HomeMy WebLinkAbout0067 CRANBERRY LANE - Health (2) C�`7 C�t,nberr� Cn- � �n�-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
. TOWN OF BARNSTABLE.
ApplirttttOtt for Diuputial Vork.5 Tuttitrurtiun rnmi
Application is hereby-made for a Permit to Construct (e ) or Repair ( ) an Individual Sewage Disposal
System at:
.....................
Location•Address or Lot No.
Owner Address
Installer Address
Type of Building Size Lot............................Sq. feet
., Dwelling— No. of Bedrooms------—3----------------------------------Expansion Attic ( ) Garbage Grinder ( )
p.I Other—Type of Building _r�ut� �_______________ No. of persons---------------------....... Showers ( ) — Cafeteria ( )
P4 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
Test Pit No. I________________minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
LZ4 Test Pit No. 2................minutes per inch Depth of Test Pit--------------------- Depth to ground water....._..................
a • ---------•-------------------•--------•--••-- -------••-----=--._......---•--------...._...----•-------•-------------...--......
D Description of Soil.......uQ� �,{.' ..4------
Ue<.use-------------•-----•-------------------------.---•----------=-------------------------------- ------------....----------------------------------------•-------.....
w
VNature 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 Compliance has been issued by the board of health.
Signed .................. ........................... ........ .---------............. '--
Dace
Application Approved By . . :... "
— Dace
Application Disapproved for the following reasons- ---------- ---------------------------------- .............-------------------.......--------------------------
-' ...... .................... ' .................-------------------------------------------------------------------------------------------------------------------------- ........................................
------- Date
Permit No. ..... �^'..��:_✓�--..._.. Issued ..........
��.
Dare
__---———————————— ___————__—————_______——————————————— —————___—————————
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
C�erttftrate of C11ompltttnee
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by -------------------------------------------------.------------------ ---------------........... ------...----------------
Installer
at ...-- -----.- (---- ----- .. .... ''1 x-------------------------------------------------------------------------------
has been installed in accordance with the provisions of TITLE of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. -. dated ��
THE ISSUANCE OF THIS CERTIFICATE SHALL NO B CONS R S A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE----------------------------------------------------------.------ ---------------------- Inspector
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE-
.....---� FEE..
Vispnuttl Workg Tunutrnr#iun Vrrntit
Permissionis�hereby granted-------------------------------------------------•--•----------------•------•------•--•------•--•--•--------•--•......•-•---•-----......-•---
to Construct,(P/or,Repair ( ) an Individual Sewage Disposal System
at No......lui=�f�.c:Ljtic.f- L&. � ._-}--e-t-v-�_`ie..t A.-------------- -- _...-- -------
- --. Street
as shown on the application for Disposal Works Construction Permit =��r_ Dated----�.'._��....._.�.�-•--••-•---•----------------•------•---- ..........................................................
Board of Health
DATE ......---•-----------------------••-..................-- •
FORM 36508 HOBBS h WARREN.INC..PUBLISHERS
No.._1...7-._`�/-. -i✓ FEs..............................
�
THE COMMONWEALTH OF MASSACHUSETTS
s BOARD OF HEALTH
TOWN OF BARNSTABLE
,���lirtttilau fur ��i���1�tti nrk,� C�a�n��rnrtiun �rrntit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
...........� ............................................................ .. .j
Location-Address or Lot No.
t\PC A.
Owner Address
Installer Address
UType of Building Size Lot............................Sq. feet
.� Dwelling—No. of Bedrooms-------3----------------------------------Expansion Attic ( ) Garbage Grinder ( )
per, Other—Type of Building 'p---------------
No. of persons----------.................. Showers ( ) — Cafeteria
Other fixtures ( )
d --------------------- •-------••-----------------------------------------.-.-.-----------------------------------
•---------•-----------
W Design Flow............................................gallons per person per day. Total daily flow............................................
1:4 Septic Tank—Liquid capacity------------gallons Length_______________ Width---------------- Diameter................ Depth................
` 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. I................minutes per inch Depth of Test Pit.-__----.._______--- Depth to ground water--.-_.-._-.-_-___._-_.-.
4.1 Test Pit No. 2.•...............minutes per inch Depth of Test Pit.................... Depth to ground water........................
a - ---------- ------------------------------------------------ -----•----------- --------------------- ------•---•-•---•••••--•.....
0 Description of Soil_._...�f� `f� � roT �QnP.-mac••-ay- .. ..•---
V ...................................
W
..........-•..... .......................•---------------------------------------------•--••-------•----------------------.---------------------•-----------------.------------__------••-------•-------
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 TITLE 5 of the State Environmental 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 ----------------------------------------------------------------------------------------------- - .......................:.-----
Dace
Application Approved BY '� �2 ;�� ------ - - L''��------------- �'��....i -f"---- -----------
lefirDa
Application Disapproved for the following reasons- ---------------- ----- --------- .......................... . .....---..................
--------------------------- ------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------- ........................................
Permit No. ..... 1....".....�� ----.._ Issued ........- ' - --
.......... .[e......
Dace
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
11trtifirate of (111jampltanve
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by ...................... ............. - ... ...---------- -----------------------------
Insraller
at ........Gi .... . '-- `/ �.... ,n.-rr�'''Lti..F IVI—A... ........_................. ......... .................... . ..... .
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. ... ..r .., ..... dated .3777 ".."".1�G,�
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT Bf CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................ - ...... - ..........._.------------------------------- Inspector ''
———————— ---———----------- ------------ _— ------- -- =---
THE COMMONWEALTH OF MASSACHUSETTS _ —
BOARD OF HEALTH
TOWN OF BARNSTABLE
No. I:-......... FEE ...............
Elisputial Workii Tnntrudinn "rrmit
Permissionis hereby granted---------------------------------"---------------------------------------------------•----------------------------------------•-•-..---.-•---
to Construct (k)"or Repair ( ) an Individual Sewage Disposal System
atNo...... ........... =---------------
Street / ` `1 / / L/
as shown on the application for Disposal Works Construction Permit N __ ____________��_ Dated_-_�.__..-......�_.__
..................
z
...................................•--------•--•-----•-••--......---------•-•....-••.......----•--••••-.
Board of Health
DATE................ --------------------------------------••-•---------------•----
FORM 36508 HOBBS 6 WARREN,INC.,PUBLISHERS