HomeMy WebLinkAbout0020 PADLOCK LANE - Health (2) 90f-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEA TH
&Z,4-1.........-.OF.................... ... . .....
Appliratiuu -fur Uiipuual Workii Totes rurtiutt Vantit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at: A' 7 _
Location-Address or Lot No.
�E7owner
/fey.,., Address
-----------------•-------•---....---•--------------•---......-----....__._.....................•.. .......
�25.�11_(Jl .--- .��r. ..........................................
Installer Address
UType of Building __ _ Size Lot_....-��'"�.Sq. feet
Dwelling—No. of Bedrooms--._•-_--.--_-3________ _____________Expansion Attic ( ) Garbage Grinder
Other—Type of Building -----------------"-___--,. No. of ersons---___-_-________-_--_---__ Showers
a YP g _-_-----•----•� S ( ) — Cafeteria ( )
dOther fixtures ..............................� ------------------------------------------------ - ----------- - -----------------------------
W Design Flow............................. -gallons/per person per day. Total daily flow.._._.. 07721 • gallons.
WSeptic Tank-�Liquid capacity-. . _ _gallons Length................ Width_------........ Diameter_-:--_--.---__ Depth-----_----------
x Disposal Trench—No. .................... Width......... .__ __ nV
T al leaching area.........--_...-----sq. ft.
Seepage Pit No.________�..__..... Diameter__! �, �'I1e o _ ______________ al leac "ng " ea--.-_-..---.-____-sq. ft.
z Other Distribution box ( ) Dosing tank ( ) ��-
Percolation Test Results Performed by------------------------ . ...................................... Date----------------------------------
a Test Pit No. 1................minutes er mch Depth of Pest Pit.................... Depth to ground water-.-.---..--.-----.--...-
f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.........------.--------
�+ ---------------------------------/_.
ODescription of Soil--------------------------------- ------------------------------------------ ------.-.-----------------------------------------
..
V -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Complian has b n issued r of al
Signed --•-•. - D ?
ApplicationApproved By------------------------------- ---- ................... --------------------•-----•---------- ----------------------- ----------------
Date
Application Disapproved for the following rea s:--•-------------------------------------------------------------------------------------------------------------
--...---••-•.....-'--------------•--.....-------•'-------•---'------------•-----------•-•••-•---•----•••••--------------•-...---•---•- •---•--••---•--------•- --•--------- ------------"----------•---
/
Permit No. 3---------------------------------------------- Issued / Date
---•-------
Date
THE COMMONWEALTH OF MASSACHUSETTS
-
BOARD O HEA TH
Appliration -for Pi-s ntitt1 Workii Towi#rurtion Vrrmi
Application is hereby made for a Permit to-Construct ( or Repair ( ) an Individual Sewage Disposal
System at
-•.....
Location-Address or Lot No
W y...• :Owner Address
...... �......r ------ MAW- .17VA6. lCtl.$0------------------ ---------------------
Installer Address .w
Q Type of Building _ Size Lot_.-.___/3 -_ _____S q. feet
Dwelling—No. of,.Bedrooms------------- ---------------.--------Expansion Attic ( ) Garb ge Grinder
Other—Type of Building ____________________________ No. of erson�_-_____--________._--___--_ howers p, yp mg p S ( ) ' Cafeteria ( ) {
Otherfixtures ----y------ --•--•••---•-------•----------------=------------•-------------- --•-------•-- ---------------------------------------------------
Design Flow____________________________-6____,`Q _gallons per person per day. Total daily flow------- .............gallons.
WSeptic Tank_/Liquid capacity-fii�_gallons Length---------------- Width................ Diameter.........---------Depth---------..-._.
x Disposal Trench—No_____________________ Width._ _ ---
. th.. .......... To 1 leaching area. -. __ ___sq. ft.
Seepage Pit No.___.__.._ Diameter__ �` �e rI 0 1 leacl' i� e --- s . ft.
I--------- 0 1 - - -_--_••-
Z Other Distribution-box ( ) Dosing tank 7
a
Percolation Test Results Performed by- w Date... 4-
Test Pit No. I_',------------minutes per inch Depth of "Pest Pit-------------------- Depth to.ground water.__.-_-_.._.__-._-_.___..
Lz Test Pit NQ 2_.__: _..._minutes per:inch. Depth of Test Pit........... _ Depth to'ground water - _:__-. _ --. .
---- -- - ---•••••-_•--•_•. _•-••' --------
Descriptionof Soil ------- r -- ---------- ---•---'•---- -----------------------.... .------ •---------------
..........................................................------------------------------------__-. --------------
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 Article XI .of.the State Sanitary Code—The.undersigned further agrees not to place the system in
operation until a Certificate,oil"Complian has b issued b di al
Signed ---••--- ......- •--- _... ./..
Da
Application Approved B
-------------
Date.
Application Disapproved for th.e following teas s:....................
----••---•-•------•------•----------------------------------------=------•_•_--•---•----•----___-------------•------------------------------------------------•---------'---•----------•-----------•---
Date
PermitNo................................................. Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH -• /7 2 -/l 2
OF..
Tntifiratr of Tomphaurr
Y T IS TO CERTI , Thai the Individual Sewage Disposal System constructed ( '�or Repaired '( )
by--- --- -------------_ --- ......................................................
Instal
a _. v A ` 'a Cr : l
------- ------- ------•--•-•••-_•---•--_••---
has`been installed in accordance with the provision of Article XI of The State Sanitary Code a described in the
3fcr
application for Disposal Works Construction Permit No____________ __ _ ______________ dated...../ - .1:. '__._ .
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A UARAEdTEE THAT THE
SYSTEM LL NpTIO SATI FACTORY.
DATE-- ---•-- ::; Inspector.
THE COMMONWEALTH OF MASSACHUSETTS .`
"•s ;.x.�a r" BOARD OF HEALTH
T
E
fir ofgi f orkii To rurtion rrrmi
Permission i reby granted---- -- - `e 11.-. ------
...............................
to ConStr ( or Repair ) I dividua�l ewage isposal Sys
atNo. _•---••9,-Q-- .rL it Ure----------------------------
et =
as shown on t/applicatiofor Dis osal Works Construction P t No.: __._:___ ted----_Board o HealtDATE___.._..__� ------�... ...------------.FORM 1255HN. INC . PUBLISHERS
y�F TH E p0�
TOWN OF BARNSTABLE
a BARWSTABLE,
y 639. ob
i639. Board of Health
pp `�0
Ufa m a'
FROM THE OFFICE OF
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