HomeMy WebLinkAbout0358 STRAWBERRY HILL ROAD - Health (2) � f-Y Straw bexr�
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
TOWN OF BARNSTABLE
ApplirFatioai for Di-nVn!3ttl Madw (foutitrurtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
-------------
catioJ-'�
ddress —or Lot No.
------ _(n. _b Sl,- S�. Z V Gu-------------------------- -------CS-Cc���'�'= -------•-----------•--------•-....--------------....
Owner ddress
.___ - --
Installer Address
Q 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
a' Other fixtures _________________________________
W Design Flow------------------------------------------ _gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid'capacity_J'_U gal Ions 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._.__....____-____--_._.
fi Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
a ............................................................................................................................................................
0 Description of Soil.........................................=............................................. -------------------------•--------------------------.....-••--•............---
x
U •-•-••--•-•-•-•-•--------••--------•.........--••---•-•----•---•--•-•-••-------•-----------------------••-•---•--••-•-•-•-•-•-••-•---•--------------••••--••-•---•--•-•-------•-.......--••---•-------•-
W --- --------------------------------------------------------------------- -------------------------- --------------------- ------------------� ` ................................................
U Nature of Repairs or Alterations—Answerduoz
applicable.--L_ C a--_____ S*1^ __.___C/�__Q(j-��.......__.
-4���.... fJ�_..._�1 � �U'n�--•--- --•-`- -•-•-- ��, `��'�r.� �....---1 .....2_- 7-k-.411F._sfo.'ip—
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 Compl' ce has bee ue of health.
Signed �_� �� ^�.//�
..._ .. ....... ._�....;...... .--------------------------------- .... ...........Y......
Application,Approved B g —� e
PP PP Y ......
Application Disapproved for the following reason • .._...................._--------------------------
........... ... . ..... - -- ---.. .. ---------:...._-----------------------------------------------------------
.........................Date......Permit No. ...... Issued ----------. e�
� � 0
No..�-----------_•.--...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
, pphration for Diti-paiial Wmrlw C owitrurtiott Urratit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
.........35� c` rc�,W�ur`f \��\\ CZ c�. �t,, ,v�� ..
---------------- -------- ------ "----------------------------------------------------.....------------------...----------
-----_--- cation- �ddress �JFF"�— - - -__ or Lot No.
. .bib v -------------------------- ....... ------- ---------------------......--------------.......----
Owner Address
......-----c '
^��5s__C�`�'� -......... . `I----F J � 2-c ..S„� +
�t � �1 S
Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling— No. of Bedrooms.__._._.___ __Expansion Attic ( )Showers Garbage Grinder
-----------------------
04 Other—Type of Building -_"-"-----------------_____ No. of persons.................. ( ) Cafeteria
a' Other fixtures ...............................................
W Design Flow.....................:-----------------------gallons per person per day. Total daily flow--------------------------------------------gallons.
WSeptic Tank—Liquid capacity_1_0 U allons 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. 1----------------minutes per inch Depth of Test Pit.-."-___"-___-.._ Depth to ground water-.--_.-.._.____"--___---
Gi, Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water._.---_-----____--_-___.
GY ----------------------------------------------------------------------------------------------------.........................................................
0 Description of Soil........................................................................................................................................................................
x
W
x ................................ ----------------------- --------------- ----------------------------------------------------------------- ---------------------•----....-----
-------------
U Nature of Repairs or Alterations—Answer hen applicable..__ eL?6,t."L--.-__�X(S. .(� ------CG�__.oQ.��$..._.____.
��_.._l_000....C,(,,L----�-r'AV------��_`- ox....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
t system in operation until a Certificate of Compliance has been ue -rd-of health.
Signed ^��� �- ..... -� ...� . .^ .
e
�y
PP Y , "` --------
Application. ....... , 1/� r -..... ....Approved B .-..... .......__..-_.... j '.
ce
Application Disapproved for the following reason-: ............-................_.-.-..._--------------------------------------------------------------------------------------
�---.. ...... ....... ,a ........... _............ ---------------- err
.................... y ----
Permit No. .. - .. ...... . . ,
Issued ......._:.. -. ..e ..`J..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
�LEL'ft�tC?X�P II� V�IIrit��iPI1TCP
THIS IS TO f.ERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( Low
by .. -
InsuJlrr "
at ... > ..... .. kC CdvJ..�xC1 t`.. L .. -..
�. . - -1 -
has been installed in accordance with tlx� provisions of TITLE of The Start E vironmentaI Code as described in
the application for Disposal Works Construction Permit No. _..------------._ dated ._----
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT E CONSTD AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE------------- - -1---. _ .. , Inspect ------ .... ---
THE COMMONWEALTH OF MASSACHUSETTS
,. BOARD OF HEALTH
TOWN OF BARNSTABLE
No.... .......... FEE ......
Dispooal Workii Tuts trrt iart rrutit
Permission is hereby granted CJ( ---------------
to Construct ( ) or Repair (� an Individual Sewage Dispo al System
atNo................-Z-�--- `5 _t'U..r�l C.����-----'~ `.\.-........�------------ ----- ---- - - - ---------------- --------------------••--••---
Strcet �
as shown on the application f r Disposal Works Construction ' rrr>t No_ _ _______ ___ __ ated... ....................... t
............. .......................... � � ... ....... . •••.
Boar of ealth
DATE.-----••----- .
FORM 36508 HOBBS&WARREN.INC..PUBLISHERS