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Home My WebLink About0012 PROSPECT AVE - Health /// S M E A D KEEPING YOU ORGANIZED No. 12534 2-153LOR k A�IE MIN.RECYCLED INITIATIVE CONTENT10Ya CartiGadRbarsaarofnp POST-CONSUMER xmv sfiDroOranwrg M012M MADE IN USA GET ARGINVED AT SMEARCOU 4 i No....... :..... Fps.......`...:................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..... "` . Applira#ion for Uh4paii al Workfi Cnnni urtw' amit Application is hereby made for a Permit to Construct � ) o R air Individual a ge Disposal Systew at: _ �c` t ..v............_....__..............Loca_ionk..ddre- .............. .... -- Location-Address or Lot Nor, .... ......�a• .`... :* ! :_/ .......................... ........................: .:::'.0 :.+ ......... ......:..........._........_ . ... w Owner Address (r' Installer Address Type of Building Size Lot_._._ feet Dwelling—No. of Bedrooms...... _-` �9 ________________________Expansion Attic ( ) Garbage Grinder (/� a'4 Other—Type of Building No. of persons............................ Showers YP g -------------•-•---•---..... p ( ) — Cafeteria ( ) Otherfixtures --------------- -------------•......•--------------•••••-------------•------•-•-•----------------------............--- ..---.••--- W Design Flow.....`z_. ..je a....................gallons per person per day. Total daily flow... �. R_G.___....____.____.gallons. WSeptic Tank—Liquid capacity.1 0allons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No.................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.... Diameter....C*�°_��-»"`-. 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........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ------------•-••-•-_...•---••-••••...•---••••-•---------•-•---•--------------------------------•------------------------------.......----•-------------.... O Description of Soil------------------------------------ ---------- x ••----•--•---••----------------------'yam ��' ..:.�...`�------...::S�-`.......`/'1-----�li.sfvc� T� W -------------------------------------------•-•--------•--• • ......r......................................... 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 TIT_Z 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 health. Signed. 41:t ----��, ,P l- � 1/ ---------•-•-•-•--•-•----.....------------.....--------- ate ApplicationApproved By.....----- / ...............•----.........-•---------................----------........ �/.. — 7 Date Application Disapproved for the following reasons-------------------------------------•--....---------•--------....-----------•----------•----•--•--......--_----- ...............................................•--------•-•----............---•----•-•-----•--•----•------•-•••.....................................------------------------------------------------ / ----_Date Permit No........7Y -------------------------------------- Issued-----1_'....'.... Z� Date MOM THE'COMMONWEALTH OF MASSACHUSETTS ¢ ,+ ti BOARD OF HEALTH •. ..... ,1 > .........OF....... ,! �Pfdl !............. ......-...-.......------• . �. ...... f�lerti�irtt#� of (�unt�li�nl�r. THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by------------------------ •--•---•-t%v..GCc� ---• •-••---•---•--•••--- -•-•--•--•---•--•.................................•-...... Installer at ................ --------- CIF r 1 _.//1 ..................................................................................... has been installed in accordance with the provisions of TIT EF 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No„... G,rf___________________ dated--.—//-. '-'7 ....................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SAXISFACTORY. P---- S` --7 l� DATE.......... ............. Inspector....._ !�t'r�� •• --•-- 7------------------- L THE COMMONWEALTH OF MASSACHUSETTS" BOARD OF HEALTH No......... ..... FEE......:"............. Permission`/is hereby granted_________.4AI' tr ............�6�.L4_l_......................................................................... to Construct (7�) or Repair ( ) an Individual Sewage Disposal System __.._.6'.,r'r{, '.E" `` � �� ....................................................................... C - - PP P Street l as shown on the application for Dis osal Works Construction,Per ........__ ted. ................ ._•••_--••• • ................... -•---•••--- ..._.._ ? L'� // .. Board of ealth DATE. / ,Z- 7 , FORM 1255 HOBBS ,WARREN, INC., PUBLISHERS LOCATION SEWAGE PERMIT NO. VILLAGE INSTALLER'S NAME & ADDRESS B U I'L D E R OR OWNER DATE "'PERMIT ISSUED DATE COMPLIANCE ISSUED i L � J 1 3 4 A �T i 12 TOWN OF BARNSTABLE .-sy- _LOCATION SEWAGE # VILLAGE ASSESSOR'S MAP & LOTaa 0) INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR�P UBLIC WATER_ (BUILDER)OR OWNER Nk, (� 0.SSf-"tt DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No I ��os�L�c.� ��1E. ----� . . :. � �I�O/--� � � � �� ►�' _ 11 '.b,, 17 � .' a1 13 G��P�� Sl41GL� �nMIL`( - 3 8Eb2G�C7� J., •Uo GAfzBAr_E T>w&I Lam( I`Low - 110 .4 s SWIG TA+.1K = 330.. jS0 % Peep • �Gi 6 PD. r 5 f o ;� . U Ste- l OOC� 6,�s.1. � , I �` , t. %� � � •� �` � f . ` �?ISPoSAL PIT - uSE loco GAL. ! ':,` t 9 . ; J �u , Prr; (`✓l ` :� ``,`` CS-' f ' f ,:aw SOX-WALL ACEA flcjo s.F. :�Cj� SF �[ 2.S 7 i 3'7S G.P.D.' r - � �.L..' r / ; `�, *I��` r•�. t,.�'y f..S. F..C7 sr', CEO i t-f,'•F Tcr AL: v fESl6W 4 5.Q�. 1 t i { s'.t` , '! ':,. j r ' i �� •. �v J r 4r r r ,s. rmTo L. ,-mQI w. J..� < - .J ,i �'.,� - 's ,� 4:.t. j it! a ! h.... .. _ •'i 1 'r t f-4 O w -CZ-TES: IU �. I►J OIZ a ry t, I t S J t i �,1t ' i•. '� e j t t !, , '''' Jn ' � 'b. - ' ` 1 s T i. i:.# ..i I � s t t, i js I, , f �,� s. �. 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