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Home My WebLink About0035 LOUIS STREET - Health 35 Louis St. , map-309 par 0 r LOCATION SEWAGE PERMIT 130• _ VILLAGE c _ INSTA LIER'S M A M E ADDRESS 4&c am ^ -- ® OtMER � 4 1lA Oct &-c / c �a 114 DAT4E PEMMIT ISSUED DATE C0ra Pl. I-ANCE ISSUED 7. 7,. � i � �� G <�� , 3 -< � �� . � � 5 � � � � � � o .o .� No.......3 22 ,.. Fms K- & . THE COMMONWEALTH OF MASSACHUSETTS BOAR® F HEALTH. JW.t.........0F.... &q,b.5 Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal S stem at .. ...1:d'.1�� .... Y `............... Locat' dres "'i or Lot No. - i�s ...................../ y�O/ 'e � � ! ddddress Installer Address UType of Building Size Lot...........................S q. feet .., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) 'k 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....................sq. ft. Seepage Pit No..................... Diameter...................: Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by........................................................................... Date........................................ 14 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 --- .g• ----- = - ------------ Description of S - s ' .o..' -------.-- ----- --•------------- - .. .-- ---- .. .- x =- c. - — --------- - U Nature of Repairs o Alteratio —Answer when applicable....__.._ _ _ .................................................................... -•--------------------------•------------------------------...-•--•-----------------................------------ --=-----------•--•-----------------•----------•------------------........••....... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITYIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has ee issued b the boa d if health. Signedl -- ... ... Date ApplicationApproved By................................. =-----------------•--•--..................--•-.......--------- Date Application Disapproved for the following reasons-------------------------------------------------------------------------------------------------------•••----•-- -------------------------------•--•••----------------------....----------------------•••--...-------••-•----------------------------------------•----------......------------------------•------------ 7� Date Permit No............... Issued_.. '7 .. Date ID .................. No.. . ... FEa jr THE COMMONWEALTH OF MASSACHUSETTS BOARD,.OF HEALTH .........OF.... Allpfiration' for Disposal Works Tonstrurtion Vrrmit Application is hereby made for a Permit to Construct or Repair (X) an Individual Sewage Disposal System at: �'JI.crL J ........... .................................................................................................. Location.-Addres It,/�_ sc V-1 _/1) �I r Lot No. .................... ................. ------------------ ------------ IT -,y r Add ess Owner -7........................................................................... .............L2 Installer Address Type of Building U Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansionf 'Attic Garbage Grinder A4 Other—Type of Building ........................... No. of persons............................;.Showers howers Cafeteria Other fixtures ........................................................................................� 1� ..4.......................................................... Design Flow...........................:.............:..gallons. per person per day. Total daily flow.............................................gallons. 9 Septic Tank—Liquid*capacity............gallons Length................ Width__............_. Diameter.............._. Depth................ Disposal Trench—No. .................... Width................._.. Total Length.....................Total leaching area.....................sq. f t. Seepage Pit No----------_-------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. f t. 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........._............... Test Pit No ................minutes per inch Depth of Test Pit............___._... Depth to ground water..._._.................. ..............................................................I........ .. ------ A 0 Description of Soil........... ......... ... ....... ...................... ------ ------ ...............V........................................................ ---------------------------------"I--------------------------------------------*---------------------------------------- �4 ..................................................................................................*....................................................................................................... U Nature of Repairs or Alterations—Answer whet y applicable______-- .........1............................................................................ ..................................................................................................................I....................1............................ .................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 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 the board of health. Signed ...... ---------- --------------- ...... ..........7"rtr Date ApplicationApproved By................................. .......................... ................................... ........................................ Date Application Disapproved for the following reasons:................ .............................................................I I I ......................... ............................................................................................................................ ....................................................................... A Date PermitNo...............K.....................9------------------ Isslik....................................................... Date _29 ,,THE'COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............LO ......0 F....... ..................................................... '%rdifiratr of Toutpliattrr THIS IS TO CERTIFY, That th',indi'v'idual Sewage Disposal System constructed or Repaired /jl .. . ..by ............... .................................................................................................... a 7 Installer— t........................................................................................... .............................................................................................. .. has been installed in accordance with the provisions o TI 5 of The State Sanitary Code a de"si d in the I A application for Disposal Works Constructior ........... \4-.�ted..... .............. ........... ,,-Permit No._0..... .. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector..7........................................................... .......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Z-)141OF f ...................................... ......i��.......................... .... .... FEE.......... .........6�f Disposal Works Tonotruditin Virrmit Perr'nission is hereby granted--.--...S! .......)7) ........ to Constr'itct or Rep-air an Individual Sewage Disposal System at No...... IJ . .........................................'.i......................................... .................................................1.(..(........... Street I ,AWn as shown on the application for Disposal Works Construction Pe�y* Dated.._.. "` '...._........ 7- yNo------- D .... ......................... ✓ ..........!�..... .............. - ------- ... .............................. DATE.----- ................................................. ioaPf Health FORM 1255 HOBBS.& WARREN. INC., PUBLISHERS t TOWN OF BARNSTABLE - UNDERGRUUND FUEL AND CHEMICAL STORAGE REGISTRATION 00 MAP NO. 0 PARCEL NO. TAG NO. 130� ADDRESS OF TANK: S 1 IS V I LLAGE Number •lr��! y''� MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : \ OWNER NAME: i �k: ` _ PHONE: 1 '` INSTALLATION DATE: BY: INSTALLER ADDRESS: 'CERT.iV0. , ABOVE BELOW STANK LOCATION�.•2., ,, L O C A T I O N WITH R Q O m Q C T T O a u I L D 2 N O) t \".ram...: CAPACITY -TYPE OF TANK in AGE YRS. FUEL/CHEMICAL TESTING CERTIFICATION [ ] PASS [ ] FAIL DATE LEAK DETECTION [ ] CHECK IF N/A TYPE/BRAND ZONE 'OF CONTRIBUTION [ ] YES [ 'j NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED` [ j YES [ ] NO DATE CONSERVATION [CHECK IF N/A DATE" BOARD OF HEALTH TAG NO. U ` ] DATE # PLEASE PROVIDE A SKETCH4SHOW.ING ' THE TANK..LOCATION ON THE BACK OF .THIS CARD