The URL can be used to link to this page

Home My WebLink About0119 PATRIOT WAY - Health (2) l� pwnlo � 1 1 a v No.....71-:.3* Fm$... 3.o... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Ditip0001 Works Tonotrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ()4) an Individual Sewage Disposal System at: ..... 1.�g,----_--�.�.T�.U�_.....1N.._b°`= --••--• c ............. ..... n Location•Addres or Lot No. ............... :... k. \............................... .................... _�...... _.......................................-•--• ---•- Owner i O t)1 Add ss ----------------- ....--------- - ._...... � W � Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.___ .................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) w Other fixtures -_••----------- -------•-------•••------------_...- -- W Design Flow.......... ... ..................gallons per person per day. Total daily flow----72;.30........................gallons. Septic Tank—Liquid capacity............gallons Length-------_------- Width................ Diameter................ Depth................ W Disposal Trench—No ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No................_.--. Diameter....Y-0....... 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........................ Li, Test Pit No. 2................minutes per inch Depth of.Test Pit---:................ Depth to ground water........................ 9 ---------------------------•------.._.-_._.....-----••---------....._------------------•-•-••_•-_............................................................ 0 Description of Soil........................................................................................................................................................................ V --••-----------------•-----•--•----•--------•---•--••------•---•-------•----•-•----------•--•-----•--------•--------------••---•----•-•-----•--•-----•-------------•----------••-•--------•------------ W Z •--•------------------------------•---••----------------------------•-------------•--------------•------•----••------•--•.....----••----------------------•-------•------------••--•- ... U Nature of Repairs or Alterations—Answer when applicable------4-0e--..p��---f�sA -_._ TQ_1 �_.._...U1 � � - - "---•-------•-----------•-------•----------------------------------------- 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 1 system in operation until a Certificate of Compliance has been issued by the board of health. 1 Signed ... - -------------- -------- ``c7l Date Application Approved By ............ ... :.-'--------------------------------------------------------------------------- ------�'3f-------7/-- Application Disapproved for the following reasons: .................. -- .-- -- -----........---- ------------ ----- --......-- ----...------------..... - - --------------------- ------------------------- ----- -------------------------------------- Date PermitNo. /4."-.34V--_------------------------- Issued ........................................................ Date No...11.: s THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Uhip sal Works Tonotrurtion frrmit Application is hereby made for a Permit to Construct ( ) or Repair (`4) an Individual Sewage Disposal System at ................. .. .......p�T_r. U'C` w � C �J Location-Address or Lot No. ....----•-•-- a �' W �F L w�n 5�ne, °• t',(`_ Pl U t .JG.k 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_.----.....S. ... ___________________gallons per person per day. Total daily flow.... ...~'.-L_----------.-----.-------gallons. WSeptic Tank—Liquid capacity.....___....gallons Length................ Width__......_._..__. Diameter__._.__......... Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. r Seepage Pit No-------- _---.__--_-- Diameter----1 Q------- Depth below inlet----41........... 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.................... Lz, Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ -----------------------------------------------------------•------------------...........-----•••--•........................................................ 0 Description of Soil........................................................................................................................................................................ x --------------------------------------------------------------------------- ---------------•-----------------------.......---------------------------------•------------------„-------... U Nature of Repairs or Alterations—Answer when applicable_....- _ � ......... 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 system in operation until a Certificate of CompUaxtceas been Issued by the board of ealth. __ZW Signed . -7_ ........ ... ....._.-...-_'.---...._....... ................Date........------- Application Approved BY - .... . , w..."c r� _.... ------------ ----7....3�- 9/-- Date Application Disapproved for the following reasons- --....................................------- ------------------------- ------------------------ --------------------------- .........................----------- I..................................................................................................................................---..................------------- - --------------------------------------- q� ... � Dare Permit No. -- -.._... -- .. ......7...... ../_------------- ---...... Issued .------------------------------------------------------ -----.. - Date THE COMMONWEALTH OF MASSACHUSETTS i BOARD OF HEALTH TOWN OF BARNSTABLE Cez#ifirate of Cumlalianee THIS IS jT,0 CERTIFY ha the dividual Sewage Disposal System constructed ( ) or Repaired ( ) --- -------------------------------------------------------------------------------------------- ---------------------------------------------------------- ------------------------------------ InstalleE at ..... ..................... . ------------w ---------------------------------------------------------------------------------------------------------------------- has been installed in accordance with the provision f TITLE 5 e S a e Environmental Code as described in the application for Disposal Works Construction Permit No. --..--- -..S . z/......... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................ '...IEl.�f1--------------------------------------------------- Inspector .------...... ......... -... ......................... -------_---- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH p IJ/ TOWN OF BARNSTABLE • No..... FEE... .......... 11ioposal Forks T n tr inn rrntit Permission is hereby granted.............. ........ -•-- .... ..-------•-•------------------------------------•---................---- to Construct ( ) o Re air a Individ al Sewage Dispos Syst atNo.............. l .-- ... ... ...... - ...... Street as shown on the application for Disposal Works Construction Permit No... __ Dated.......................................... ...................... f DATE................. _�l•.----�• -- _... Board of H ealt h FORM 36508 HOBBS✓4 WARREN,INC..PUBLISHERS