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Home My WebLink About0061 LINDA LANE - Health (3) C�� Z,t nola. Gn ., Cen+: THE COMMONWEALTH OF MASSACHUSETTS 7 c le;,042i BOARD OF HEALTH d`�� TOWN OF BARNSTABLE Appliratiun for 14spuua1 Works Tonstrurtion Famit Application is hereby made for a Permit to Construct ( ) or Repair ( tea Individual Sewage Disposal System at ..........( 1..,1,.1 .YJ .... - ....................... ............... .!'`" - ...................................__............. Lof ion-Address or Lot No. - ....... >sv� .. 1?_L �fi ti---------------------------------------- 5 �!1 --� .._:.......................................... 'A n ,n ---- -- W ................ .l�fF! <^F�. er�� ----••............ .....•... ��.v -`�. ..... _�K.. .... ............. a Installer Address UType of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms-----7 ---------------------------------- Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Ga Other fixtures -----------------------------••• . - d -----•-------------------------- W Design Flow..--...."5.161 .......................gallons per person per day. Total daily flow-----_M�1 0....._....._.._.___•....gallons. GG Septic Tank—Liquid c acity. ......._.gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No. 1 Width....I?----------- Total Length------1_(ct`....... 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. ,................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........................ a ---------------------------------------------- •... ....... .... --------------------------------------- -------------------•-------------------=------•---------- 0 Description of Soil..................................................................................................... x W --------------------------------------------------------------•---------•-•---------•-•---•-•-•-•---------•--••--------•-------------•-----•--•----•-------•------•.... •-- UNature of Repairs or Alterations—Answer when applicable......A)w..._Tbvl .......... _ ........ al"-•------------•-------------------------------.................................................. 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 by t e board of health. Signed `7—:0�3—�� Date Application Approved By ........... ae"�- ...... :)- Date Application Disapproved for the following reasons- ............................................ --------------------------------------------------------------------- ............ --- --------------------------------------- ----------------------- ------- --------------------------------------------------------------------------- --------------------------- --------- .................--a-te------- Permit No. .. �-----------------------I.... Issued ------. D ............... ........-----...--------'--------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appfiration for Disposal Works Cnnnstrnr#ion Wrnn# Y" Application is hereby made for a Permit to Construct ( ) or Repair Individual Sewage Disposal System at: ...........-• - vt . ._.`- v- ------------------------ --•------------C n-v-`'�.--------------------------------.•...................------•---- o aton-Address or Lot No. Ow er ddre s w �,4 _�- :v 5 � ,----------------- — o_�__ o..... .��_ ..._V . P Installer Address Q . :Type of Building Size Lot.................... .....Sq. feet U - Dwelling—No. of Bedrooms..___—2�.....__.._._•...................Expansion Attic ( ) Garbage Grinder ( ) p-I Other—Type of Building ............................ No. of persons___.___..__................. Showers ( ) — Cafeteria ( ) dOther fixtures -----------------------------------------------------------------------•-. ---•--------------•---------------------------------....................... W Design Flow......_.... 7-15-7---------------------gallons per person per day. Total daily flow..... .......................gallons. 1:4 Septic Tank—Liquid capacity-•_-_-_ gallons Length--------------_ Width................ Diameter---------------- Depth................ WDisposal Trench—No.. r� - -�!Width...._..?`........ Total Length.......]a...... 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. I................minutes per inch Depth of Test Pit.................... Depth to ground water--_-_--______---___-__-. �14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--__-_-__-_-_-__--.--___ 9 -----------•---•••----------•---•--------•••--•-••••-••••-••----•----•--•-••--......•................................................................... •--.-- ODescription of Soil-----------------------------------------------------------------------------------------------------------------------------------------------------------------••---- x U -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- .......................7.. U Nature o� Repairs or Alterations—Answer when applicable-------A_)W_.___.F__� - ....... y1 ------n!1-LX_ ------ G E's=� �' ------------------------------------------------------------------------------------------------ Agreement: IThe 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 by the board of health. Signed, \1.. ---a3--�- ........ ........_...- .. \- llate Application Approved B Date Application Disapproved for the following reasons,---- - PermitNo. � .�. .... ... ....... ✓ Issued ---........---------------------------.------- ..`----- ` Dare THE COMMONWEALTH OF MASSACHUSE17S BOARD OF HEALTH TOWN OF BARNSTABLE CITer#ifira ey d (11umylia n.ce THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (f L_ — by G .V 1 - 5� 1 ---------------------------------------- --- I Installer , ---------------------------- ---------------------------------------- --------------------------------t------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Wo�s Construction Permit No. .................Q._-., 3.,/----- dated _.--___.-_-_-_...._____------------..___--.-.-__ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......... t ''� ----------- Inspector ..A .("/-�'.�_...... �� ' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No, /� �a TOWN OF BARNSTABLE Vl-...:,. �.� FEE.W............. Disposal Workii Tonstrudion rrrmit Permission is hereby granted......... .. 1P L _._Sz( ---------------------------------------------------------------------- to Construct ( ) or Repair ( -)—an Individual Sewage Disposal System e , atNo..........-------•-- -1------- ................... - ' ` --------------------------------------------------------------------------- Street 2 as shown on the application for Disposal Works Construction Permit No._.fJ:. 3�_ Dated.......................................... /� ------------------------------••••••••:-�-------------•---------------...--•---............-- DATE_ Z_ -�_3_-l(/ ______ Board of Health FORM 36508 HOBBS&WARREN.INC..PUBLISHERS