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Home My WebLink About0442 PRINCE HINCKLEY ROAD - Health (2) yUa Pry n�u I��c�� 2�, (�r�. l�/o � I �S No.. ....._ 1... F> s............. . ........... APPROVED THE COMMONWEALTH OF MASSACHUSETTS �e ry ' D t BOARD OF HEALTH TOWN OF BARNSTABLE igned , pphrattait for Diripwial �'ii vrks Tontitrnr#ion Vami# Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: I i_or ........................................................... Location-Address or Lot No. ......................S.. Y iS.........t�N-±:�T -----•--------•------------- ...................` ... o,cner Address ...........(2bya'r---•.................` •!�o� R " --------------- ........................................ Installer Address Q 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 ( ) a' 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. 3 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............... ... rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 •--•--•--•..........-v----- ------------•---••-•e----------•..............................�........... .......��....--- Description of Soil.6.�-.:Z........--5�-----•-------..7 .` ...--------- �G��✓ fez. .---....no?t?s --•....... ........�. U ••�!�3a ..----••-•---.��r.4^( .�-L ...............•--------------------•-----------------------------.....------•----------------•---------•----..........--•--------... W •• •-•-••-••----------------------------------------- --------•--••--•--........-------•-•-•••-•--••---•------•----------------...--•••-•--•--•----••-••-•---•--•----------------------......_......••- V Nature of Repairs or Alterations—Answer when applicable iti?g .--::- •--•--••---•------- wt...Y`?d.......s`��ve•.. C�tzr�`wl Cv?ev'�-... �ci�N •�za�ectt,tu►� �t� �'�� T""o-.-• `�..� �.. .. .....-•---.... 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. Signe . ... .......�1t ........:............... . A...... Application Approved By ...................... ...... ... ... .. � Q.. ... ..... .. . ..... ............. ....... ............ ................. . .e.. ... . . Application Disapproved forth follo i g reasons: .......................................................................... ............................................ ... ....... ................ ....... .. ----- ................................................................... . .- . .......................................... Dare Permit No. --------- ----- --- Issued .............. .-... ..... ..- No.___...--•......-....... Fas.. ...... THE COMMONWEALTH OF MASSACHUSETTS f' BOARD OF HEALTH � `,�, /'y/TOWN OF BARNSTABLE • 5 ,��lirtttiuYt fur-�#i��u 3�I1 'I�urk� C�a�gt�trnr#tun rrutit • Application is hereby made for a `Permit to Construct ( ) or'Repair ( )4 an Individual Sewage Disposal System at ...y�i2, �K?,leC...__. .!vu�At� �'. .. -°��. C.ca�ti.l1 '._.:....--------- ------------ Location-Address or Lot No. ......................YJ 1 \Faly v r "`............................ S�Wti O cner Address WhE t�K .--••-•••.C°�w �.----•---•-------............................. ........... I S ww Installer 1 Address Type of Building Size Lot............................Sq. feet .-t Dwelling—No. of Bedrooms..... ._---J---------------------------------Expansjon Attic ( ) Garbage Grinder ( ) W Other—Type of Building --------------------------•- No. of persons----1----------------------- Showers ( ) — Cafeteria ( ) dOther fixtures --------------------------------------------------------------•-..;.... 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 ( ) Percolation Test Results Performed by--------------------- ................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground[water_...................._.. (4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ...•---••-••-----------------••---••-••-•------•••---------•--••••-•----•••--•-------........--•••-....._................_...•--•....•--•..._..._....--_..... D Description of Soil_0:n._--- v .__.._._._.-•-.Z•_ U •-•----------- --------•-•.._4'..�^I .....-------------------------•-------•-------------------------•---------••----...------------•---.............----•---.............•. - W --•-------------------------------------------•-•....-----------------...........----•-•--- •-•------••-•-------•-•---------------•••••--•-------••••••••--•----•--•-------•---•-•--••-•--•----_..... U Nature of Repairs or Alterations—Answer when applicable. ....... ! ?t.�_jKpCGOvcS s �� 3�t Sops r` ............ .....�OM...w.----rY2ot' ....F? S-C�W...... ..zHcttl�uln w ._....Q�r � �TwO. `F-._ ...... 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 y p p sued by the board of health.system in operation until a Certificate-of-..Compliance has been is ' Signed- ..er- ----Z. ..................�rl..._�...-- -----`�4��l 4 Application Approved B -! ti'. ./ :1%r2�f/C.. ... � ..!!� PP PP y ....... _ ... .........: , .. ��------ Application .e...... . ..� Disapproved for6thefollow�g reasons: ...............�.--..............................-........... ............ I ......... ............. .-------- ---------------------- ------- ..... .............; v................. - .... .... - ............ .� Date .................. Permit No. .................r'�....�.................. Issued .............. . F/./.!� ........... ............. / Daze l THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE k6er#tf rate of C�umpliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by --------. .�.S.k ...........C°c _..... Rj)�K'&......I—F k►aS"C =EL7.......i; Ui .................._-------..-------------------............. at ....y.�4 t.........................:.....:::.................. :.:.....-- ..._............ ..1s�17 /vv{//�........--------------------.... .............. has been installed in accordance with the provisions of TITLE of The St ,t n ronmental Code as described in the application for Disposal Works Construction Permit No. .... ..Z _ ��.... dated ......-_........................_...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION /SATIS*FA�CTORY. DATE_...... ............ �� / -- Inspect,;r— _..: ��f�...��.� . ...................6.............. ................. ............P THE COMMONWEALTH-OF MASSACHUSETTS BOARD OF HEALTH .-/ TOWN OF BARNSTABLE `-/ �-- No.-• , .._....,.__ FEE.---••................. Disposal Workv Tunotrutiun "unfit Permission is hereby granted..._ ---------- -------------•--------------.....•--•---------•-••----•--................ to Construct ( ) or Repair an Individual Sewage Disposal System 1 at No U. Z• P \WCL`• l-lNhl l_L4� s ///�� ///, ---- ------- ......... ....:... Strcet 1.. !/..... /_� as shown on the application for Isposal Works Construction ermrt No__________________--- D(/ated_ _._�._.. ...__�...�................ Board of Health DATE.......................y.-..C.1!_...J-------------------------------- FORM 36508 HOBBS 6 WARREN.INC.,PUBLISHERS 1 s i ! li i I i ;i 1 f `' � I f � � - Z I l � '� 1 I I I I � I I I I I I I I � p "--� I I � �----------_.___—_------------------, .I t ��.. _ � I � I I I I _. _ ,, _ . , , _.rt.._._.�, I i - C I � � 1 � � -- J 1 • - j _ _-____ _._ - --'- 1 1 I - i �,� � 1 - I 1 I I �; 1 i I I l'r J� 1 I �1 � I I _, i ( � " . I I I � i I 'i Y I I 1 -�a I ( -�-�-�-- . I I _---. I I 1 �� w I tl I I I I I i `i ri I � _ _ I� 1 —