HomeMy WebLinkAbout0430 POPONESSETT ROAD - Health c-� arq-��$� J
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No.._ -3. Fas....... :n..� ..
THE COMMONWEALTH OF MASSACHUSETTS
APPROVED . BOARD OF HEALTH
Barnstable Conservation Department TOWN OF B A R N ST A B L E
'�7 ,12- 7,
Sig itC [ tloilrt�ti}Jtt�a � I t�rltl� �d1P►tr1YCiAIiPXlltt
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System of
------ -----
n Location-Addr,s or Lot No.
r1l _ �� -----------------•------•----•--••- -_��/ O._. lJ ?AC7� _
r ..
Owner Ad css
Installer Address
e of Buildin — '' L "Sr'N�t i '!i�1
Q Typ g �iI!//� I Size Lot. l __..Sq. feet
Dwelling— No. of Bedrooms---_--_--------------------------------Expansion Attic WO) Garbage Grinder (00)
p, Other—Type of Building .�/�'fAAf.. No. of persons....../V---------------- Showers (a) — Cafeteria (Np
0.t Other fixtures ------------------------------------------------------
W Design Flow............................................gallons per person per day. Total daily flow................................._..........gallons.
WSeptic Tank—Liquid capacityla-4>.gallons Length---- -_�,.... Width.....4?........ Diameter---------------- Depth................
x Disposal Trench-- No. .................... Width.................... Total Length................... Total leaching area....................sq. ft.
Seepage Pit No-------!A.......... Diameter---.-.24?.......... Depth below inlet......6_.......... 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........................
R+ ----•------------------------------•------------------.......__.....----------------------------......---...................---------_.•--•••••--•-•-•-......
0 Description of Soil...........5A.& ._._._...
W ----•--•---•--------- ..................................................................................................................................................................................
UNature 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 Compliance has been ' ued by the board of health.
Signed ..... } ...... ...,...................... .7/..... ......................
�t2lz 6� t f �j Dace
�i
Application Approved By ............. �a/± -e,.. ....._...................... _.... .-oL:ate
V (J ...... ....
Dace
Application Disapproved for the following reasons: ......................... ............................................................................................................
............. ...............................
Da
L--------------------------------------------------------
Permit No. ................ Issued
Dare
No.._1��-..��13. Fas.......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
ppliration for. Uiopoml Wor1w Tonotrnrtion rrrntit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: .
` ...� � -• --- ---...--•---------------------------------
Lorttian-:�ddress or Lot No.
Own,, Ad- ess
ess
--------------
Installer (y SizerLot__'�------- •- Sq.U Type of Building - ,�'E`,ji'i�E"A/T//���,/-'SiN�I� �I ��,_.. feet
�-. Dwelling—No. of Bedrooms......... --_--_---"--------------_--Expansion Attic (NO) Garbage Grinder (WO)
Other—T
a ype of Building 1,�.,!.�'.f�.4.. No. of persons_.....�................ Showers (a) — Cafeteria (/�)
dOther fixtures --------------------- ---------------------------------------------------------------- ---------------------------------------------------•--------\
w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. .
WSeptic Tank—Liquid capacity 15c�K>..gallons Length___/__ Width----�?---------- Diameter................ Depth................
x Disposal Trench--No. .................... Width.................... "Total Length...._'-............. Total leaching area....................sq. ft.
� Seepage Pit No-------_n�._.......... Diameter....... ....._..._ Depth below inlet_..._.6......... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
a
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........................
�i f
D Description of Soil.. 'r/-1/..�(./.
--------------------------------•--- ...........................................
x C
w
VNature 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 Compliance has been is-sued by
the board of health. / J
Signed ........_
- f/ �fr✓................................_
r Date ..........
I-le
Application Approved By ............... ....... ............ ............................ '.- ..... .... ....
` � �* ] Date
Application Disapproved for the following reasons: ..... . ............ . ..................................................................... ..........................
....... .............. .......................... . ......................................................................... . ... - --............................... ........................................
Dace
PermitNo. ......../... �-� -... ...1..3............... Issued ........................o�.e.......................................
r
----------------
THE COMMONWEALTH OF MASSACHUSETTS
: . 'BOARD OF HEALTH
TOWN OF BARNSTABLE
(IT r#ifirate of Tamplitt�ccE
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
b ��,.+-�-...............cam--.,��.t. ....... ....__....._.._ - ............. ................ ........................ ... ........................
y ......................
1nscJlcr
at ......... . ..3.0........ s e .... -r _JL4 ......................................... . .................. . .....
has been installed in accord�nce�e 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.......... ...._................ ...... ...... Inspector ......_ ...... .. 0 _....
i
q .
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Q TOWN OF BARNSTABLE
No.-..j�._•��--`=•��� FEE......../-n<2
Ropooal Worbi Tonotrudion rrntit
Permission is hereby granted........cl—AteZ�-.....-1=� --------------------------------------------------------------
to Construct ( ) or Repair �) an Indivill Sewage Disposal System
t No.•-•-•-•-•-- -----�rb •-- ---.------ ••---------------
a � ^
Street as shown on the application for Disposal Works Construction Permit No.Y_,-31, Dated---._.,�-..a.....................
............................ J ------------------------------------------•---"---------
Board of Health
DATE................ -. ��--.......-•----••-••-•-•-
FORM 36508 HOBBS&WARREN.INC..PUBLISHERS
E . C , TOWN OF BARNSTABLE
LOCATION Yo PgS�ET �oA SEWAGE #
VILLAGE ASSESSOR'S MAP & LOT
INSTALLER'S NAME PHONE NO. 4E/Z!?t/ - -A h'U.TE -CMG '
SEPTIC TANK CAPACITY FL46 la L
LEACHING FACILITY:(type)_ 'TTS (size) /oU/>Gl4L
NO. OF BEDROOMS14PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER TX-4-
DATE PERMIT ISSUED:
DATE COLIPLIANCE ISSUED:
VARIANCE GRANTED: Yes No l/
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