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Home My WebLink About0218 FIVE CORNERS ROAD - Health (2) Q 00c, C&-rv'ncf I 12.E . . w. 0-77 Al 7f- THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH �p b cc'' ..........T.own. :...............OF....Ba=table...................................................... I Applir atinn for Disposal WorkS Tonstrartiun Vamit Application is hereby made for a Permit to Construct (X� or Repair ( ) an Individual Sewage Disposal System at: $..F ig... i2rneru..Rpod.a...!ea :termille---- ----•! t••.#2---••-••-••......••----. :..._..... .... - Location-Address or Lot No ........J. ejs_.Y.---3mith--•-------------------------------------•----..... ......Baxnstable................................................................ Owner Address ........Vett%ring..3.r athems.......................................... ......Barns t able...------------....,......_..----------.......-----......... Installer Address Q Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms................3.........................Expansion Attic ( ) Garbage Grinder ( ) WOther—Type of Building ............................ No. of persons...........6_...._.__._... Showers ( ) — Cafeteria ( ) Other fixtures = ................. :... W Design Flow:.............59t.......................gallons per person per day. Total daily flow.......3 ............................gallons. RS Septic Tank—Liquid capacity!OOP-gallons Length......4------- 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,(Al Dosing tank ( ) -7 ^ o `-%-7. Percolation Test Results Performed by.......................................................................... Date.................... •----------------- Test Pit No. 1_:__�____....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...EO-= A ---- .......... .....a\_%Sc0L....... `. qk..)...!%1 3b - vm•D--...S. i 45t i T ....................••-------...----•-------•------•---•---••--•-•--•--•----.-•-- 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 TITLL4 5 of the State Sanitary 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 b . Date � Application Approved By....................... ---------- ------- Date Application-Disapproved for the following reasons---------------------------•---------------------•-----•------------------------------••--••-------- •--•--=•- ---------------------------..••-•-•----...•-•-------•--•--•---•-----•---------•-•-------••••----.....-- ............................................7 ----••.. .� �- --- -7'----------------------------- Permit No.................•------------------------- Issued l j Date Date No............�...P.. �� t,_ -� Fims...... ':y. � .. THE COMMONWEALTH OF MASSACHUSETTS 3 BOARD OF HEALTH 10� OF..................... . ....�arY1�;��..?Z�.... ..............---------........._...----------- AVOlt-rutiun for Uhip sal. Works Towitrurtiun Prrutit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: ................ive........................................................orners Roa . nrville lot �2 .. -•--..._._.....-----........-----------------•------------....------------------.....4...------•-- Ja.es K• ,o�,ca�tllon-Address Barnstable or Lot No. ............................. ... ............................................................ .................................................................................................. Owner Address w 7eterino Brothers Barnstable --------. ........ Installer Address PQ UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.................. ....................._...Expansion Attic ( ) Garbage-Grinder ( ) Other—Type T e of Building ............... No. of ersons_....._....6..........__.. Showers p., yp g ------------- p ( ) — Cafeteria ( ) a' Other t res ---------------------------- WDesign Flow............... .........................gallons per person per day. Total daily flow------Z.0.............................gallons. WSeptic Tank—Liquid capacit ........000._.gallons Length------4........Width......8....... Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area___••___--------__--sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... of}beaching area............._....sq. ft. Z Other Distribution box (AO) Dosing tank ( ) 1I I r" 7.7• c Percolation Test Results Performed bY---•-•------•--------•--------•---------------•--------------------------- bate........................................ Test Pit No. 1.... 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........................ x ----- O D scription of Soil �" 1�LD !.-L` ��°�l ..........................................! • W__ �t W ------------------------- UNature of Repairs or Alterations—Answer when,applicable-•__,................................:::...................................................... -----------------------------------------•-----...--------------------------------.. Agreement 1 The undersigned "agrees to install the aforedescribed Individual:Sewage Disposal System in accordance with the provisions of TITIZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued 1 the board of health. «� ---- ....................................... ApplicationApproved .------ � . ___.____...C - � +k Date Application Disapproved for the following reasons----------------------------------------------------------------------------------- .................----------- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF` HEALTH � ...............OF. r Tr0if irFatr of Tompiianrr .� THIS IS TO,CERTIFY, That the Individual Sewage Disposal System constructed (K) or Repaired ( ) by..`..wrtp c rya j .....t�S........ ------------------------------•----........----- at. ..0 T , a + " ' t nstall '...................................................... has been installed'in accordance with the provisions of T j of The State Sanitary de s described in the application for Disposal Works Construction Permit No. ,'�71----------------- ...`.......-...•----•--•-------- THE ISSUANCE OF THIS CERTIFICATE SHALL`'NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. � DATE.'............................................................................. Ins pector............................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 71' / �• 1.,C�UON)+................OF...... 1. � a' 1'` .. ..----------•-------...------ y '/ ,.....,. No ........... FEE...................... Diuvu 1 Works _ janitrudiun rrutit Permission is hereby granted.... Q. ' Y'i �� ' to Construct K) or Repair ( ) an Individual Sewa a Dls os stem at No. = ••.Z. --- -......_ 1 .C?t 1 �' ±. 1�.1..L Street as shown on the application for Disposal Works Construction Per No ,../_..__ Dated`. 11...�.................. Board of Heal ' DATE.................................................. r FORM 1255 HOBBS & WARREN, INC., PUBLISHERS � l - t..�� 7 '�:., "'� c`if��K � '�', "'A�yy §f�f sir' �`� '� •.ar - r 'r`:i •�.e ;••�3 r .-��°' {• :7 Z r �' "+, y 'L: .: i� u !'+' �'. '„"'N '0i-s%re,;ram c''i. `y y T '�e., "'z-. "' r: F.r�r +• -. .1 .3�'•,._ � ,A, �. R'f.�,,. .4�.��./i`�-�cu.+�.,;� a, .s '� .�_.a_`.'`F_>�"��"- �.:"yP 'i�i..c�§ ,. k-'� .-( '��,3:"!` ,;;+ �t" .�.,. .,,�• �r"^ .. 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