HomeMy WebLinkAbout0522 SOUTH MAIN STREET - Health (2) S M E A D
No.2-153LY
UPC 12934
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INRIATIVE
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WROVEO THE COMMONWEALTH OF MASSACHUSETTS
OARD OF HEALTH
TOWN OF BARNSTABLE
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Appliratiun for Di_rpuuttl Workii TonMrnr#inn Vrrntit
Application is hereby made for a Permit to Construct ( ) or Repair (�n Individual Sewage Disposal
System
. / .......................................e ••••••--•---•-•--•-••-•••••-••--•-•••--•--•-•---••-•-•----•-......•-•-----------------------------
..
Lo on-Address or Lot No.
11Z/ t-�
...........•••• . ..................... ----•- • . ..----- ---........ ...
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 ( )
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 ( )
~' Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water.....................
f3� Test Pit No. 2................minutes per inch Depth of Test Pit.-------_._.__...--- Depth to ground water........................
/1 ---------------------------------------------------------------•-----------------------------------•---------------------•-•-----------------------•---.-----
0 Description of Soil.c.,1. '!
{ U ---------------------------------------------------------------•---------------------------------------------------------------------------------------------------..._..._..... ....-•---------------
-----------------------------------------------------------------------------------------------------------
V Nature Re airs or Alterations—Ans ver en applt ble._.111c � -_.. I._•_____ ___
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 Compliance has bee Is by the board of health.
Signed ....6l�,. ....... C.
Dace q
Application Approved By ........ ....�-.. .c°l..'-.....1
- _............................ Dace
Application Disapproved for the following reasons:, --------------------------------------------------------------------------------------............-----------------------------
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------
Dace
PermitNo. .. >1---�..---L�---�--------------------- Issued ............................_.... ... ...............
Date
TOWN OF BARNSTABLE
LOCATION. �� j/I'1� , �"- j SEWAGE # 3
VILLAGE C, ti+�-,. L ASSESSOR'S MAP LOTVM-110,
INSTALLER'S NAME & PHONE NO.R 01 i 4
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) 94, t'l `� (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER_
BUILDER OR OWNER ,
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
V Pr'tftrate of TontlTtianre
T IS S T CE TIF , That th .Indiv'dual Sew-age Disposal System constructed ( ) or Repaired
by I G /✓� U7j � ------- �'U./ - -------- ..
at .?c,? ...... .......................... .Y1.7.pGG-j-�e----- ------------------------------------------------------------------------...._-------------
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. .___._.__.------.j��..��... dated ..._....
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISF..CTORY.
��
DATE.- ''.... .............—` 7.... Inspector--^ --.. ....................
------,—_-- _ --- ----------------------- ---------------------4-------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
C� TOWN OF BARNSTABLE
No..../... .. ..... FEE �J_.�••••.
Rapnli al lu -Tuntr0Uan-Vautit
Perrriissidn is hereby granted.�-._...:__..,._.T_.._.�� G>7l�iGGl/<c
i. .. . ......•••......
to Constructs( ) gr''Repair ( an Indi 'dual Sewage Disposal System
at No.. �? �_.... ..:.. rt11.t2---- =-------- _i'C7"�` cl/---.---
•---• -••••......--
Street �yj� Q
as shown on the application for Disposal Works Construction Permit No./-t_33_e'___ Dated.........4
............................ ......................................................
Board of Health
DATE. ..... �.... �".
- I
' FORM 36508 HOBBS Q WARREN.INC.,PUBLISHERS
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No...7 y__3 Fizicia.:. ..........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
3j 5?/TOWN OF BARNSTABLE
Apphratiou for Bir ootti Worko Towtrnrtion Vrrmit
Application is hereby made for a Permit to Construct ( ) or Repair (,45"'an Individual Sewage Disposal
System at
..... .. ............................................... ...••-------•-------------•--------------.--•-.------•...-•--••----------.---------..•----....--•-
Lo on-Address or Lot No.
'- -- ��==�°.............................-••------ --- ------------••-------•----•-. -....._ ..... --------
caner
Ln-.---.-• - Q ............... �' I� l(/ -(v--t--------01--r.---/Q �dr -
--.. .....
Installer Address
UType of Building Size Lot---------.......--..........Sq. feet
Dwelling— No. of Bedrooms-__________.j__________________________Expansion Attic ( ) Garbage Grinder ( )
'k Other—Type of Building No. of ersons____________________________ Showers
Pk g --------------------------- P ( ) — Cafeteria ( )
dOther fixtures ---------------------------------------•--..._.._...-------------•--------------------- -
j 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_-____-_-________-___-_.
L% Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
a --••------•-----------------•••--•--•-•••-•------•••--•••---•--------•----------•------------------------------•----------•---•--------•------------
0 Description of Soil.
U ------------------------- -----------------------------------------------•----------------------------------------------------------------------------•-------------------•--------•------
-------------- -------------------------------------------------------------------------------------- -------- - - - - f --------
U Nature Re airs or Alterations—Answer when appli ble__ ------------ __
Agreement: 6
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 Compliance has bee issu by the board of health. 3
Signed ....�/� /....i..... . ....................... . . ........ ..................
Date
ApplicationApproved BY - --- ------------------------------------------- -------------------------- --------..
�� Dace
Application Disapproved for the following reafonr: ........................................................................................
.......... . . . ........................................... . ...-....... .................. .- . . .......................-.....--.......... . . ----------------.-------------------
Permit No. ...... - 3.- --6-------------------- Issued . D ate
Dace