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HomeMy WebLinkAbout1444 SANTUIT-NEWTOWN ROAD - Health 1444; Santu*t Newtown koad?a A�vfM1 ��✓ A'iOryl24 I I� I II, Ill II 14, THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Pispoiial ' irkii Tonotrurtion lbratit Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at: �p 1 � ..L 0")f��:. • .....(?_4..................... in c-n A r ss `! sor L.t. '2Locat - .�--------------------------------- ---`-_----- ....' .o...FC:. .......................•--.... Owner Address W Installer Address Type of Building ff Size Lot............................Sq. feet Dwelling=No. of Bedrooms._.... 1. }___________________________Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ________________ ________________ _ d -------------------------------------------------------------------••--•--••------ W Design Flow__ASS?©. _p_Q____________________gallons per person per day. Total daily flow........ ...-.•._..................gallons. Septic Tank—Liquid capacity./_Qtt_a..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 ( ) aPercolation 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........................ a ............. ---•••-•••••......-••--•• ••--••••••-----•--•---------------•----•••---••---•-•-........................................................ 0 Description of Soil-----------------------------------------------------------------------•-------•........................................................................................ x 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 Complia ce has been iss -led board o health. Signed ----�--------- --------- . --- s' Date ApplicationApproved By ------------------- -- -- ---------- C ....... .....---------------------------........................ ---- ------ ---1.,---------- Date Application Disapproved for the wing reasons: ............................................................................ ----- -------------------------------------------------------------------------- -----.............. ............ ---------------------------------------............................................ --------------------------------------- Permit No. ......................................... Cl- Issued ....... Date Date No................_....... - Fim.... THE COMMONWEALTH OF MASSACHUSETTS : s BOARD OF HEALTH i "t TOWN OF BARNSTABLE " Appliration for Disposal Works Tnnst.rur#iun Fermi# �h Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: L Avg, s_i"`fl.:.......I V F GJ�f) h �� Locatio A dress or Lot N - Owner Address a ----•-------....-•---------...•••••.._..---•----•------•--•-•••••................................. ••-•--•--•--•-------------...---......---................-----•--................................• , Installer Address d Type of Building / Size Lot............................Sq. feet u! (._.>Showers" g Dwelling— s...-- p , Grinder ( ) Other—Type Type of BuildingBms l _...... No. of persons .Attic ,(Ga>ba Garbage Grinder ( ) Q' Other fixtures ---------------------------••-•. . W Design Flow..Ste..6 P per person per day. Total daily flow--------- _.........................gallons. WSeptic Tank—Liquid capacity j0 0__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 -••-----------------•••----...-•••----•----------•----•-------------------....--•-----•-•--•-•-•••...•-••.....•---••--•-•-•-------•-------•--•---•......•-•-- 0 Description of Soil......................................................................................---------------.................................................................. x U ------------- •----------------- ----------------------------------------------- •----------- •--------- ---•--------------------------------.............-------------------- 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 issued by the board of health. Signed.:...1 �% -- !.�-/ n----------:- -- -- Date Application Approved BY7. -.1. +!Uate- Application Disapproved for the llowing reasons• ........................................................... .— - - ................................................................................................................................................................................................................ ................Date PermitNo. ......................................... Issued a........................Date t_ THE COMMONWEALTH OF MASSACHUSETTS ' BOARD OF HEALTH TOWN OF BARNSTABLE Cex#ifi.ca#e of Taray[iance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by ---- '�fp �i....: ... 77 4 -----------�-----------------------------�......----------------------------- / ...-.. ' / Y Installe at ... �� !-j-------- �/1.. L; >�off;... ... 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. .... .�: fa........................ dated .......................:------.................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. s e...._eo DATE-----.. -------=---------------------- Inspecto [ i :..' "�.-� '�rv' J. . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �a,-.�1. TOWN OF BARNSTABLE /.. No........................ FEE..............Disposal Iforks/T � } rion V1,rani Permission is hereby granted..........^ .*^ .t�.....!�✓.Z.r ?_. "y-------------------------- to Construct (Y) or Repair ( ) an Individual age Disposal ystem may/ at No...? ±� %✓ ��.r� :Z•: ._,..--• C"� /tC''! .5... `'/......... !1 X. .......... ...... ; Street �•-� as shown on the application for Disposal Works Construction Permit No.� _"a5�Dated..... .... Board of �e lth DATE.. `"�. � ..._ ........................... `/ y FORM 36508 HOBBS&WARREN.INC..PUBLISHERS y3� - 7r�.3 l� �� W ASH EQ P E N SFT ONE �_.. , _ . _ . _ . ESE V• G,S.5� 0 Cl ED q - - i c7a - F`T, Ai i1)� tr Y 1c0 F'T LC,NJ OF G LLVVS l� V. NO'r TO SCALE. .� i� TEST PIT I -73,00 — ,-- - -- ID' r --- s� \� SUMCE_ PROP(DSE.D T ols. gox � � 0 Tz � � � --- l �` -�k.--. ��� 1 NS?.�1�� . _:. ,�• ��k _--�D tit i�t .T7--? 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