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Home My WebLink About0197 ROLLING HITCH ROAD - Health (2) l 9'I All"i7 A." aj �c,�i--, . °/G 0! G 3 H C/i 0LGi7 Off Lk Ae- P 9 D- No.. ..... .. Fxs......... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Uhgp vial Works Tonstrartiun 1hrmit Application is hereby made for a Permit to Construct ( ) or Repa an Individual Sewage Disposal System at: 1/ .................'? ! .L ...._.... U t tL...........1_`�•7 ...... .........��- !L'-----------!!5` -......�° �1 t Location-Address or Lot No. ......................—.......................................................................... .........._...........__.........__---.........•-•-................__________•____._.._.....--____ Owner Address Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building No. of persons____________________________ Showers — Cafeteria Otherfixtures ---------------------------------------------------------•--------------------------•-----•-----••••--•••-••••---....•--....-•••-•-••---•-•-•....__.. w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. x Disposal Trench undo capacity........W gallons Length Total Length Total leaching area.................... w Septic9 g g P g g -----•--------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. 1----------------minutes per inch Depth of Test Pit__________.......... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit...:................ Depth to ground water------------------------ ....................................................................................................-----------------------------------------------------------•---••--•--------------------------------......................................................... Descriptionof Soil........... _.L .._� ...........................................Q ...........................................` ` x c., w __ U Nature If Repairs or Alterations—Answer when applicable_________ ____________; ............................... 2`` �To-.t i— Agreem nt: 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. -- -. --.,- _..... ...........................W.0.................. ------Y2- 9 Application Approved By . .... ..!fo!llowningreasl: ------- Dace Application Disapproved for the -----------------------------................................--- - --- --- -----.............................................. ---------------------- ---- - Dace Permit No. ........... Issued .. ..-- ----------- - ---'----'--- ...--. .-- e ------ AA 119 No� ---- F�$......... ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Disposal Workii Tonstrurtinn rrrmit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: .............../'? v1VP.e a_ .v../ZA'.1.�°.1.�...........fig. _....f?o� !�✓ ---------�!!-! f!.--••------ R ---...4�'.: `t Location-Address or Lot No. ......................—.......................................................................... ---.......•--------------•-----._.......------------------------_...._............................ Owner Address e K �'O r� A. C^ 3 v�o s.4 4 L. f I t4_1 _*4_j ,.a .....--•---------••--------•----------------•---------------------------------------------------- -------- --------------------------------•----------................................ � Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 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. 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........................ f1 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 ------••-----•-•----••-----•...........................•---•-----------•--...................__.._.....-------------------•----...........................•_. D Description of Soil........... -._-Z----------=C`/-X ` ry` C c_�^✓ ~'*- ............. x U ---------------•--------------•--•----------------•••------•---•---•--••••-•-•----------•-•---------------------•-•--•--•---•--•---•---•••.._...-------•-••------••---•.. W UNature -f Repairs or Alterations—Answer when applicable---------- ............a--------------[.ry r___�_'?xj"!�✓-S........._. --- ------- ----------------------•-•----'--*----_r 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. Signed .....-.---. �..c.-.. ... c�}��......:--`:_=- ,p ...-------- lDate A lication A roved B l /-_------------- --------------- ---------------------- pP PP Y " / .... -- - - Date Application Disapproved for the following reasonr: ----------------...---------............-------.................----.. ------ .............................. ------------------- ------------------------ - - -. .....---------- -- ------------------------------------------....................................... I Permit ------ ----- ------ ---- ----------- Issued ........ ..� r" ' ....-...---------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of (ITAIntylianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired,( , by ---------- N c 1(�h'1 0 0"v%� ------------------------------------------------------------------------- -------.........................................--------------- Installer at --------------I9 7----------- w4- -�-1t2:e-`�.......... -SN- ------C1 7 . ..i .......__ .............................................. has been installed in accordance with the provisions of TITLE The toyn�,vironmental Code as described in the application for Disposal Works Construction Permit No. .... ... -''r---- ... �j.".:I....-- dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT B CONS RUEDIAS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. . DATE-------------------------------------------------------------------------------------------------------- Inspector ......................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ? No.......... ... .. FEE. .. .. .......--•--- Disposal Works TDonstnutio4nn'ti# Permission is hereby granted........ Vic! ' .........C,�s`�....__..0...................... to Construct ( ) or Repair ( an Individual Sew a e D's osal System at No. 19"7 iLO�L- ta `-c r} � � C as shown on the agplicatio" for Disposal Works Construction errimStr o!1�,1�. .___. Dated! .._-_.!.._............ L.. a DATE.........-------------d..----- ----------------------.._... Boardof H e lth f FORM 36508 HOBBS&a WARREN.INC..PUBLISHERS