HomeMy WebLinkAbout0111 OLD KINGS ROAD - Health /dl dLD ►��t
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w< TOWN OF BARNSTABLE
LOCATION de4,4,0 SEWAGE #
VILLAGE GUTU 1' ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO. 7�F�iZuO-77
SEPTIC TANK CAPACITY �600
LEACHING FACILITY:(type) . /Ni'�i- �Z (size) (�
NO. OF BEDROOMS-PRIVATE WELL OR UBEIZR- WATE
BUILDER O g W LZK-EZ
f l
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No (�
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Dhjipnittl Wnrbi Towitrnrtinn ramit
Application is hereby made for a Permit to Construct ( ) or Repair (X� an Individual Sewage Disposal
System at
......�./.� ...... ... -...-------------------------------------------------------------
L dt Dr• or Lot No.
......................_.......................................................................... ........................
C� W�-�--- A ress
5�
----------------------------------
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 ( )
a' Other fixtures _______________________________ __
W Design Flow.............. ....................gallons per person per day. Total daily flow-------------- —70........_._....gallons.
WSeptic Tank—Liquid capacityY60 _gallons Length---------------- Width_._.__.i__--__. Diameter---------------- Depth..........
x Disposal Trench—No. ._J............. 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. I----------------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........................
------------------ ----------------------------------------•----•-------------------------------------------•-------........-----------........---...--..----
ODescription of Soil.................................................................................. ---------------------------------------------------------------------......----------
x
U ---------------------------------•--------------------•--------------•-------•-----._.......-----------------------------------------------------------------------•-------------------••--------------
x ------------------------------------------------------------------------------------------------------------------------------------------------- •---------------
U Nature of Repairs or Alteration —Answer when applicable.-____/..^l <<-_._ '._� c5 �_C-...__.
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 ha een ire by board of health.
Signed ............... . . I�JG`I
Date
Application Approved By .......... � V ------------------------------------------------------------------- ----F_ _—1-1-41L
Application Disapproved for the following rea.rons- ------------------ ---- ------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ........................................
qqt� Dace
Permit No. .......1...L1-----------L ' ..... Issued
- Date
Q—
No... .-����. - Fps..............................
f F THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Bi-tipinittl Workii Tonitrnrtion lirrmit
Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal
System at
.. l//_._.....�J .......1 � - .. -----------
C_ ..........J%--------------------------------------------------------------
�Cn qv ..
_V�—_/_•-._..._.....L�ati�on ..dN SC.�-� or Lot No.
owner Address
Installer f Address
Type of Building Size Lot.................... Sq. feet
., Dwelling— No. of Bedrooms----------- `,= ------------- -------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building -------------( ...... No. of persons---------------------------- Showers ( ) — Cafeteria ( )
a' Other fixtures --------------•-•-------------------------------------------------
W Design Flow............... _................gallons per person per day.' Total daily flow._..._-_.___ ' ...............gallons.
W Septic Tank—L:quid capacity(OV.galIons /L•ength................ Width---------------- Diameter_------------- Depth................
Disposal Trench—No. ........... Width~"'f�I--_-_._ Total Length ..... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter----------------:--- Depth below inlet........t'........ Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing�lt nk,( ' )
Percolation Test Results Performed by------- ---------------- (----------------------------------------------- Date........................................
Test Pit No. I----------------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........................
W ...........................................-.................................................................................................................
0 Description of Soil........................................................................................................................................................................
W
U
x -------------------------- ------------------------------------------------------------------------------------------- ----------•-•-•------------------•-------••--•--•-••••-•--•-............-•--•-•-
U Nature of Repai-s or Alterations—Answer hen applicable....-. ^J L4-._ -.../. � ......
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 the board of health.
Signed ............... ..
Dare
Application Approved By -------------- t.<v,-- ... ------------------------------......----------------------------- ------- = c�7.
Application Disapproved for the following reasons- ------------------------------------------------------------------------------------------------------------------------------------
.............................................................................................................................................................................................................. ........................................
q Date
PermitNo. ( t - t f----------------------- Issued ........------- . .........._.............._...............
Dace
--------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
(�Ertifirak of (lontyliance
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( � )
by ...._.... ..................... ........ 15�C11.... .D LG . C ----- ------..........._....---------.......--------------....---------
Installer .,
at ... - ...... //.............6%J�---------- / / ,5.---- CG' 1 --------------------C----`' ' v... -------- --
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. _._... � V dated ----------------------PP P y . .............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE C�ONSTRUE6 AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE. .......�`�. �'+ 'r'.._.�...... - - Inspect r---... _ ---_-
V
--------------------------------------------------------------------- ------
THE COMMONWEALTH OF MASSACHUSETTS /, _ Gulf
BOARD OF HEALTH V
TOWN OF BARNSTABLE
`n L/ FEE.. G_..
No....�r l !/ .......
�io�n�nl ork� �on��rion �pruti� _
Permission is hereby granted-------_----- ........................................C...7.....lCD�--------••--.......---....
to Construct ( ) or Repair O an Individual Sewage Disposal System
at No... / 1.... .......... 'r!. '.C—f !!978.......... Ua_..U. ...
Street
as shown on the application for Disposal Works Construction Permit Dated.._.__. /.1...........__
Board of Health
DATE•---•-... 6 .V ....p• •-------------•-------------------••-• `
F
FORM 36508 HOBBS&WARREN.INC USHERS