HomeMy WebLinkAbout0007 COTTAGE LANE - Health (2) ��J _ o 00�
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THE COMMONWEALTH OF MASSACHUSETTS /F
BOARD OF HEALTH
TOWN OF BARNSTABLE
AVIVfirativit for Diri wial Works C ontitrur#iun JIrrmit
Application is hereby made for a Permit to Construct (jO or Repair ( ) an Individual Sewage Disposal
System at:
-•••••-•••.....�-�•----.....�...-----------------------•-----------°�- ` ---.----�z�. --------------- ------------
Location-Address or Lot No.
ya -----------------------------------------------
Installer Address
d Type of Building Size Lot........... ......Sq. feet
g— ------------------------- p' ( ) Garbage Grinder ( )
Dwelling No. of Bedrooms______________ ...__Ex Expansion Attic
aOther—Type of Building --------- ----------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
dOther fixtures -_............ ........... ----------------_--._..-----------------------------..........--------•---------•------••----•-••----•....._--••--
W Design Flow................ .>"�.......... ..........gallons per person per day. Total daily flow------------- ..............gallo s.
W Septic Tank—Liquid capacity.1.0�Pgallons Length----jft_� .._
"'Width--____....g1, Diameter................ Depth..- •.-.......
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area.....................sq. ft.
3 Seepage Pit No------X............. Diameter._�9-__E�` Depth below inlet_...��: ....... Total leaching area.....:S.sq. ft.
Z Other Distribution box ( ) Dosing tank ( ) r_
aPercolation Test Results Performed by... o- K__.. P ... 1-� �"{ 4rt�l te.........i. ,
Test Pit No. I---`_._._minutes per inch Depth of Test Pit......A..5`�._._... Depth to ground water........#-1.�/A.....
(s, Test Pit No. 2....k.v..minutes per inch Depth of Test Pit------ Depth to ground water..........i,4- 4--
P4 .................................... .................................................
•--•--•. ---------------.....---•--......... �r --.•.....DDescri Description of Soil`�►..�....--•o " .r? z�
..0� e � � �... ...------------------ -----.0 , ._
W
UNature of Repairs or Alterations—Answer when applicable...............................................................................................
--------------------------•-•----••--•••--•-...................-••-
Agreement:
The undersigned agrees to install the aforedescribed Ind}'� i al ewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environm tal Code(— h undersig ed further agrees not to place the
;.;
system in operation until a Certificate of Compli e has b en i ued y the bo rd of health.
Signed ..... ._ 2.-! 1
... ....................... ....................... .... .... ......... ........:......
Dace �J Application Approved By ........... .�.. � -..........._................... .................................. `3..—.����..-. /
Application Disapproved for the following reasons: ..... ........... ........ .... ........ ................. ......._.....................-- .........
....................... .......................................................................... .... .... . ........................................................... ........................................
PermitNo. ...... .... ........ ...... ...................
Issued .............................................. .. ...D�e......
Date
—________________— ____——__._____—_—___—_—___————_______——.____—._______———__
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of Compliance
THIS IS T 0 CERTIFY, That the Individual Sewage Disposal System constructed (y) or Repaired ( )
by ......................... ... ........-Cam.................... .........------- ......
lacrdlcr�i � n
at .-� ... ...A j ........1 - --_.../ ............. ............................... .......
has been installed in accord�i4C'e with the—provisions of 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 -------------------------------------------.------------------------------------
-------------------------- ---------------------------------------------- -
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
FEE----� .......
�i��r��tt1 irk �ti��#r�tr#ilan �rruti#
Permissionis hereby granted......... -----------------------------------------------------------------------------•---.----------•-•-
to Construct (�6 or Repair ( ) an Individual Sewage Dis osal S stem
atNo.........L, ------ --------4D............ --------•---
Strcct "
as shown on the application for Disposal Works Construction Permit No j_ ._�,9Dated.._.__..'.....................I.............
••-•-----•--•----••-------------••••-•••-----••••------------------••••--•••---•------........•••--•-_...
