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HomeMy WebLinkAbout0062 HILLSIDE DRIVE - Health (2) � a I��lls�d�. Or-, c��- _ _ -- - - - - - _ � 9 3 �o3R - - -- - ASSESSORS MAP NO: i 9 3 No.. PARCEL NO- © 3 9 FRs.....c.3...��............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiuu for Di-tiva!3 al Warkg Cfuuutrurtiuu Errant Application is hereby made for a Permit to Construct ( ) or Repair (--�) an Individual Sewage Disposal System at: ------------------------------------- ... o�...,�.... .... ......... - -------------------- •lddress or Lot No. ------o----------------------------------------•------•-•-•-- W Address a ---•----•-•------------ . .... .... -------------•--------- •-•-•-----•------••-----------------......----------•-----------...---------------•-•-•-•--------. Installer Address Type of Building Size Lot............................Sq. feet �-, Dwelling— 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. W Septic 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...................................... r..I 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........................ P -------------------------------------------------------------------------------••-----------•-------........................... ---- •--------------------- 0 Description of Soil..........................................................................................................................................--............................... x w --------------------------------------------------------------------------------------------------------------/---�--,-�-,-�-�-------------- ---------------------------------------------------------•---• V 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 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 ............. . - ---- 3..'.o2 o'..9. ........ ..._'- --.......�.......-------- Dace e� Application.Approved By ............. e,. . . .... -------- ------------------------- ---------- ---------------- . ....3 r,Ao..^F 5 Dace Application Disapproved for the following reasons: ..... ------------------------------------------------------------------ ---------------------- ......... .....................................----------------------------------- ------------------------------------------------- --------------------.._------------ ----- ........................................ Dace Permit No. ---- ----(- - -v'�"-------------------- Issued ..............��,��....: Dace No.---/f:41/�f4 3 9 FRs......._ ��........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Applirativit for Di►ipwial Wor1w Towitrnrtinn Prrmit Application is hereby made for a Permit to Construct ( ) or Repair (� Individual Sewage Disposal System at: .................. a----l........_..•. --......--------------------------------....-- -----------------------!'' �.._. ter: ...................................... o atcon- Address or Lot No. ............. ..._ ti... •--•---•••----------- O/w�nep— Address Installer Address Type of Building Size Lot.............................Sq. feet Dwelling— No. of Bedrooms._-____-��_---__-__-_-_---_-_-__---__.-Expansion Attic ( ) Garbage Grinder ( ) 4 Other—Type of Building ____________________________ No. of persons.-_---_--_--.---.--------. Showers ( ) — Cafeteria ( ) p' 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 ( ) Percolation Test Results Performed by............. ............................................................ Date........................................ Test Pit No. I----------------minutes per incli-,Depth of Test Pit.................... Depth to ground water........................ (r4 Test Pit No. 2................minutes per inch Depth,of Test Pit-------------------- Depth to ground water........................ P4 .......- ---------- ------------------------------------ ----------------------------------------- -------------- -------- •----------------- ................. ODescription of Soil..................."......................................................•............................................................................................ x V ............................................. -•••-•••••---•--•--••-•--•--•••-------•-----•-•-••---•••--••--•-----------•--•--...-------•--•---••--•----•.............................................. W UNature of Repairs or Alterations—Answer when applicable._.----�t _--------- ...... . ........... Agreement: I - 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 j system in operation until a Certificate of Compliance has been issued by the board of health. Signed . _,<•. u D ke r .��1....'.............. .... �'- 2 o- S" ........... Dace " Application.Approved By .............1e �,, -- -- .«.�4 .r..--9 j' Application Disapproved for the following reasons-- --------------------------------------------------------------------------------------- ---------------------------------I- ----- ----- ----------------------------- ---------------------------------------------------- ------ ------------------------------------------------------ ----------------------------------- ........................................ Dace • L Permlt No. .......... ? �....................... Issued .._. ........ `.`� .. •���------------ Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 6XIEl'tifirate of (11,umplianre THIS.,IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by ......__..... mac. ...... - __.. ---------- ---------------... ....... - ---- - -.....:--............................... louullcr at -------------C¢._,;2........ ...... :. ' -----------------------------------------.......----------------------.._..------------------------ has been installed in accordance with the provisions of TITI,E 5 f The State Environmental Code as described in the application for Disposal Works Construction Permit No. ------- ..... ........_.----- . dated ...... --- - .. r 9�L- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE .. ... _.. ... a ......._. ...� �. - Inspects... f / E �i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE � .......... --- --_•--. �tr�rti�n �prntit granted j1�ii 1art4� �Qn C. J..----_------- -----•--------------------------•----••--------------•-•- Permission is hereby gn to Construct ( ) or Repair. (--j'an Individual Sewage Disposal System at No............... A , e....; ------ --------------------•---------- Street as shown on the application for Disposal Works Construction Permit No.? Dated Dated- �..- _:�?�-_.-_--.__ ................................... Board of Health DATE ••^:�C�---=�V7..... FORM 36508 HOBBS&WARREN.INC..PUBLISHERS