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Home My WebLink About0012 PUTTER LANE - Health (2) fyo r a No.... .:. � FEs...Y ...'- THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH -LIB TOWN OF BARNSTABLE Appl#a ion for DiipnsFal Works Tottlitrnrtiun Famit Application is hereby made for a Permit to Construct ( ) or Repair (�an Individual Sewage Disposal System at: - ...--.r_,1. ...D ..... .`.c __ - ? 1 ,.....(rtlti.ir4� ....... . .......•-•- YI' Location-Address or Lot �---� ....................... ........... Owner Installer Address Q Type of Building Size Lot.......:....................Sq. feet U Dwelling—No. of Bedrooms....._3.................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures ------------------•--------------------------- W Design Flow....... 5_lam- --•-_---•---__----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....1.0. .._._..... Depth below inlet._.._ .t........... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •------------------•-•-•----•--.•--•---•-••-•--•--------------------------•---•-------------.....--...--.....---•------------------•----............_...._. 0 Description of Soil...............................................................................-------------•----------------------......--•------------------------------•--•---•----- x W -•-------•-----------------------•-•--------•------•-----•-•-------••-•-•--•••-••-•-........•-••--•-----•-------•----------------•-•-•-•-•--•----•--••••......... •...Alterations .Answer ..... .....t ------ -----c4(V ...... .K-x-� s�►--� -�,--Sic' ` •-----------------------•-------------.................................................. 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 b issued by the board of health. Signed .. -- ...--`Z------ ..... ------.-- .---._................................._. Dare Application Approved By .................. . --�.- --. �J.- 1---- 'G-. Due Application Disapproved for the following reasons- ------------------------------------------------------------------.............................................--------------- ---------------------- ----- --------------------------------------------------------- - ------------------------------------------ ---------- ------------------------------------------------- ........................................ Dare Permit No. ........... -.. ��...lJ..." �� ........................ Issued ............................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ( TOWN OF BARNSTABLE Appliration for Disposal Works Toustrnrtinn rumit Application is hereby made for a Permit to Construct ( ) or Repair Individual Sewage Disposal System at: ) ................... ------- ;.... - .. �. �� i+k"= ��'tubs- 5. .--•-----------------------•-r------ ✓ Location-Address ---or Lot Nd.- Owner -•-Ad-ress Installer Address Type of Building Size Lot............................Sq. feet V Dwelling No. of Bedrooms_______._ _____Ex anion Attic� g— ____________________________ p ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( a ) — Cafeteria ( ) dOther fixtures -------------------------------------------------------------••••-•-------------•--------------------------••----•••-•--••-•---•••------•-----•••--•- W Design Flow------- _. ------------------------gallons per person per day. Total daily flow.......... -_Cez______.______________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........j------------ Diameter....1-0.t._._.___ 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__________________.____. 4.I Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-----_---------------- P4 ---•--------------------------------------------------------------------••................................................................................... 0 Description of Soil........................................................................................................................................................................ x U -••••----••••-------•--....-•----•-------•••-----•--•-----•--•--•-••-•-••-------•---•-----••------•-•--•-•-----------•-••---••-•-•--•--•----•-••------•--•--•••---•-•-•---•-------------------------- w x -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•••-•-- U Nature of Repairs or Alterations—Answer when applicable------A!�------O_�____..La_tic�____[�iT__---t � _�______. 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 ben issued by the board of health. Signed .....� ---------- ---------...... -------- --- ---------------------------------------- ------ -- Date Application Approved BY --------------- ^��.......... ...-.......... --- -----.5'.- Date Application Disapproved for the following reasons- --------------------------------------------------------------------------------------------------------------------------------------( ------------- ------------------------------------- --- -- ----------- ---- -- - -------------........................ ----- -------------------------- Date PermitNo. - ------�,-yv....................... Issued ------------------- ------------------------------------------ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE CL�elrttftcz to of Q'I'antylianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( �--� by ----------------------------------------------------------------------------------- -------------------------------- Installer at 1-cam- J �-cam...-.� .�^ 2 �{-- .. �ti-9.5 ✓1 --------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code]as described in the application for Disposal Works Construction Permit No. ..-, -.-��1.,..1{1..--..----- dated ----._Z-----.-_._....................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU - S A GUAR/['TEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY..DATE --... J-1-- -=—� --------------------------------------------------------- Inspector ----. ...... �-C--- ......... - . --------- ------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH n TOWN OF BARNSTABLE FEE:.... Disposal Works Tlinstrnrtion Vprrmit Permission is hereby granted.......... -G---------------................................. .... to Construct ( ) or Repair ( `-)-an-4ndividual wage Disposal System atNo. ....... ---- _ -•-------------------............................................ Street as shown on the application for Disposal Works Construction Permit No._ . _ __________________ ..---•--•................ -• ---- Board of Health DATE---._..._..'_ate_... �- = ��......----••. FORM 36508 HOBBS&WARREN.INC..PUBLISHERS