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Home My WebLink About0015 GREAT MARSH ROAD - Health (2) /fi e InaloA �--- r, u W' A ohn Le Mm., ns . y qqrr F�s..... �?.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiaan for Dispas al Works Cfaanstrurtuan 1hrutit Application is hereby made for a Permit to Construct ( ) or Repair ( V/ an Individual Sewage Disposal System at: Location-Address or Lot No. _...L .4 ..................................................... -----------------.-�'`�:�............................................................. Owner` �� p ddresi r.. . ---• ........ . Installer ti Address , Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms....•.......................................Ex Expansion Attic a g— p ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ------------------------------------------------•-----............................................................................................... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity/0 ...gallons Length................ Width................ Diameter------------.... Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No---------I---------- Diameter.'.X(-_--___- 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-----------_............ f.T Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ w' -------------------------------------------------------------------------------------•---------- •--------------- --•----------------- ODescription of Soil ..... .. ...................... -..............................-------------•---.....-------------------............•--- U --------------------------------------------------- •--------------------- .---------------------------------------------- ---------------------------- -------------------------------- •--• r ----------------------------------------------------------------------------------------------------------------- -- ------------------------•------------------------ U Nature of Repairs or Alterations—Answer when applicable.____: •..__C' n......... .......... L�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—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i rd of health. l i .-�^---� ---------- --.......................................... ----- Signed 1 Dare ApplicationApproved By ----------- �----------------------------------------------------------------------------- ------`C1 Dace Application Disapproved for the following reasons- ------------------------------------ ---------------.............................................................. .................... .................................................................................. .................................................................................. ..... ........................... ..... .. Permit No. 91..a- ' Y.. ................. Issued .............. Dace.---------- Dare V// THE COMMONWEALTH OF MASSACHUSETTS 4 BOARD Ol HEALTH TOWN OF BARNSTABLE Appliratiun for Bi-4paiial Workii Tumitrnrtiun 1hrmit Applicati`n is hereby made for a Permit to Construct ( ) or Repair ( V�an Individual Sewage Disposal System at: .........�5" .G:�-�-�.....(..'!�r�� ..�.�................... .............. ....��-��-��J? �a M Location-Address or Lot o. .....--•-\-•-`-...-------••-•-\G� a G�SS . --•------------------......................... -•---.....-----••S_c Gv� ..........................................................�.... Owner l f Address d C1 C� s n�S------------�-----•--Installer Address vType of Building Size Lot............................Sq. feet �-t Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a4 Other—T e of Building No. of persons............................ Showers — YP g----------------•------------ P ( Cafeteria ( ) dOther fixtures -------------------------------------------------------•••••-•-----------•••••......... ............................................................. W Design Flow..................................JJ.._.._...gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacityl-�Q0-__gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No---------- Diameter._�_X(...... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( L-f Dosing tank ( ) '-. 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........................ O Description of Soil 1 ...... ----------------------•---••--•----------- x w - `- UNature of Repairs or Alterations—Answ r when applicable-------.G- --__-__Q n---•_____-�-- 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 i bo d of health. Signed �� .... h . Date Application Approved By .......... -�,, �,. )------------------------------- �— ---. ...---��—ice e ��-- Application Disapproved for the following reasons: ------ ------ ------------------------------------------------------------------------- -------------------------------------- -----------------.---------------------------....................................................................................................................-.---.--'---..--..---.. ........................1------............--.---.-------------- Date ......... .... Permit No. -..... ..- .` .-... Issued ------------ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE r Tertifirate of Tomplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ✓) by-------------------(' G S---------ems � ^s..... . -- - -------------------------------------------------------I---------------------------------------------------------------- ------\----__� - a..- smiler at ------------- (-5 .....�.s e-e�� r'V S\, �G. ' Cttn C r I�L `e ---------------- 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. .......a.-..y...gS.-T------- dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. . } DATE.................................... IC Inspector ....-ri ------------ , ..- ✓a .............. ?-1--.... E' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �� uu No..... TOWN OF BARNSTABLE :.-1._��.� �..."-:.... Disposal Workii Tundrnrtiun ramit n� ss c co.'( Permission is hereby granted------ r11 ---- F•---------- -----------------............................................................................. to Construct ( ) or Repai ( ✓) an Individual S .wage Disposal System at No.. lS ��-00. t" Gar.S = Street qq,, L// as shown on the application for Disposal Works Construction Permit No.!-a ---------- Dated.......................................... ...........................•. -------- ,--------•--------------•-------••- DATE----•-------/_.n-- .. ....................................... Board of Health FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS