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HomeMy WebLinkAbout0036 COTTAGE LANE - Health (3) Ol . (" v J A= wj r r � 99 /FEB THE COMMONWEALTH OF MASSACHUSETTS / �- BOARD OF HEALTH Cv TOWN OF BARNSTABLE Apphration for Diri uua1 Works Toutitrrirtiuri ramit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: .............. ...... ......-----..._......--•- ................... C -- �. .... ..... ---•-- Location-Address ----or Lot No: Address Installer Address �� a3 UType of Building Size Lot......................�.Sq. feet UDwelling—No. of Bedrooms.................---------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ......................... -----•-----------•-•----•----.------------------------------- ----------------- W Design Flow......._------_-...___ ---gallons per person er day. Total daily flow_..__._.._...____.......P.................gallony. SeptiDis osal Trench Liquid capacitI/ 7T- -Mons Length__> _ ". Width--- � ...�Diameter---_------------ Depth.... .J.. W ispo Tank nc - No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. x T n --......3 Seepage Pit Iv o._......�....-...... lliameter._.�.._ Depth below inlet..... Total leaching area,/e0.:-<.sq. ft. Z Other Distribution box ( ) Dosin tank ( ) �. ''" Percolation Test Results Performed b �_._. Date.__.._ .. z? _S. .. Y ... -- ----�•------ ..// - 1.4 Test Pit No. I___._w_minutes per inch Depth of Test Pit--- ."-__- Depth to ground water_../ ? 6-10.4 (s, Test Pit No. 2....._.. ...minutes per inch Depth of Test Pit./-S-7-___.�... Depth to ground water...... '._.. 9 ..........................................................................................._........_.r......_................._..__...........c............ . ................... ...._._.._..__.Y.+ ....vvQ D Descrl tion of Soil--- � Q ��` `✓6 nit. T7 .. � = ............ x -!�2-..................------•----------------•-------•-----------•--------------••••--•••-•••••••••-..................•--•-...... U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ................... ••-•-••....•-•-••••••••••--••---•-•-••••-•-••-•-•-••-•-•••----•....................•-•--•••....._._.........-•-•-•--•---•-•••---••-•••--•••••••-••......................------.--••- Agreement: The undersigned agrees to install the aforedescribed Indivi ual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Envir ental Code The under igned further agrees not to place the system in operation until a Certificate of Co Ian h s een f sued by the oar( of health. U ll'~ S (� ... .. ............................................. ......Signe ..... .... ...... Date Application Approved By ................. ............... .. s: Dace Application Disapproved for the following reasons: . .... ......... .. .............................................................................................. ...................................................................... . ............................. ..... ...................................................... ........................................ e� Date PermitNo. ............/ -- ----...--- ----..'.. Issued ... . ... .............................................. Date ------------------------------------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE U-Qrtifi ate of Contlatianre THIS IS O CERTIF hat the Individual Sewage Disposal System constructed or Repaired ( ) by ......................... ..................................... �j lnsra er ...... at ............ ..G .-f. �1 ' 1`�-..... .... ..- .. -...... ....... -... ...�..,,D. .... .----- .............. f +� �'� has been installed in accordance with the provisions of TITLE 5 The State Environmental Code as described in the application for Disposal Works Construction Permit No. ...-_.�.--V .---/...I..C.... 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.....1.®�.... ....... �iu�ruuttl ur�u �uriutrtiuri �rrnttt Permission is hereby granted------------ ......................................................................................... to Construct (>2 or Repair ( ) an Jndividual Sewage is osal Syst Cat No.......... ......... Street as shown on the application for Disposal Works Construction Permit No._ /(4'__ Dated.......................................... •-----•--------•--•----••-•-••-•-•--•-•---•--•-------------••-•---•-----•---•--•••......--•---•-•••---•- Board of Health DATE-------------------------------------------------------------------------------- FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS f ..+«ew,'k1�diJ.�r+irv`:�l'i�+�'.�i��,'4*'.�,'1.`.�"+..�C.!`�r�w•�•#�,,;�7 a..�K.:�,i��.�R�'1�:�"„�yr �}dsSiM..i.&}.'�h;:..t>r,?:�r"�'�^'ti..f...,::tw',�."-'+.�'.=t`ra;.: fir-�-_..._-.