Board of Health
DATE.................................----------------------•-----------------•-----
FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS
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THE COMMONWEALTH OF MASSACHUSETTS
F f BOARD OF HEALTH, -
TOWN OF BARNSTABLE
Appliratiun for Diripuial Works Tontitrurt"tun Frrmit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at
...............�:o.....---•--•-�-------•-...--•--'----------•-•--° ............�-----•-�.....-----------•--•-----------------=----
.-----•-•------.....--------•
Location-Address or Lot No.
/a a ..r. G ,..... --------•----•---------------------------- -----------••------------•-----------------------
•----------------------
.........
...............a »
rwner Address
S
Installer Address
U _ Type of Building- Size Lot..._-•---..p .._..Sq. feet
Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
dOther fixtures ..............................................•-------...............................................................................................
Design Flow............................................gallons per person per day. Total daily flow------------- ..............gallons.
W . . � f - r
WSeptic Tank—Liquid capacityji2Pfl ?gallons Length.---___�-_�o..Fr Width--.. Diameter---------------- Depth-.' .
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area.....................sq. ft.
Seepage Pit No--------_---------- Diameter..10...�-rS= Depth below inlet...- ....... Total leaching area... n::�.sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
0-4 't om `' c-----C��?€ 1<_ ca b.<<. -,lDate-----:, rY_::�.--'4r.�:_.k-1!71 �(
Percolation Test Results Performed by...........:.:....... .. .. ...-......- ..
Test Pit No. I---`..k-.......minutes per inch Depth of Test Pit-------k5k.'.'. Depth to ground water........a-!.�A.,...
44 Test Pit No. 2....Gv_.-minutes per inch Depth of Test Pit........ Depth to ground water..........t-J.f ..
f ----'---•'.............••••---------'------•-----------------••-•"-----•-----.......------........--•-----•---....---......----•...........-•---------.--•--
D Description of Soil---�•-j2 o.-.` .? . is-1._6.._ _ Z..... 1Sv, •4.c
- -- , •---•-- .A..--�iC'E•----...:r.<..?... EM
"►� ............................................4>e...zna �-.......----'---�......-�.............•r��-�-'-t--5 /.'�_--------- �- �-'L t-------u t .�
W
UNature 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 TITLE 5 of the State Environmental Code The undersigned further agrees not to place the
system in operation until a Certificate of Compltaln� has been issued%by the boa health.
Signed 1 / 7
\� - --'--......'-...........--................ Date
ApplicationApproved By ................ „< ------- . L.... ..... ....... .............................. . --------- ie.......
Application Disapproved for the follow na g reasons: .................... ...........................................................................................................
............ ...................................... ............................ . .... . .... -- . ............. . .................. .. ........................................
Permit No. ....... ..7...7/..-......I.. ------ ----- --- Issued ...............................................................
D.te......
Dace ti
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
CPrtifirate of Tomplizinrie
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( )
by ................ :,<�E `1 C.,<...-----------------...--------.----- ------------------- ----------....._...........................................................-----------------------------
.�.. Inamlirr�i �, n
at .................� .. .....t) ...... j. _�:.,; -- �.............._1-...-./�� rr� -......L --:....
has been installed in accorda?�Fe with the provisions of 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 ---- .... -... ......................... ..... ... -. ............. ......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
_��.7 TOWN OF BARNSTABLE s
No............:.......: FEE.... ae
,... -••--•----•
�i��uuttl murk �unutri�rtilan �rrmit -
Permissionis hereby granted------... ----------------------------------------------------------------•-------------••------------.---
to Construct (�O�o_r Repair ( ) an Individual Sewage Disposal System at No.........1•-- a...l........�....------....R. �� .;.a ....�60..---•---- P�r�r,!! !. .......................
Street
as shown on the application for Disposal Works Construction Permit No..��--!: ! Dated..........................................
........................................................................................................
Board of Health
DATE--------------------------------------------------------------------------------
FORM 36508 HOBBS&WARREN.INC..PUBLISHERS
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