ----•-------------------------•------•--------------•--- V ..............................................-•......-•-----•--------------•-••-••-------------••----.....-----•----------------•--•••------•--------••-•--------••--•--•..............---••-------•-- W ------------------------------------- U Nature of Repairs or Alterations—Answer when a licable._.._i'_s . ! _foot/ 5�� r,.�/r --------------------------------------------4.e�.�.A ..�... c ----- -------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITiS 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been-issued by the board of heal . Signed........... -----•-•---•--••C/(---.......� ----./......--•-------------••-•-- •-------------------....._ Date Application Approved By..............f.'!-, -----.�.�?.. - -- .................. y' �1...' - Date Application Disapproved for the following reasons-----------------------------------------------------------------------------------------------------•••-----•-. -------------------•-----------•---•-•••...--•-••-------•-•-......--•---•--------•--•--------•-._...-----I--••-•--•----•-•--•--••-----••--------•-----------•-•---•-------------------------•---•---•.•-- Date C PermitNo.......i`..: 7 .................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........( ::..... (9rrtifirat a of T-Outpliattrr THIS,IS TO CERTIFY Th the Individual Sewage Disposal System constructed ( ) or Repaired-4<) by ;- =�� -+�^-.... L��-�� -•----•--.... --•----•................••--.............----------•-------........•........--•---------------..........-------------•----.._........ Installer I at-•----•---•-------._...V_ ----.....p ...................... P. _'I.AL has been installed in accordance with the provisions of 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.... .__S'./7.... ........... dated---------....................................... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATI F CTORY. DATE.............................. ..............................•-----•-----•--_. Inspector.....---•--....-----�---.------------------.._...._..---..._._....._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �i N ..o._ ..�P_:1 FEE."4............. -Disposal Works k".31m tr ion rrmit Permission is hereby granted............ .1��ln.........a,-,-IV'-e"..... to Construct ( ) or Repair � an Individual Sewage Disposal System J at No...............•.7-/ �..._.rr_:-cl �f.r��...,... �..- ..; '. .�F Street r. as shown on the application for Disposal Works Construction Permit Nq�,� f___ �� Dated.......................................... ...........................• .... 6 Board of Health DATE.......................1�-----lZ......S FORM 1255 HOBBS & WARREN, INC., PUBLISHERS