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Home My WebLink About0169 GOSNOLD STREET - Health MIT 1 zj q�'�� b7• ,i + Z L't.lS,�`.�� •.�l :%.yq� t iX�F`�y� � it;`§�+t.b fll�:l"',Q #��_ `t 3q, , �9 LO-CATION SEWAGE PERMIT NO. VIL AGE SEWE INSTA LLER :.N E i ADDRESS I a UILDE R OR OWNER - ro' DATE PERMIT ISSUED _ DATE COMPLIANCE- ISSUED � GJ � � 4 � � � '' R� /, �.. � c I i I� - _ JNo.......... ......./ Fss..$5.44:....... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF" "HEALTH .........................T.oWn.....OF........Darns tabs..e-----------.•--••----------•---•---------------•- Appliration for Diopooa'l Works Tonstrnrtion Permit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: 169...G:Q_sn_also... ............................ -••---•----------._........---...---------.._...-----------------...----...._....---.......------. Location-Address or Lot No. heodorR..._. hQe................................................ Ls,--Ka_-----•---•--- Owner Address a A- &... • Ce_sspool••Service ------------•-•-__•_•__,_•_•-•-- 128...Bishops.... errace•,--_H Installer Address Type of Building Size Lot.............•.._ ._....___Sq. feet Dwelling Bdrooms____________________________.. ng—No. o e .............Expansion Attic ( ) Garbage Grinder (PLO ) Other—T e of Building ............................ No. of persons--_-_----_ Showers — Cafeteria Otherfixtures ..........=........................................................................................................................................... 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.................... 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........................................ as 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........................ ----•---------------------•----------------- ...... •---•........... -•---------- •------••-•-••....__...._........._.......__.......... O Description of Soil........Salelei............................------------------ x U ----•--•••••••-------••--••-•-•••-••-•.......--•._....•------------------••---•-••-•...••-••---------....---••--••--••-•••-••--•••--_....---•---••--------••--------•--••--------•------•••-----•-•••••• W ..............=........................................................................................................................................................................................... UNature of Repairs or Alterations—Answer when applicable------Installation...af--- ---(-one........ thousan(l)....gallone...stone...packed...leach...pit...(-overflow)-................................................... Agreement: The undersigned agrees to install the aforedescribed, Individual Sewage Disposal System in accordance with the provisions of A'I Ti 1-2 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by th boar of health. Signed..�4WZI, .. `" •------------------------ -11'317B.......... Date ApplicationApproved By-•••••-------•--•------•-•--•--•--------------------------------•---------•-............_..••••-- ......................................... Date Application Disapproved for the following reasons:-------•--------------------•---------------------...-------------------------------------------------._........ ---------------------------------------------------------------------------------------------------------.•••.-••-...--••--•--------------•--•-----•••---••••-•-----=-•----••-••-•-•••--••---••-•-------- Date PermitNo.... $"'..........................................._ Issued....................................................... Date �Nol7=..... ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .� .........................gown.....OF........Barnatabl.`A.................................................. ' pphratiun for Bhipofi al Works Tongtrur#inn rumit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: , 169....G.QBnald...5t.. ...HyAnnlB............................ .................................................................................................... Location-Address or Lot No. hoe------------------------------------------------- 169... Xad............. Owner ti Address A... -R_J1?0spoo1...S.erYkov--------------------------------- 124 B�ahop+�..,.�.��T'�t; ' Installer •; � Address , QType,of Building i?, Size Lot...:........................Sq. feet U Dwelling—No. of Bedrooms...........................4...._____..__Expansion Attic ( i) Garbage Grinder ( ) aOther—Type of Building .............:....... No. of persons..........4......_.__.__`_! Showers Cafeteria ( ) Ga Other fixtures .............................................................. d = ................................... ---•-••--•......... .........................•-- WDesign'Flow:........:........................:.........gallons per person per day. Total daily flow,........._........._..............:._.:__._gallons. 1:4 Septic•Tank`—Liquid'capacity............gallons Length................ Width.................Diameter!-------- t__ Depth................ 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 ( ) PercolationTest Results Performed by---------••••-•------••......---•---•--•---••••-•................................................... ---••-•• Date..........`--............................ a. Test Pit No. I................minutes per inch Depth of Test Pit............. Depth to ground"water......................... (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----------------------------------------•--•----....-----...........................:...----------- •--•----••---•-----•---••--------••---•------------------ ODescription of Soil------..Sand--------•-----------------•------•-•----------•-----•-••--------------------- •----------;•--------------••----------------------------------- x x -•-•••••••••-------------------------------•----•--••--••-------•-•••••--•------••-••-•--•--------••---•-•--------------••-•--......•----------••--••--•-•---•-••----...._....------------------------•- U Nature of Repairs or Alterations—Answer when applicable.......InStallatjol}---4f---a--I-r000---(-C�~ne....... thonsand-)---gallone---atane---pao-ked---leach...pt•t---(ove flow)--------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIE 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by thgboard of health. Signed... W4- ................---------•-----------• 1.� ?3 �g ate Application Approved By--••----•----••-----------•.......................•=•-••--•-••=•-•------........-•-•--••---•--- . ............................. ••--•------••- Date Application Disapproved for the following reasons:.................................................... .....�`_ ......---•-------------------------••-------------•-----------------------....------------------------------••-•-----•--•--•-----••••--•-••--•-- Date PermitNo....78--............................................. Issued•....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............T Ow-n...............OF..........Barno-tabl-e.......................................... QTrr"iif iratr of faoutph aurr � �e THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (X ) by....A...&-.:3..QeeBpAnl...S.ex.ylce.....12B...Bishops...Terraoe-.--EyaTon s.,...Ma, fX....c 01.------- Instal ler t at_.169...SxosXlQ.1d...2 .R-► ',t'ieQ.d ore---R•---KehQe•-••--•-•...........................................••.•. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.-7Sn.............................. . dated_-..._---_---.._--_.r__.__..__.._._._._........ THE,ISSUANCE OF THIS CERTIFICATE' SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. s 17 r O%+ J-1, DATE......... ..I..- —�d...................................e.............. Inspector--� .`�. --.................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ; Town. Barnstable ' ._........O F.................................................................................... No.. .............. FEE..a5...QO....... .7. - .. Dinpona1- Workii T-5nnotrurtion anti# Permission is hereby granted.A_.&...B_._�"t' {9 D ._..fi> L?T��.B: ...12$...Bishops...T-er...s-.-H!annis to Construct ( ) or Repair (X) an Individual Sewage Disposal System at No.169...G snoid:--Bt_..,...HYS442 s.,..--------r---•--.-••The.o1oxe...R.,...Kahoe-------------------------•---------------- Street as shown on the application for DisposalWorks Construction Permit No78 . Dated..........&M�'7� •-------------------•-•--. Board of Heh -�- 7 DATE............ ......._...•••....-••------:-:"" FORM 1255 H CBS & WARREN. INC., PUBLISHERS ,r