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HomeMy WebLinkAbout0120 OLD CRAIGVILLE ROAD - Health MO 61d COr` viIIf off, &N, e v r JJ_ .......�. Fss....... ........ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Disposal i8orkii Tonstrnrtinn runfit Application is hereby made for a Permit to Construct ( ) or Repair ) an Individual Sewage Disposal System cation-A ress or Lot No. .....:..':�'�......._. : 4 - -------------------------•---------- -----------.............................-- ---.......-------------- ------.....--- Ow er Address a .... c, -�---••-- �'AJVW.. V2 ------2- �El W..wat AtE. ....... Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons,........................... Showers — Cafeteria 04 Other fixtures -----------------y. 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----_--____-_-__-_--_-_. Test Pit No. 2................minutes per inch Depth of.Test Pit---:................ Depth to ground water........................ a' • •-----•----•••--------•••--------•---•-•-•--•--••-•---••--•--•••...............••--------.........................................-------- O Description of Soil ' �........�U_Z.----•-••-•-•--•---•`�-....... _ ��� 0 f� .._._.. -� ----.. W U Natu e of Re firs or Alterations—Answer when applicable.___ .......... pz�..___.__________.. Agre ment: 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 Com fiance has beenfl issued by the board of health. Siged ----_....--- ....�.m ..... - ----------- .......... A . - - Date ApplicationApproved By --- . . .................... ..... ............ ................................................. .... ... ... ........ .... ........... .. .1 ' Date Application Disapproved for the following reasons- ------------------------------------------------------ ------------------------........................................................ ---------------------------------------------------- ---------------------------------------------------- -------------------------- _ Date Permit No. ... Issued ...................... Date 9 V No.-.!.!•-----�?t Z Fzs.......3 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Disposal Works Tonstrurtion jhrmft Application is hereby made for a Permit to Construct ( ) or Repair 4) an Individual Sewage Disposal System at: ._..19_0--© ..------ - -�� ._-- ---�°! --- -------------------------------- --�` tion- dress or Lot No. .-.. -"'!--.-. ���-�� ------------------------------- ......................................................---....--------......-- .......... ^O�S ter �O. ................n 3� Addrel-zw � � - .. . ........................................ ` ..._...-_ .. -----------...----_-_ p� Installer Address d Type of Building Size Lot----------------------------Sq. feet �. Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of ersons____________________________ Showers a YP g ---------------------------- P ( ) — 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. 3 Seepage Pit No--------------------- Diameter-------------------- Depth below inlet-------------------- Total leaching area------------------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ~'' Percolation Test Results Performed by-------------------------------------------------------------------------- Date---------------------------------------- 0.4 a Test Pit No. 1----------------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........................ x -------- --- - 0 Description of Soil--- }-Z _Sv _____________________-2 _ .__..__ �� 0Lt=-tN�_______�`-b_______S ___________ ----------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Na a of Re airs or Alterations—Answer when applicable_____!! _____---__3____---�!�F 1---. ��, _____._-_ -- `' - � -5 awl.----------'-D ----------�=�`A_A �"'�---------S�p�--1c �(1--4%� Agr ent: 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 Certific e of Co lian has been issued by the board of health. Application Approved BY ------------------------------------ --- ----------------------------------------------------- ---------------- ------------------ Application Disapproved for the following reasons- ---------------------------------------------------------------------------------------------------------------��------------------ -------------------- ------------------------------- -------------------------------------------------------------------- ---------------------------------------- - 21 �w -------------------- PermitNo- ------------- -- '-------------------------- Issued ------------------------------------------------------------------- Dm j THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (IEr#ifirzib of Compliance THIS IS TO /ERTIFY, That the Individual Sewage Disposal System constructed ( )-or Repaired ( ) b �•:�C.t�- iW s at ----------I --------------- ------------ -------------------- - ��a - has been installed in accordance with the provisions of TITLE 5 of The State 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. DATE------------ -�� -��. -l ----------------------------- Inspector --------- ----------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE �- No - ------Zl�.. �oo�l orko �ono �lan �rrnti� Permission is hereby granted_---�`cY- �W' 'Sot to Construct ( ) or Repair an Individual Sewage Disposal $stem atNo.___-i ' -------- � � ' \ 4 ---------------- ---------------- Street - i as shown on the application for Disposal Works Construction Permit No.-7.1.2 1-2- Dated_-_-__ ---Z __ l/ Faard of Health DATE~_---d--1-------��--_------------__-------------------- FORM 365M HOMS h WARREN.WC_PtjRUSFiERS