HomeMy WebLinkAbout0083 LUMBERT MILL ROAD - Health (2) ic�8 )o yc�
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
1 TOWN OF BARNSTABLE
Aplifiration for Uhipo al Works Tonstrnrtion Errant
Application is hereby made for a Permit to Construct ) or Repair an Individual Sewage Disposal
rr y ( r .Vf r
System at:
...".00J.919...........6 2.4 A2 ......... -_�- -------------------------------
Location-Address - or Lot No.
-----•--•----------------•------•--•-••-- ----------__.....----.........----- --------•--.....-•---••-----••--•-.......
Ow�er Address
...............•-•--•--•--•••••. ..
Installer Address
Type of Building Size Lot............................Sq. feet
aDwelling—No. of Bedrooms............ ............................Expansion Attic ( ) Garbage Grinder ( )
04 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' 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.
Seepage Pit No.___C...)e1p_...... Diameter____________________ Depth below inlet.....................Total leaching area.............,....sq. ft.
Z Other Distribution box (2<) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I....:...........minutes per inch Depth of Test Pit.................... Depth to ground water-____---___:--_-_-------
rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_-____-___--___.._.---_
04 -----------•---•------------------••----•-•---•----------•-----•----•-•--•----------......------••-•.........................................................
0 Description of Soil..............................................................................................................................=........................................
x
W ----------------------------•-----•-----•-----•---------••------------------•-----------------••-------••-------------------------------------------•------••-------------------•----••--------.......•.
UNature of�Zepairs or Alterations—Answer when applicable..............................•............____......__.__......................................
u .....ioXAe '1z� .aze.crlc--------------------•.....-•------...........--------
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 ---:..'�/ _.�J�... �* ..................
Application Approved BY CJ ..L .u- -... ------ --
Application Disapproved for the following reasons- --------------------........................................................------- -------------------------------------------
-------------------- -- -----------------------------------------------.^---- ---- ------------- .......--...------------------------- ------------------------..........-----....---------- ------....-----------------------------
PermitNo. ....... Q...-.-.J.-�1 --------------------------- Issued ......................................................... e
Date
c
Na.. +�/)- /[� i Fes$..`.__ T.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH,
TOWN OF BARNSTABLE-j �
Appliration' for Disposal Works Tonstrartion ramit
Application is hereby made form Permit to Construct ( ) or Repair an Individual Sewage Disposal
System at: A, - (e 1 l
-- .. .. ...- -
Location-Address w or Lot No.
s„irk.............................•-•--------
Owner Address
wJwlf... .. �°'-`-• a`t,ST........---•----------------------•-
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms..........._K...........................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No. of persons............................ Showers — Cafeteria
QI 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.
Seepage Pit ----- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
rx Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
04 •---•-------••------•--•------•-----------------------•-•..........---•••••••....-••......------•............................................................
Descriptionof Soil..................................................................--.......---............................................=--=---------------•••............---------•-
x ,
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 TITLE 5 of the State Environmental Code—The undersigned further agrees.not to place the
system in operation until a Certificate of Compliance has beenissued by the�oard of health.
Signed ........ ..../... l� o .........
Application Approved BY ...............
�.-._.. ... to
Application Disapproved for the following reasons: ...................•----....------------------------....-----------------------------------------.................--------------------
--------------------------------------------- ---------------------------------------------------------------------------------------•----•-• ...............-----••---•--.-..............-•-------- .......-----............................
PermitNo. --------05..:......�._/.I�...................... Issued ------------------...-o�!...........................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Cgertilirate of 1011omyXiance
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired._(." )
by Vl r R�it "C......... cam..
Installer
at . ...3........ ��. ....... /f h Q �` f.,
I
U ✓ ti'T .a• Qf.., i. r•i - - - r'e:..:....................'------•-----••--:� --n------------....-...-•------------------------.........---------------------
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. ........� ...-..v, -.-.. dated .................................... .---
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE-------------...... .. ..'./.. ------------------------------------------------- Inspector --------------. ............. ........................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
No......��._... .. FEE..; ................
Disposal Works Tons#rnr#ion rrrmi#
Permission is hereby granted.............LL1.4?A.-R........ s' i •-•-----•...........................................................................
to Construct ( ) or Repair ( an Individual Sewage Disposal System
at No.--------.R.'-:?-.... --.�,U ►/6 2................. 2 A :e.,C'f x ...............................................
Street �,
as shown on the application for Disposal Works Construction Permit No..�rl.n_..?./.'-�'f- Dated..........................................
.......................................... ...... J_...--•---......................-•---•............
DATE.............................•----•--...................................•...... Board of Health
FORM 36508 HOBBS Q WARREN.INC..PUBLISHERS