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Home My WebLink About0325 POPONESSETT ROAD - Health Il' 4�': IV MW RON O i'A R:a•�� (�,}�yyy T— 'urn^'�.� � � pu No...?.T A7 THE COMMONWEALTH OF MASSACHUSETTS BOAR®9,11675-4 HE LTH .J ... aLUd................:...OF...... 1�!. .f. ...------•---.....-----..................... App iration for Diipnual Works Toustrurtinn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( � Individual Sewage Disposal System L . ..._.. 6�� or Lot No.Llle --------------------------------- --------------------------------------------------- ---- -----------------..------- Address . . .....' 1s4li.�. ........................................ ..............................-............................. .. Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.._....................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ 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. 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............................................................-•--...-----------••-------------------------------------•--•----------------------•-•-••-•---•------------- x U U Nature Repairs or Alterations Answe m�en applicable. ._ ....-�..::._ G�. _.-_--- -_I�_... / . ._...._. ---._.....0 -------- 1'4 � ----------•---------•-- •-----••--••--------------- A ement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL I Ti LE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i ✓he board,,9f health. Signed... d -Y—k I at Application Approved BY ( ^`` } -•--•---•-•-----------------•-- ---•-•-------------Da.-e-.......•...... Date Application Disapproved for the following reasons----------------------------------------------------------- =............................................ ........-•-----------------------------•---•----•---••-•------.....----.....----•-..-.---......----------------------••---------•--•---------------•-•-•--------•-----•-•-----•---------•-•----- Date PermitNo.....:. - --------------- Issued...........................................-........... Date THE COMMONWEALTH OF MASSACHUSETTS _`-- BOARD OF HEALTH App iration for Disposal Vorkii Tonstrnrtinn Fermi# Application is hereby made for a Permit to Construct ( ) or Repair Individual Sewage Disposal Systew,t: ... . .; r .... r! > r ( Location-Ad res or Lot No. 9 t . ......... . .Or r Address a a � ...................................................... s .................._. ............................Sq. feet U Type o Bull in g Size Lot Dwelling—No. of Bedrooms.--- E....................................Expansion Attic ( ) Garbage Grinder ( ) `4 e� Other—T yp of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther 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. 3 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........................ 4q Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ----------•------...--••••-•---------•--------•------------------------••----------.......................-----•-••-••--••-------....•. ----- ----------- ---- 0 Description of Soil....................................................................................................................................................................... x v ................................................... -------------------------- •------•-•--•-----------•--•----•-•---•--•-•---------•-••••-•-•------••- U Nature of Repairs or Alterations Answe en apphcable. f _ ..._.�__.__._..�__________________ `-. .. �� /\ l C......... r f ,ter------ --------•-•-•-------- a/- A�ment // The undersigned agrees to install the afor edescribed Individual Sewage Disposal System in accordance with the provisions of TiTITE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued;by%'the boar0%'of health. Signed__..,� 'f�K:%..._C `i:? '' ' .......................... ........� �1:_•�� Date Application Approved By. .. -. :::..-:=-�......--•----------------------------- Date Application Disapproved for the following reasons-----------------------------•-••----•--------------•---•---•------------------------------•-•---••----•---....•- .....-•......................................•-----------•------.....---------•-••-----......------......._...--------------------------------------------------------------•••-----•---••-•-------...... Date _... ........ Issued....................................................... Permit No....... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTIJ/ /7 Z. ::..... ......................OF.... x--.-.�........:: ................................ �rr#if irtt�r laf f�um�rli�nrr THIS IS,TO-CERTIFY hat the Individual Sewage Disposal System constructed ( ) or Repaired --'�" Installer /r at------...... has been installed in accordance witil/tI e provisions of TITIIZ 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.-_____t .�_ .5.._.._.._. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE. �o-..��.��.-... .� Inspector................ ............................................................. THE COMMONWEALTH OF MASSACHUSETTS Yam_ BOARD OF HE LTFJ V �/ h �••G .4;2..................OF.. J �1!/ "" � r3 ✓ (} ci........................ .. ...................................... No...t_......_....1..�.._ FEE e ......... T no#rnr#ion "permit Permission is hereby granted------e ......... }`=L LJ✓" i to Construct ( ) or Repai ��) an Individual Sewage Disposal Systems r .. � t ✓ /, L`3' ^,.. 1... Street as shown on the application for Disposal Works Construction Permit No..; .'. -- Dated.......................................... DATE. .." • -•d Board of Health L - ..' f FORM 1255 HOBBS & WARREN. INC., PUBLISHERS TOWN OF OF BARNSTABLE LOCATION 325- 1/ o g42ag y2&Sar 11- SEWAGE # VILLAGE_a ASSESSOR'S MAP & LOT 6-3 _ 601 INSTALLER'S NAME & PHONE NO. ,� (,Q� > /9 � Q-yq_ SEPTIC TANK CAPACITY LEACHING FACILITY:(type) p (size) 3--y NO. OF BEDROOMS , PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER V / DATE PERMIT ISSUED: -- DATE COMPLIANCE ISSUED: a ct l'Sl VARIANCE GRANTED: Yes No l 3,119 / r