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Home My WebLink About0380 PHINNEY'S LANE - Health (2) Cif . 1 J eN S M E A D KEEPING YOU ORGANIZED No. 12134 2-153LGN SUSTAINABLE MIN.RECYCLED FORESTRY INITIATIVE CONTENT10% CertfieaSourotng POST-CONSUMER® wwwsflpmgrem org SR-01290 MADE IN USA CET ORGANIZED AT SMEAD.COM THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE ApplirFatilan for Uisvnaagl Workii Tnnitrur#inn ranfit Application is hereby made for a Permit to Construct ( ) or Repair (),�an Individual Sewage Disposal System at: 1 . ._...�. ......... .Lf.... ._ ................ ............... --------------------- -• -----------..................__ ocaf ori, r'ess u .. ��.............. ... . �� u_ ..... t_...� wn Addre 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 ( ) Otherfixtures -------------------------------•-•------------------------•--------------•------•----- - 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--------------------- 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--_----______-_--_-____. 44 Test Pit No. 2................minutes per inch Depth of.Test Pit---................. Depth to ground water........................ a •-------•------------•--------•----•-----------------------•---------------••------------------------..._...------•--•---•-------...................0 Description of Soil--------------------------------............................................ w U Nature of Repairs or Alterations—Answer when applicable__�____________________________ _____________.__----_` --_---------- ------ ---------- l. v, - ' v ,. ..=-o---- Kt to = _ 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 Compbanc as bcoR4""�ed-bj the board of health. Signed Application Approved B -` � .... . Application Disapproved for .......................... the following reasons- ---------------------------------- --------------------------- ---------------------------- --- --------------I................................ Permit No. " / t 4 ........ ........................................................................................................................ ----------- -------------------------------------- Dace --- ----� ----- --G�........................ . Issued -.......................... ----------------... Dace y. 2 L/ No.;./.. ..�.... '� Fizz.3�.�.�.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Disposal Marks Tons riirnun VarAft Application is hereby made for a Permit to Construct ( ) or Repair (�an Individual Sewage Disposal System at: , ........ Vk 1 '�Z.�I._%.... LJ ....... ........... ......... ....... - ......................... Locatiot -address i or Lot N, .. wne��r ,- ��\� ....... ns .... rresaller et i ...r..� :... UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............... _____)._.__._______.___.__._Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures ......................... 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..................... 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........................ 93;4 Test Pit No. 2...........:....minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ---------------------------------------------------•----....----•----------..........--- Descrptono Soil................................................................................=........................................................................................ x w UNature of Repairs or Alterations—Answer when applicable ..................................................��.__....___........_________._...._. ............ ..... .1R_PRM? .'.) 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 Corn .iaacf has beep, n issued by the board of health. Signe ---- ------------------- f .. Application Approved B pP PP Y - ................................... ------------------ Date Application Disapproved for the following reasons- ---.................................... ------------.-........---.------------------- ............................................................................................................................................................................. 1.................................... Permit No. .......�-��.."---------..................... Issued --------.............. Date ...................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Terttft.cazte of Tantyltazn e THIS IS CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired(. ) by `. ---------------------------------------..........................------------------------------ ----------------------/... ......................................... ler has been installed in accordance with the provisions of TITLE 5 of he rate E ronmental Cod as scrib in the application for Disposal Works Construction Permit No. .......... - .'......... - dated ....... G> THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......................1'" .. ....-. .-1................... Inspector ... ... 0. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Dish l Works Tnntrnrtinii. amft Permission is hereby granted_t � -�� (1 to Construct ( or Repair,(--) an Individual wage Disposal System at Now !` �(j' �N.� --------•----- . .... ree� r as shown on the application for Disposal Works Construction Permit N. "_.- at/ _ . _� � 2 -------- -- - - Board of'Health j DATE................. • �'._.. •----------=------------ g! FORM 36508 HOBBS a4 WARREN,INC..PUBLISHERS