HomeMy WebLinkAbout1842 FALMOUTH ROAD/RTE 28 - Health (2) 1�lq
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THE COMMONWEALTH OF MASSACHUSETTS
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epdrt: BOAR® OF HEALTH
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TOWN OF BARNSTABLE
trtt#to&fur Elhipoua1 Worse Tonotrurtion rjerutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
..................-........... .........................................
..........................................
Location.Address or Lot No.
V(Zt 3 AC V_L''�
•------•................................... ................................................... .............................--
Owner Address
a �i C � hSEf����
.An
--•- q;
Installer Address
Type of Building Size Lot............................S feet
Dwelling—No. of Bedrooms............................................Expansion Attic (IJO) Garbage Grinder ( )
`4 Other—T e of Building a yp g ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
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........................................
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......---...............
P4 .----------•------------------------------•----•--•••--------•-•-••---------•••...-----...-•-•-.._...--•--...--•--------•...-•-•--------•.....--•--•---....--
0 Description of Soil...............................................................................-----------------------•----------------•---------------------...-••---------•••.....:..
x -
V .................................•---•---------•-••••--------------------••-•••-••------•--••••--••-••--•--•-•••......-----•--------••-------•••-•------•••----•---•-------•-•---•-•---•--•------------
W
----------------------------------••--•--------•-•••--•••-•--••-•-••-----------•••-•--------•-•-••-----------•-----------••-----••••------•-•-------••---------•-----•--••.....-----•••........----•--•
U Nature of Repairs or Alterations—Answer when applicable-------APP_-__ r ---..:�-_-�At-_.'�D--_P!_5�......._.
.....-------•-••---•-------•-------------------••-•----•--••-------•-••------------•••-•--•-••-••.................
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—T ndersigned further agrees not to place the
system in operation until a Certificate of Compliance has been isXy&by
the bpajo of health.
Signed-, ..---- --- ------
Date
ApplicationApproved By ---------- �.�.^ - -------------------------------------------------------------- ------/.-..�6
Application Disapproved for the ollowing reasons: .......... -- ....-- ----
= ------ ------- ----------ate-----------------
9f D.-...-.7..... -.. Issued
Permit No. .....��-
Date
k
No....2 ... 7.1 F�$......3.... ...........
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
;TOWN OF BARNSTABLE
Appliration for Uhipviial Works Tom5trarthitt Vrrmit
Application is hereby made for a Permi4o C'gristruet—("") or Repair ( ) an Individual Sewage Disposal
System at:
( 5�{2, T 2F��t���., �( rZs7
•.......................................Location.-. ..........................................
.. .........._....._._........._......_.._......_........._....._........._...._..._......_.......___
Location-Address or Lot No.
fw 3�I�>� 1�.LcKLI�f
Owner Address
_._.�... VT>Z--•.... •.._.........•...............•---
Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling No. of Bedrooms............ 2- .._..Ex Expansion Attic
� g— ----------------------- p (h{o) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria.( )
� Othe:fixtures .....................•-•------•---•--•------•---•••-----...•-•----------•.......----------•.....-••-•--•-••-•-•--------•........._........••--------
W Design Ffow............................................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. 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........................
t4 ....•-•----•----------------•-•---...-•••••......•••--- ----------•---------------------------------
--------------------
•---------
--••-
0 Description of Soil..................................................................
------------=-----------------------------------------------•--------------------•-----•--......-•_..
x
W
x ---------------------------------------------------------------------------------------------------------------- �........•-----•-•------•--.---------------------------•--.
V Nature of Repairs or Alterations—Answer when applicable_____}q . __ -__.- Trt�1 e___ tl....�:.�:............
------------------------•----------------------------------------------------- ......................................
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—Th findersigned further agrees not to place the
system in operation until a Certificate of Compliance has been is old b, the b a 0 of health.
Signed - -` ----------------------------------
Application Approved B e
pP PP Y -..... -... �= ---------------------------- -- . ...9
Date
Application Disapproved for the ollowing reasons: ...... -- ---------------- -- ----------------------- -- ------------- -- -------------------------------------
.. .. .................. ...... . . ---.........------.-- ...---- ............. -- .----.......... ...........--------------------------.... ......................-----------------
Date
Permit No. ......
... ........... ... m Issued -- ------------------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
TPrtif rate of C�lany1ianre
THIS IS TO CERTIFY,That the Individual Sewage Disposal System constructed ( ) or Repaired (��)
by.................. ...(7� ....&.; 2,.
--..... 4Innsale,
i 'h- ----------------.at .................. � ' .
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. -.......� ............ dated ------------------------------------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
(�
DATE.... -----------Y j-----.- .....�..� ........................ Inspector ..............................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�J TOWN OF BARNSTABLE
No.../.................7u FEE...: ....
Permission is hereby granted........... ee ----------------------------------------------------------•-•-----
to Construct ( ) or Repair ( an Individu` Se�rage,Disposal System n,
at No..••-•••-••-•-......� =------.F.. .t � aX---.---------------f�.�G�Q"',A
Street ec�,
as shown on the application for Disposal Works Construction Permit No.._.C"6_r f i Dated..........................................
.............................. r ...................................................
/ ( ) Board of Health
DATE------... ( ................................... �,/
FORM 36508 HOBBS&WARREN.INC..PUBLISHERS