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Home My WebLink About0363 SEA STREET - Health ;�3.63�Se Street Country Cottage • ��is -r ` o I i V i 1. I i LOCATION `` SEWAGE PERMIT NO. VILLAGE I N S T A LL NIS NAME i ADDRESS a DER OR NER V5 e, Ce t- I DATE PERMIT ISSU-ED DATE COMPLIANCE ISSUED � orb XXXr N ....P. Fil: ..... ...... ... ......... THE COMMONWEALTH.OF MASSACHUSE77S BOARD OF HEALTH --------7owo.........OF........ ............................. Appliration for Disposal Morks Toustrurtion Frrmit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: _c±............................... .................................................................................................. or Lot No. _ie..? 5.j C ............ -------------------------------------------------- caner L . .......... ........................................ Installer Address Type of Building Size Lot.............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder `4 aOther—Type of Building .............................No. of persons___.._.__....______.__..__.. Showers Cafeteria Otherfixtures ...................................................................................................................................................... Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. 1:4 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________-__-_---------_. f� Test Pit No. 2................minutes per inch Depth of Test Pit.___.__.........__.. Depth to ground water......___..........._... Description of ...... ---- ------*-------------------- .......................................................................................................... 0 Sol1. �4 .......... ............................................... .......:........ ... ........ ......... ............ .... ... U ........................................................................................................................................................................................................ W x .......................................................................................................................................................................—-------*-------------- U Nature of Repairs or Alterations—Answer when applicable.......1=1_1940----9.47212'M......P.,I t......................... ...................................................................................................................................................',"",',,",' 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 be issued,by the boar il of health. Sig . . . .... Application Approved By........ . . ............ xd w�........Z�ZZ RADa)te ----------------------------- ..... � ...... FO...... 2 ................... Date Application Disapproved for the following reasons:.............................................................................................................. ......................................................................................................................................................................................................... Date -Permit No......................................................... Issued... ......4 ............... -4� .......................... Date .r (� V �♦ ► N`tee'% 9-3 ............................� o.-- • -.._....... THE COMMONWEALTH OF MASSACHUSETTS BOARD �,-(?F HEALTH ............:/.f�( � ........OF......,� A. I� �-f'. 1..��.............................. Appliration'-for Uhipvii al Works Cna mitrar ti orn Vamit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: • •• Lo fion_.Address _ or Lot No -- .._..�T 1 Installer Address Type of Building Size Lot............................Sq. feet 0-4 U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) 'k Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures - ------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width-_--_--_-_.-.__- Diameter................ Depth................ x DispAal 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........................................ aTest 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........................ -------------•---------•----------------•-............---...---•--------•-•-•---•---•-•-•..-•-•...........-•--•--••--...------------•---•---••--•--•--..-•-- O Description of Soil............. -' = ' / / �— r'` f---•--•-••-•-----------. .............. .......... _.•..._................•.•............._..._........._...__..__...... x W •-•--•-------------------------------•-----•----------•••••......---•----------- -----•-••••--•--••--------------•--------------...••-••••---•------•--•---•----•...•-••--......•-••••••................ UNature of Repairs,or Alterations—Answer when applicable-__---:----:- ..............------------ --------,t:-:'-!---------------------------- , X Agreement: -f+� r The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with- the provisions of TIT11 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. ,r• - Sig d \/ �.l�...�` '`.J ` I.:._s: .�1,L _S_r........ /_.. �_,ice:...'' »..._ r `; f 1----------• ----..---•--- --------=-- •------- ... ate /1 . Application Approved By........ -- . --•-----•--------+ ----------•---•--- _..----•------------------------- Date Application Disapproved,for the following reasons---------------••--•-------------------------------•-----------•----------------•-----------•••--._...•••.---..» :................•••-•••------••-----•-••--••••-----••-•-•--...-••••••••.........••••-------•--•-.........•-•••--••---....-------•-••-••••-•---•--••-•••••••-----•---••--•--••••----------••-•------•--. Date PermitNo......................................................... Issued-.....;.................................................. " `t Date THE COMMONWEALTH OF MASSACHUSETTSy � .} BOARD_ OF HEALTH ` °W .........................................; i .OF.- / �`J�' J ! 'ail' :......................... turdif irtttt of Taampli aurr THIS.IS,TO-CERTIFY, That the Individual Sewage,Disposal System.,,constructed ( ) or Repaired (%�1 by =�'•-,•i' J........!.�.:d�........................................................ ...................` `_.. ... ............. } ! Installer ti_ �.. at ==l• ---•• . ..:-%.1 r.. .. ..---... ..._ ....✓_/t / --------------•------------ ._..........---....-/..•=.. ..•`Jt'.. .�. has been installed in accordance with the/provisions of T 5 of The State Sanitary Code as de sc 'b in the application for Disposal Works Construction Permit No. ........................._. dated------ ....................................... THE ISSUANCE OF_ THIS CERTIFICATE SHALL NOT BE CONST ED AS A G. ARANTEE THAT THE SYSTEM WILL FUN CTI Ok-4�TISFACTORY. j ;� x" DATE............ . `'... .'. :..h-IJ..... .. -----------•-----------. Inspector..--•- -- .�. .................. 1 { THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .... . 3 N ................. FEE........................... �i��raa��a1 axrka� C��aa�#raUan p�iati� Permission is hereby granted............... f.��Lf_`.. ..%. �{��... .__r.: ..!:_:................................................ »».._. to Construct ( ) or Repair _(h) an Individual Sewage Disposal System _ Street as shown on the application for Disposal Works Construction Per o..-.jj.;;_�� ' . ...................................... �d Hea1 Board of DATE ..... ..................................................... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS _ �✓ TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATION Date Owner `��,�C�� A)rJ Z-- Tenant u, Address Address �- Compliance Remarks or Regulation# Yes No Recommendations 2.. Kitchen Facilities ` 3. Bathroom Facilities 4. Water Supply -r\ 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation " 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural A Elements V 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal /'►�� 16. Sewage Disposal , 17. Temporary Housing PART II 37. Plocarding of Condemned Dwelling; Removal of Occupants; Demolition Person(s) Interviewed Insp or If Public Building such as Store or Hotel/Motel specify here