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Home My WebLink About0271 CAP'N LIJAH'S ROAD - Health (2) eu��arr� Von al 1p"We gmtodn wom ®® 3 w /// i i i No.... �.� Fps...., 0............._ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Uiipusal Works Tonstrnrtion ' amit Application is hereby made for a Permit to Construct ( ) or Repair (.)(-) an Individual Sewage Disposal System at: ocat on-Address or t - =-------- ... r..ut ------------ .......Y. Installer Address Pq Type of Building Size Lot............................Sq. feet �-, Dwelling—No. of Bedrooms............. __________________________Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) G4 Other fixtures -------------------------------- - d -----------------------------------------------------------------------------------•••--•---•------- WDesign 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water................... 4q Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 --••--•-••-•------------••-.._..--•••-•-•----•-•------------=••--•------._...__...-•----.._..---••--......................................................... 0 Description of Soil............................................................................... -------------------------------------------•----------------------------------------•. V ---------------------------------••--------------------------------------------------------------------------------------------------------------•----•-••-------------------•---•--------------- W V Nat re of Repairs or Alterations—Answer when applicable---�� v __r 5�.n® - _.lefU,fi�1.y lctf__-__-___. nrz__rt __r fitr �'�-------------•------------------------- -------------------------------------------=--------------------------............................................ 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 Compliance has been issued b the board of health. Signed - ,2-t�-pa Dare Application Approved BY ( u -""' ------------------------------------------------------ w" = Date ?---... !> Application Disapproved for the following reasons- ........-- --- ----------------------------------- ----------- -------------------------------- ------------------- ------ -------- -- - --- -- -- - ------------.................-----.......--------....--- --- ---------------- ------------------------------------------------------------------- ------.........------------------------- PermitNo- -------------7..- ---- ---------------------.. Issued .........................................................D ate ------ Daze .me;µ �No....1..—: $ Fins --........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratinn for Disposal Works Tonstrnrtion jhrmit Application is hereby made for a, Permit to Construct ( ) or Repair (.�) an Individual Sewage Disposal System at: // ..a—Z41.tnh�5 �ardc Q+t r_Lt�l2 - - - - ...... - --....... .......... --------•-...•••...... � ocatton-Address rr J.o // - �f�Tj,l=til.�_._� tC .. a7� �4 _h-!iCcSlor�onNerut�lQ Own W ......•..... --�= —C��a?/��'e�!._........ .............. .....3.S a !-�'/!'L ess...Y.r...-------------------------- Installerf.l �- ddr a ...... Address d Type of Building Size Lot___________________________S q. feet V Dwelling—No. of Bedrooms............. ..........................Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—Type of Building ._..___._.. No. of persons............................ Showers YP g ----------------- P ( ) -- Cafeteria ( ) dOther 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 ( ) Dosing tank ( ) N-I Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. I................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........................ ------------------------------ ----------------------------------------- ------ .-.--------------------------------- •-------------- O Description of Soil........................................................................................................................................................................ w ------------------------------------------------------------------------------------------ Y�) --------------------------------------3------------ U Nature of Repairs or Alterations—Answer when applicable:__Kuq reana__� l'�s /��c�t nr;_di�J �b•_r-Talr9----•------•-----------------•--•---•----------•---•-...-•--- --------------- 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 Compliance has been issued b the board of health. Z Signed - ------------------------------•--------- ----A-'1-4°..'_............ q Application Approved By --------------( - �,,!•<M<^- ---------- Dne Application Disapproved for the following reasons- ................................... ------------------------------------ ---------------------------------------- -------------------- ------------------------------ ------------- --- ---- .----------------...------- ............................................................---------- ------------------.----------......--- Permit No. _A....... d ----------------------- Issued --------------------..............................................------Date Date vF THE COMMONWEALTH OF MASSACHUSETTS pR(H� BOARD OF HEALTH i, TOWN OF BARNSTABLE CEec#tfirtt#e of Compliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( Q4 ) by....................A.........1�-------------- - �' ................. r- ----------------------- ----------------------------------------------------------------------------------------------------------------------------- Installer at .--------- �-7.L ------- .-------- --�Q............. ------------------------------_----- -------------------------------------------------- has been installed in f cordance itv� h the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .....P.........5.'-�-.---------- dated ............................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--.. ._, 9 ----------------........................ Inspecto ..................... - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No.-�.��.--.�.......... - FEE.. !2.--......----• Disposal Works Tonstrnrtion rrnnt Permission is hereby granted..........----...---'b...... �'-----•---•--•--=----•----•---.........---•------.........---•--.........--••-•---.... to Construct ( ) or Repair (_j6.an Individual Sewage Disposal System at No.------•-----ram 7-./._.....r` ,.. ..Lid. -•----•- .--�' x .. ........'........................ .... Street as shown on the application for Disposal Works Construction Permit No.. - _ Dated.......................................... ..................... _ A?-- ---'-`-'-`-`------_ ..----------------------------------- Board of Health ` DATE----=-•-------•---•--...---•---------••..............•------•--- FORM 36508 HOBBS h WARREN.INC..PUBLISHERS