HomeMy WebLinkAbout0056 PLEASANT PINES AVE - Health (3) r2d ,
LOCATION SEWAGE - PERMIT NO-
V I L L A G E
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INST 'A LLER'S NAME i ADDRESS
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-A*--- OWNER
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DATE PERMIT ISSUED �.�
DATE COMPLIANCE ISSUED � /
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ASSESSORS MAP NO'
PARCEL NO:
No................------•• Fas.............
.................
THE COMMONWEALTH- OF-WASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratio,i for Di-nvo.3ttl Workri Tautitrnr#ion jhrmi#
Application is her made for a Permit to Construct ( ) or Repair (k—�an Individual Sewage Disposal
System at:
3A.- -------�RkNL3.A� -------cgr�=k'......*------------------------------------------*-----------------
- Location-A dress or Lot No.
� �
. a ----------------------------- ..------------......---••------
Owner ddress
Installer Address
UType of Building Size Lot............................Sq. feet
�-, Dwelling— No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons__...._-_____________-._____ Showers ( ) — Cafeteria ( )
Otherfixtures ---------------------------------------------------------------------------------------'-----------...------------------------------...........------
W Design Flow.......................................... allons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity._.. 11ons 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 ( )
aPercolation Test Results Performed by----------- -------------------------------------------------------------- Date..------------------......--------......
Test Pit No. I----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water.......................
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_.......................
04 ------------------------------------------------------------------------------------------------------------------------------------------------------------
ODescription of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------
x
U .-------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------................
W ------------------------------------------------------------------------------ ---------------------- -------- ,�.�
U Xaturet 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 Compliav4Z has been ' sue by the board of health.
�1� 1cC
Signed ..... . . ................ .
cC
Application Approved By -►.; �s�t�t�a,�-` - .........:. ....-ems�1�1 ------------------------------- ----..
Dace
Application Disapproved for the following rearonr: ... :......_ - ------------------------
------ ------ ------------------------------ - . ............... .......------- -------- - . ...........
Permit No. � `.-..; .. ..... Issued ------- � .. ��.....
Dace
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Ter#iftrate of Torttylianre
T S IST g TIFY, That the Individual Sewage Disposal System constructed ( �) or Repaired CER
by �-� _........ ................- -
-
at .........................l#........ --- ---------.--------Q
has been installed in accordance with the provisions of TITLE o The State E vironmental Code as describeds in
the application for Disposal Works Construction Permit No. dated
_ ... ...... �._......
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT
BE CONSTRUAS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTTOORY.
^ `✓ I ector'!^- 'o
DATE...... "..... ------------ --- ns P
9
--------------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
✓ ' TOWN OF BARNSTABLEy
No..-...................... FEE...............
Disp oat Works Tonotrwtuan "permit
Permission is hereby granted--------- -.. 5 C-4- --------•-----------------------•----•--.........
to Construct ( ) or Repair ( L/an Indi i(tual Sewage isposal System� (t
at No.......... ....�--Q------ ��_C•� C.�^ �. .`? - 1` 1
Street -------- /._.._... ....
as shown on the application for Disposal Works Construction Permit o �� YDated.....
� `
�- ..
--
r..04, Boar of; Health
DATE------...-.. ----
FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS
No......`.............. . .F�a '
• t .. ..........
THE COMMONWEALTH OF-MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Allp iration for Divi-Voottl Worko Tonotrurtion rumit
Application is hereby made for a Permit to Construct ( ) or Repair (�_4n Individual Sewage Disposal
System at
.........k.la..---Y\.C ........ .!�........vt...`e... ---- ------------------------------------------
Location-A\ dress or Lot No.
...................... ---------------------- ------�U`1==� ------•------•-----••-------•-•-----------------•---
Owner d \
a v. �_... M,-� _.... ���c'`'` a s� ....
Installer \ Address
d Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Otherfixtures ----------------------------------------------------------- --------------------------- I
----- ....-•-------
W Design Flow.......................................... . allons per person per day. Total daily flow............................................
WSeptic Tank—Liquid capacity....4 llons 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......................................
Test Pit No. I................minutes per inch Depth of Test Pit._.---_______--_--- Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
P4 •-•••-•...................................................•-•--••-•-••--••--•••-•-••--•.......•--•--.........................................................
0 Description of Soil........................................................................................................................................................................
U
W a,
t
....._..---•-----------------------------•------•------------........_.......----------•-..........-----.....-�-----.---- ----.............................-•---•--....---........x
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 Complia�%�
as been ' sued by the board of health.
Signed ......................... I �
Dare
Application Approved By ..............::.................... ----------------------
Date �J---- ------
Application Disapproved for the following reasonf- ------------------------------------------------- . . .. .............................. . ..............
J
_........ ----------------------------------------------------.... ............................ --.. .�. .. ------------ ------
.-
Permit No. ........ .. 9-------- Issued � e....... ...
Date