HomeMy WebLinkAbout0050 CAMP OPECHEE ROAD - Health (2) alo � , 53
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for BioVoottl Workii Tonitrnrtion rrrmit
Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal
System at: i
oc ion-i\ddr• o�Lot No. _
Owne � C j lz e � r ss
,
Installer Address
d Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms______________________________ __ _Expansion Attic ( ) Garbage Grinder ( )a Other—Type of Building ____________________________ No. of persons---------------------.------ Showers ( ) — Cafeteria ( )
Q' 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-----------------•----•--------•--•---
a
a 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........................
1:4 •--•----•----------------- --------•------•••••-••-•••••-••-•-----------•---•--------------- --------------------------------
----•---------------
��1 -------------------
0 Description of Soil----•-• •--•--------- _
U =
r�Wi ----•--------------------------------•-•---------------------------------------------•-••----------------------------------------- ............. ................... ------•-----_
Nature of Repairs or Alterations—Answer n a 1•ca ...
_e-,S___ ..-__mdr __.__
----------------------------- T _4- ..t ----------` ` t to 1 = �.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Envi(ia�
ental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Corn e has-been issued by the board of health. `Si ned -� � (. -/l !1 � ..
g ----------- -- - ---------- --------------- -......................................
Dare
Application Approved By ---- ��...-, r`--�-.. `........--.._... ......�.� Due
Application Application Disapproved for t e following rea.tonf: .. ............................ ....... .................. ---------
. ...... . ..................p................./.......... .............. ............-............... .... ................................... ---------�j ' --�-'�----
Dve
Permit No- ------ - Issued ------- �. --.- - ....
1
Iy Dace
............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Bi-nVooiil Workii Tonotrnrt"inn rrrmit
Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal
System at: r
oc ton-Addre /� / I—
.Ca, .\..... ....� �`_. ..�............................. l_GC � e h)4t So. 12-0
Owne`
�L� .
.... 5 `5�55 Y_____S___C 0 _.
Installer
� Address
VType 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-.._____-.___-__-.___._-
(s. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
W ------------------------------•-••............-•-------•------....•---------•----......------..............----------••-•--••••.......•----....••••••......
DDescription of Soil------. ....... ......---•----- ------•--•-••--.........C--------------------------•---•-.._...---------------•-•---•-----•--........._...----
x 7`a .
W --••------------------------•--------------•----------•--------•----•------------------------------•-. ----------------------------
Nature of Repairs or Alterations—Answe-r win aP�Plicable............._.. ems_______....._. ..__
Agreement:
The undersigned agrees to install the aforedescribed Individual"Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Enviro ental Code —The undersigned further agrees not to place the
system in operation until a Certificate of Com, iance has been issued by the board of health. q
Signed ..., `-;------- ? 1 ..
Dare
Application Approved By ........._... -----------------------------------------...----------------....._.......: L.l..'.a_r�l..y.
Date
Application Disapproved fort e following reasons- ---------------------------------------------------------------------------------------------------------------
--------------
.................................................................................._........................._....__.........._........................_................................................... 1 t —
Permit No. .....q. y......6.5 --------- ------ ---- Issued -------IJ...' a .`.f."._-1. ...........Da
Dare
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Cer#iftrate of Complianre 4�
T" IS TO CEO TIFY, That the Individ>�al Sewag. Disposal System constructed ( ) or Repaired ( )
�-v L.. \\e w- r c S
by .... G_. c�...�._.....------__....---------------....------._---------- ------------------------------- --------...Q----------------------------------- --------------------------
at ..................................... 0..._.......�� \................
..... �-- --Install, .............��'� - - - - ............
has been installed in accordance with the provisions dt TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. -------- _-.. ..... dated ------------------------------------------- .
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE_........ ,, - ------------- Inspector -/y2� ,�/ --------------------./------------------
------------------------------------------------------------- ------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE d
FEE. --•---•--•---••-
�i��rosit� or��on�tr�trtio�tt �rri�tit
Permission is hereby granted e` ••-- ..... ...........................................................
to Construct ( ) or Repair ( an Individual Sewage Disp sal System
at No. C
Street u
as shown on the application for Disposal Works Construction Permit No�-il -/0Sy Dated......... ^.a...��.`1......
......................... J� T,-�J.l-
aBoard of Health
DATE.......... .................................
FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS