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Home My WebLink About0005 HAYWARD ROAD - Health (2) C04J. No.........:l.-z .y FPS.... a............... APPROVE THE COMMONWEALTH OF MASSACHUSETTS �c0". !! BOARD OF HEALTH J7 n TOWN OF BARNSTABLE ..Signed � Appliratinn for Diripmi al Wurku Tongtrnrtiun Prruld Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: j ... ....... �.. , o------------------•--...---------- .........C��(., .................................................... Locati t -Address or Lot No.�� .......,.�Jvv� �L.............................................................. � _t._.....V../C�......--•.................................................. Ow ier Addre s --- ---------•------ �3a---- . . . .......... ........................................... Installer Address Type of Building Size Lot............................Sq. feet UDwelling— No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) dOther 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit----_............... Depth to ground water........................ 914 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •--•---•.........................•--------•-----•--••---•••--.......------------........--•----•----......................................................... 0 Description of Soil.....Fl.P?S—......... .-------••-•---•--------•---•------------- U •-----...----•--••••-----••.-- ------------------------------------•••......••----••-•--......•--• •...--.....-- ---•-•-•----•....--•-•--•-•--.................`----...... W U Nature of Repairs or Alterations—Answer when applicable----- LS�I� ....... .. > � 9r .�j'A6lNf.l ri % . 7k1 -f---------------•-•-•--•-•--.... 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 Com liance has been issued by the board of health. Signed .................... ...41...q Y Dace Application Approved By ........... .. ....�........ .. .... .... Dace Application Disapproved for the ollowing reasons: ...... ....................................................... ................................----.................. ........................ ................. ..................................................................... ..................................................................... .......... ...................................... Permit No. ........... ---- - -Y-- Issued ........................................ . ..a......Date...... Dace -csi .a+1'`::. :.;rtdix^jpi.+,=i<'i* ,,C' ..,da� i..yo..n«.={;.;+,...;:.-�:+;nsv= No.. 9 ...2 :.y Fi$....,.,.-�.).........- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH --�---cs� / TOWN OF BARNSTABLE A hration for Di�ti wia�� 1 Wnrlti Towitrnrttnn Vrrntt# Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal Systein at: r -•-.�� .._._. � Q---------------------------------- ---------------------------------------'...: .................................. Location-Address or Lot No. LJc�I'�_.. ._ ':4�L----•---••----••-•---••-----------•---------------- C_. _ iZ .............................................................. Owner Address a ��` �= ��.✓sb' .................. ----.......a.... ............................................ Installer Address UType of Building Size Lot............................Sq. feet .-t Dwelling— No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ 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. 3 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........................ 0' -----------------------------------------------------------•---------•=---------..............-•----......................................................... 0 Description of Soil..... . � -------------------•----••----------------------.._..---------- V ..........••-•-•-•--••---••--•-----•----•---•---......--•-•-----•-•-•-••-----------•••-•.........---••-•------•••----------••-----------•-------------------- W U Nature of Repairs or Alterations—Answer when applicable.___. 04..?.!_.__.___.-"......?. ...._....!&��A. ............. 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 ... .... .....:-.. ... �- -- .. - -- ...................... - ..............�y............ Dare ApplicationApproved By -----...--- ------�-a. ,- - .........................................................._.--. .:. -... ems.. Application Disapproved for the ollowing reasons: ........................................................................................................................................ .. ...................................... . ...... ....... . ..... . . ... ....................................................................--.......... ................--... ........................................ Permit No. /y�',/ �...- . V. ........... .................................... ................ate.....---........�.-.. Issued Dale THE COMMONWEALTH OF MASSACHUSE17S BOARD OF HEALTH TOWN OF BARNSTABLE LLttertifi ate of MR�ont lianve THIS IS TO CERTIFY, That the Individual Sewage Disposal System cons acted ( ) or Repaired ) by ...................... .... s...-.....+{` ` .. o•.. .-...-.. b- ................ N c_�c�4.......�......- -------------------..--------- // t :n�er S �. C ...................v............................. .......... ...... .......__.............. ........................................................................................ .. 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. -_.....J./--..�..�.a..L�...... dated ...................... _............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................ ...�-°'....,,�. ,�........................................ Inspecto /�.��''�,/Z^:�/'il-...�......---- ...:. - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No... TOWN OF BARNSTABLE c.,�..�.�:.��.Y Bignmal Norkii Ton,strutilan "rrnti# Permission is hereby granted------. ------ .............n!;�t------- ....................................................... to Construct ( ) or Repair (,?�'an Individual Sewage Disposal-System atNo....5r.... ........ `a.................... .. ---- Street qq.. as shown on the application for Disposal Works Construction Permit No.1_ _.") _ Dated........................................... ----------- ----------------------------------------•-------•....... �DATE ..... . �. .l._ ( � Board of Health FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS