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Home My WebLink About0108 THISTLE DRIVE - Health (2)�j" i3 i i 7 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Divi-pp,qul Workii Tonotrnrtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair 6�) an Individual Sewage Disposal System at: ...AW f ,4�Lc� -`�'uv------------------------------------------------- --... t �� ovation-Address or I9L.N12. .......�i�-�eS'� l�lJ ....� —---- � ---f.............................................................1 ...�. Owner �_ ress � y �r,Ctrs Installer Address d Type of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms---------- ----------------------------------Expansion Attic ( ) Garbage Grinder `4 Other—Type of Building ____________________________ No. of persons--.___.__.___________--___- Showers ( ) — Cafeteria ( ) da Design Flow`Other fixture ._........ ......................................................-----------••-------•-•---------- -------------•-•---••--------------•---•-•-••---•...--------- W g __________________________________________gallons per person per day. Total daily flow....._._._........�Q.____._._______..__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 on �_... Dia eter_--_-/a--._____ Depth below inlet____.(a........... Total leaching area..................sq. ft. z Other Distribution box - Dosing tank ( ) Percolation Test Results Performed by-------- -------------------------------------------------------------•--- Date........................................ � :: a Test Pit,'No. I________________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........................ .......................• ---------.....---•---•--...-------••--•-•-••-•-----•--••-------------...------------•---------------•------------•------------_--•- 0 Description of Soil........................................................................................................................................................................ x U •••-----•--------•••-••-•---------------------------------------------------•-----------------------------------------------------------•----------------------------•-----------•--•--------------•---- W ----------------- --------------------------------------------------------------------------------------------------- -----------------------------•---•--•--•--------------------•-----•-----•••--•--- U Nature of Repairs or Alterations—Answer when applicable__ ).D.......A---------/Q00 -.Q.Cm:`lQ�__ - .. ��— •----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 Comphanc0has been is d b the board of health. Signed ----- .............. ............ Dace Application Approved By ......... ............ 1..-....j®...` � ---------- Da,e Application Disapproved for the following reasons: . .................. ............ . ................................ ........................................ ...................................... ---- ---------------------------------------------------------------- Q Date Permit No. f..j....... -- -------------------------------- Date . . ...... ............... Dare rx 7 Fi ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for Uiupuml Work.6 Tomitrurtiun Prrmit ,Application is hereby made for a Permit to Construct '( ) or Repair an Individual Sewage Disposal System at: .. - Locatiou-Address or Lot No. Q..cS C�L �l1 �.. / _/l_ .JE L. f� .,✓l t.l ......................_......-..__..........---Owner-------•-•----•---------•---------------- •-----•---------••--- --•---•--••f---------•----...--••----••-----...._.................._..--- Wo Ad � �4 IJ-1-�ZWy Mress . 0 t N i c u Installer Address UType of Building Size Lot............................Sq. feet 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 �.�.�� -_-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((j/'s 4-0) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ f14 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:D.D....... ---------&4UUaj... t�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 system in operation until a Certificate of Compliancl'has been iss d b 2 the board of health. Signed ...................... ................... ..... ... - ........ ........f ...........------ Dace Application Approved By --------- e .. _ -,: , ,................... - - - - --------- -------I------�o-----t�:5 V Dace Application Disapproved for the following reasons: ................................................................................................. .............. .................... . . ............................ .................................. ... ............................................... ---------------------------------------- PermitNo. ............ 67`..7�--------- ------------------- Issued ................................................... ........ Dare ---------------------- --------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C�elr#iftctt#>e of Q-11umpliance THIS IS TO CERTIFY, T the Individual Sewage Disposal System constructed ( ) or Repaired by ------------------------------------------------ �G/(-r U-C�i-`-7--- ------ nl---.5--,C.✓-._T -- Installer at _....... L�.._.�1C1 ��j...---...C:.. n 7"-%-t!%�c.---------------------------- 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- ----------- .--------- dated ............._ _ _..... ..: ...--------------_ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO STRU AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.... ..............3-----. .;' '�./------------- -- Inspec or.. - - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE � No......................... FEE........................ Biupnuttl Workii Tuno#r ion "rrnttf Permission is hereby granted................................................-a_!1_RR. :-f.AJ—S 1,Li J ----------------•-••••....•---_.... to Construct ( ) or Repair (X) an Individual Sewage Disposal System /D ................................t� Street �< as shown on the application for Disposal Works Construction Permit No.? -___ Dated....... j vBoard of Health DATE................ --------=�......_.----------------•--- FORM 36308 HOBBS 6 WARREN,INC..PUBLISHERS -