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Home My WebLink About0184 NOTTINGHAM DRIVE - Health (2) / 7 � � oa3 ;.d 0 No.. Fas.............................. ---n--�•-...._..� �r^VV� T E COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Date OWN OF BARNSTABLE . pphrativit for Diripwi it Wurkii C omitrurtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ) an Individual Sewage Disposal System at: L off' i ... � �._....._....�. �_ l.l.�s -•.-••••.................................................... Loea(_ti n-Address or Lot No. . .............................. ---------•--•-- ------------------•-------------..------------------ Ad ess O sncrfL ,-I Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling— No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons.....................--..... Showers ( ) - Cafeteria ( ) Otherfixtures ---------------------------------------------------------------------------------------------------------•-•---------------------------•-•----- 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 ( ) aPercolation Test Results Performed by.......................................................................... Date....................................... Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fi. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ----••-••-•------------------------••---•------------------•---•--•-----•-------•-•-•-•..._........---•-•................................................... 0 Description of Soil.. ."Z......&s- -....... ---...........-'.....----� ....../-1 alJA.�£-------. ------------------------------------------------------------------------------------------------------•-------------- ------------------------•-----......------------------------........--••••......-- w U Nature of Repairs or Alterations—Answers when applicable.-I��-......0 ..'..k(.QW....... ................. .t� ''� ----------z-----..... a u� / �i w-4.. T! ................S ue 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 .. .. .... �........................... Application Approved By ----- g.............. .. Application Disapproved for the following reasons: .... .............................. .. . ..... .. ........:............................................................. ......................... .... _ Issued .............. ......... ....................,........... Da e - c . No.i................. FEB ........ I THE COMMONWEALTH OF MASSACHUSETTS -� BOARD OF HEALTH rTOWN OF BARNSTABLE ' Apphration for Uiripoiul Works Tot/mtrurtion Urrmit Application is hereby made for a Permit to,C gnsl uct ( ) (orf l.t o) an Individual Sewage Disposal System at: t_o'T- N 3 ... y,...- .......................................................... --------•-•••.. ^.'�..... ._....=....---•.......................• Locati n-i\ddrrss or Lot No. ......................� ...LL- C�`�..1:3.'t .-`�`�1+1 S •----------------------- Owner Address W 1't til. -----------Z a S 1?—` ..........L.fA /-t 4/4..✓r✓iL& ,� .. Installer Address UType of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms----------------------------------------_.-Expansion Attic ( ) Garbage Grinder ( ) aOther Other—Type of Building ............................ No. of persons...---...--................. Showers ( ) — Cafeteria 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......(I.............. Diameter.............................. Depth below inlet........Ln........ 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........................ fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ----------------------------------------••-------------------------------�------............................-----.....-------•---...._...... Q. Description of Soil ®." Sv�� = 1\_........ `------------------12. 9._._.C�OfF�cs ......... x W Z ---............................................................................................................... •---••--•---•-••-•---•---•••-•-•--------•-•••••-••-•-•-••-•-----.........._......... U Nature of Repairs or Alterations—Answer twhen applicable...s ------.( 7�_ :_.tt,_C�C _......1� �w........ ...... ...........................................................` . ....-••-•--� -------_S.:�rV_E------•---•-r..0------ !-STD�✓` ------......£rT/G......5`'S?�`'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 issued by the board of health. Signed .�.: ..c <�>..� c,` �- say......�......................... `-!...... .. . �.... � t Application Approved By ......�.. �...�/ 7l./ �< "........ ., ./thy :.................. L.� ..,.. J Date Application Disapproved for the following reasons: .. . ........ .......''- . . .... ................................ --............ .--.................... ..... Permit No. .....1...... .... Date ......�.../`1.....��........................ Issued .......#�/e .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certilftrate of (gomplinure THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired,*—) ------C'ova.N ...... ' lastauer ' WQ =�cv��/r....................................................... at .......0.. .`(......_..._..N.6.................C,\:`. .r ...._..... 1� 1-. .................��' ............. . has been installed in accordance with the provisions of TITLE -�f he State Environmental Code as described in the application for Disposal Works Construction Permit No. -...._. dared ..__.-_................................_. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT B CONSTU /AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION f SATISFACTORY: ' DATE..............L...-..................�............._� .... Inspector . ........ ...... .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No.- 1 1..............: FEE. ............. Rio rnottl orkv Toim#ruaioin Wrmif Permission is hereby granted.....-l' .lC-�� 4 J' '--------------------------•-------•------.----•-•-•---.....-----------.............._. to Construct ( ) or Repair an Individual Sewage Disposal System (��,n / �/ Noit iv.� �_ Ar-_ Street "1��l at No.•....k. -•---•• -----••••--•-•------•- ------..`��- ��_ _....._...--------- ------ ............ Strcct as shown on the application for Disposal Works Construction Permit NoI_...I...........�..-- Dated- ...............n.....y .... Board of Acalth DATE �q,, ----- FORM 3650a HOBBS r}WARREN.INC..PUBLISHERS