HomeMy WebLinkAbout0432 GREAT MARSH ROAD - Health (2) 9 a 6ro4 Marsi, a, (uq-,
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appfiration.fur Dtvi-tanutti Workii Tomitrur#tun rruttt
Application is hereby made for a Permit to Construct ( ) or Repair (off an Individual Sewage Disposal
System at:
14 i�
Loc tou-:\ddress or Lot No.
Owner Address
aInstaller ------•-----------------------/ ... Ad ess� �C._...L.S
UType of Building � --^�� Size Lot............................Sq. feet
t., Dwelling—No. of Bedrooms_________________V_-.__..________----Expansion Attic ( ) Garbage Grinder ( )
aOther
—Type of Building ____________________________ No. of persons-_-_____._________-__..... Showers ( ) — Cafeteria ( )
QOther fixtures --------------•-•-•--------------- ......--•---------.-----...---•--------------------. ---...---•----••••••.................._...........••--••••••-
W Design Flow................... ----------gallons per person per day. Total daily flow............._ -' ........................gallons.
WSeptic Tank—Liquid capacity Z __gallons Length________________ Width---------------- Diameter---------------- Depth----------------
x Disposal Trench—No. ........./....... Width.....:71------- 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 ( )
aPercolation 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
w
x ---------------------------------------------------------------------- --------------- --------------------------
U Nature of Repairs or Alterations—Answer when applicable.__ �J -__._� � =_�O ................
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 b n is ued by t e b of health.
Signed -------------------- .... . . ...... - /
Date t�
Application Approved By ....................� ....t ' -X- -------- 1-3...:./.4r
Application Disapproved for the following rearons- ------------- ------ -------------------------------------------------- ----------------------------------------------------------
---------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ........................................
Date
Permit No. ---------7.(.!5...........to-F�'. ........ ........ Issued ..........................
Date
c? i�o 078
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Di-lipwial Works Tomitrur#ion Frrmi#
Application is hereby made for a Permit to Construct ( ) or Repair (oC) an Individual Sewage Disposal
System at:
Location.Address or Lot No.
...................... --••--•----...--------•...-----•----••-•--••----••-••••---••••---------• ...................................... =..........
....••......
Owner Address/ _ ••
W Q/�-�O L Erb 1 6-.1 t v-��/C"�-7'..$%J -7(._r� r�_j/I t ✓I/1( C C S
--••••- ----...................................................7 ----•• -•------•...................•-----..........----- -
Installer Address
U Type of Building Size Lot.....................
....... feet
., Dwelling— No. of Bedrooms_________________ Expansion Attic,(1 ) Garbage Grinder ( )
04 Other—Type of Building ---------------------------- No. of persons. —- -.--_- Showers ( ) — Cafeteria ( )
dOther fixtures ------------------------------------------ - --------------------------------------••----------------------•-------•--------
W Design Flow-_-•________________ '__............gallons per person per day. Total daily flow..............
WSeptic Tank—Liquid capacity�� ___gallons Length---------------- Width-_--_-..._-_---- Diameter_............. Depth................
x Disposal Trench—No. ---------Z........ Width_____ _ _______ Total Length.... Total leaching area....................sq. ft.
Seepage Pit No...................... Diameter.................... Depth below inlet-----ff2` _.. 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........................
G4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
C14 -•---•------------------•----------•----••••-----••---••--------•-••-----•--•-......-----•-••------•..............._......................
---................
0 Description of Soil........................................................................................................................................................................
x
U --------•••-•--•••-•----•--.....•--•---•--•••-•-••--•---•----•--•---•---------•---••-••-•------•--•-•••-----•------••-•----•------------•--•-•--•--•---•-••••------------------•...---•---•---•---••-••.
w
----------------------------•-----.....---------------------------------------------------------.-•--- -----------------...----...-•------------------------•--
U Nature of Repairs or Alterations—Answer when applicable.-_.��� L_._...�`U�__5'* ��-./_.!Q)................
'5-
=� CM =._ �_._Qa ?�-. = ------ ic:T.!Z�F�rr✓ts Wrr
r �_ .....................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 is ued by t e boa d of health.
Signed --------------------p 1 � ----/C-�--
-- ------- ---------
Date
Application Approved BY Q. -�� - y�_d� - -........ .
C1 ................................... . .....� - ^j
Date-
Application Disapproved for the following reasons- -------------------------------------------------------------------------------------------------------------------------------------
--------------- ---------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- ........................................
Date
PermitNo. -------�'5 - .----- ......_.._ Issued -------------------------------------------------------D .......
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
'Y'lEICtiftrate of Q-1-ampliMnre
THIS IS TO CERTIF—Y T at theme Individual Sewage DisposalSystem constructed ( ) or Repaired ( )
by ... ....... ........... --In -------- ----------------- -------------.-......-.-............---------------------------------------
Insol Ier
�( z
at .. ...........:............
��—:--------- --lt" ,1vo-It 's N - `- i�...., �f.� I..l_�
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. -..- -1�-- �./�...1?........ dated -------------------------_--------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
1� �� �-1
DATE ....... . ... -�' - - Inspect@ra ....-
-----------—1175 ------------------------------------------------ -------
i THE COMMONWEALTH OF MASSACHUSETTS
079 BOARD OF HEALTH
n — �) TOWN OF BARNSTABLE
11hipood World Tomi#rudivit rrmit
Permission is hereby granted................�G/�ir� -_--_____-(::G- `!
------•-----------------------••........--•.......•...._..
to Construct ( ) or Repair (�) an Individual Sewage_Disposal System
atNo........................................... - --•---------------------------------
Street (��-.-- c3
as shown on the application for Disposal Works Construction Permit No,� _'m---__-_ Dated------- ..' "_ ,._Z.......
t
............................... •-------•-------------•_... -•-•---------------------
Board of Health
DATE..............2. !- .�.._���....
FORM 36508 HOBBS&WARREN,INC.,PUBLISHERS