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HomeMy WebLinkAbout0306 CAP'N LIJAH'S ROAD - Health (2) ©l� OAPn L` 'S . r I I i I I i i I I N SMEAD KEEPING YOU ORGANIZED No. 12134 2-153LGN m�Eov m wma m CONW toy Cnufi��Q PMCONSUMER SF;-0l o MADE IN USA GET ORGANIZED AT SMEAD.CAM r No...El.:.. Fxs... ?............ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliratilarn for Uispuiia1 Varkii Tiamtrnrtion Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: j :..... �2 .............. , ... ,. (e...�E✓v.. lc. .----_ � ...... Lot No. .... ................................. or a .. l--e�- -- Sal !' Address r .. ......... staller Address Type Building Size Lot............................Sq. feet .-� Dwelling—No. of Bedrooms....!�V................................Expansion Attic ( ) Garbage Grinder ( ) aa Other—T e of Buildili YP g ____________________________ No. of persons............................. Showers ( ) — Cafeteria d 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.( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................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........................ --------------------------------•-•--...-----------------•--------......--•••-•--••----•----_.............................................................. C Description of Soil............ ...........................:..................................................................................................-••••----•-•------•---•---•- x c, ..................................-•--------••-••••••------•-••--•-••-•-•••-•----•--••---•-•-••••••-••...---•••......------•---•-..... -----••••••----••-----•._....................................... lY -----•.............................................................................................................. .......... � U Nature of Repairs or Alterations—Answer when applicable._---. ..... . Cl ._. _. .. --•--------------------------------------------.................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environment Code—The undersigned further agrees not to place the system in operation until a Certificate of Complian( as been is ued by;thabnd of he th. Signed - ------------1----- Dare Application Approved By .... ---- -- u. ---�. -----7,n--V- /....... Da[e Application Disapproved for the following reasons: -- ----------------- ---- - -- -- ------------------------ - --------------------------------------------- . ---- ----------------------------------------------------------------------- ---- f"� Date Permit No. ....... `__ G ' P.` Issued --------------------- Date s No..... l=• `• Fxs.... t%. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - TOWN-OF BARNSTABLE Appliraf ou for Uiipntial Igorks Tonotrnrti.on anti Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual. Sewage Disposal System at .......................... .---- Loca ion- dr�9s, or Lot No. ��{ � . . ... ow W Address �., sue - . .. . �. In ler -• ddress UType uilding Size Lot............................Sq. feet Dwelling—No. of Bedrooms......���..............................Expansion Attic ( ) Garbage Grinder ( ) a Other—T e of Building a Other—Type g ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures . WDesign Flow...........:................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons. Length................ Width................ Diameter.........---.... Depth........... 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........................................ Test Pit No. 1------------------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........--.............. ------------------------------ •------------------- "-------- "--------- .."-"""""..-------------------- --"-------------------------------- •-••-•--------- ----- �• V0 Description of Soil............."......................................................-"-"""""""-----------"-----"----"-""-------"""-•--""-""""-------------------••••................... ............•....................................................•••••-•-......................---........--•--......--•.....--••-•-•------•---...•----.......••-•--......------•--•........-•-.......-- UW --•--•----------------------------------------------•-------------------•-------...-------•---------------------------- ------11...... ' Nature of Repairs or Alterations—Answer when applicable...------- . . •....•-•-•-••...............................•-•-•------•--••--•••-•-......-----...•-•--•--•••............---.......................... 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 is been issued by the oa�heal Signed -- - Application Approved BY - . .. -----.....-----------------------------------..............--------------- ----'' e--.. .....-. Application Disapproved for the ollowing reasons' ....................................................'-----.....................................------.----------- --------------..... ---------------- - ---------- - ------- - ----- -- --- -- ---------- ------ -- ------ -------------- -- ------------......................---------------------............... ........................ ------------- Date PermitNo. ..... ...... .............. ......... Issued ........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE &rtificax#e of C�oz>rt}aliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed g p y ( ) or Repaired by ...--...... ti Installer at ......... ----.- --- - ---- ---- - - ---- --------------------------------------------------------------------------------- has been installed in acAornce wit the provisions of TITLE 5 of The tate Environmental Code as described in the application for Disposal Works Construction Permit No. .......� ---�........ dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 1 jf ,•--� DATE-------------------------------------------------------------------------------------------------------- Inspector .............................................--------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS I BOARD OF HEALTH � TOWN OF BARNSTABLE No...��..-.�v^'� FEE. .�,.�........... Bispno 1 Workp Tian nawn rrrmit Permission is hereby granted-------- --• -•-• ---•--....I� ......-----•----•- .......................................................... to Construct ( ) or Repair �) an ndividual Sewage Dispose System atNo.................................................................... .............................................. Street as shown on the'application for Disposal Works Construction 'Permit No.;.' \\ _.. Dated.......................................... ..�:y...................... ....Y .._1.....-•--------------------------......_.._._......_...... �_ � Board of Health DATE ,1 ---(/------------------"--"------------"------" ���/// FORM 36508 HOBBS&WARREN,INC.,PUBLISHERS -