��,_� �.� 4 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Di;ipai3al Wnrk.6 Tomitrurt"inn ramit Application is hereby made for a Permit to Construct (! ) or Repair ( ) an Individual Sewage Disposal System at: .........�.--�--- ...............CT�-��-----.... ---�....----_-------_---- Location !- ........................................ .. ••... -Address or Lot No. ......................_._ i................................... W � !`ssner �r Address........................................... I d Y 4 -t6 Installer Address UType of Building Size Lot................ feet Dwelling—No. of Bedrooms........-------------------------------- ---Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) d Other fixtures W Design Flow...............5 _..___............gallons per person er day. Total daily flow.-_.........__.......��. .................gallons. WSeptic Tank—Liquid capacitv/.�r_gal Ions Length__.e"_ Width---- ...Diameter________________ Depth....K:_.�. `, x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No--------/----------- Diameter._-/a.......... Depth below inlet..... : -_- Total leaching areale,F=_�'sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by .................._. .-r- Date........................................ a Test Pit No. I-----V _minutes per inch Depth of Test Pit---- _�.-�._.. Depth to ground water... �S.lr� fi Test Pit No. 2.... Z._._minutes per inch Depth of Test Pit-_/--S-`-- Depth to ground water......(/_/ .. 9 ;; .................. ....•----•----.. ----..... D Descri,tion of Soil.-- ---.....Q.:��.�f.-- �f..../.S�l 5`�.= 1 ! '^ t...nG:a!T • V :;y --. P.I!t::�i _4 .......: .u/. :..............................•------•---------------------................. ---------.............._..- -------- -...... U Nature of Repairs or Alterations—Answer when applicable.__.-___..._...............................................................................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 l��The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the �oard of health. t Sign .!...�!!._(,' .�:.�.-- --; .1?.�: ��..... ......�.....��......�..:...... Date Application Approved By ........................................ . .t e..,.�> /...................... ...-- ecz ... ./i i.` �.j. Application Disapproved for the following reasons: ... ..................................................................................................................... ....... ... ....... ... ' . ............................................... ................' ... .... ' ......._................................_..... .. . ........................................ Dace PermitNo. .... -../.. Issued ........................................................ ...... ............ Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE - C�ertifirate of (gIImplian e THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( -) or Repaired ( ) by ...............- y L ...--------_.....-----..r..__...._.................................................. ... ............ ................_......._.............................-- Installer p at ............�� ,---------- .._.;-, -5 "--1I . r�,<�t�t. �....,1! U.. ........... ' .: tee.. n"_Q-A---------------------------------- has been installed in accordance with the provisions of TITLE 5 yf,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 // No .. -..!-•l-� FEE.......��........... �i��rn��tl nrk� �>an�tr�rtilan �rrmit Permission is hereby granted...---------��e��r ��r���`��-------------------------------•---._..............--------•----------•-•--.........---.... to Construct or Repair ( ) an jndividual SewageJ,/Jr'�/is sal Sy-syt��e/m �.rf//����//CAI /^+ n - r '� f --------- �----•--•-- - et ( �. Street as shown on the application for Disposal Works Construction Permit No.----- -- Dated........................................... --......•---•----•-•---•----...---•-.---••---•-•--------------------•.-----•••----•-----.....•---•.------ Board of Health DATE.------•---------••-------------•----------------- ---•-- FORM 36308 HOBBS R WARREN.INC.,PUBLISHERS - } fi"' , .� a } ,.�.: a� .""ri,,;a°,T?, �'' '.R�a .•.{ a x - u?e43ar-.:.-� .�,-. 0 t ��'�...r.. 'P h.:-.' -.. ,. f 'N}• t9 -1', : .4...., v' N 1�y . ;x- gz,a�; �i?'wEY��T�`a�+�.mai.:.'�:'� %5„'. t.r`�'� 'a .,�-'•� .-ra` ?§:.. yrss 'F: g»:x _ I.ov ti'ZorJ rc ;� Q �r Al 3 c, y.ls-r a A0,, • l - d j"' � � ZM ✓v I � j f,4H T {{{ tiles"--s ley et 1 � �o��. z� � 3 PI� P�rGrF� �1 e/FT u►J�.eSs aT�FF�l�11SE (.1oTC'D; C.ASNe�— _-44 5. PIM JoIN1S S►+aL.L PW Mares L.ILTSW-'r'iCO+T. co Go�lsr�uc-ticr.L �Ta.ILs Tb P-E lai acccy2�►�11�E t�11 TT� � ,. 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