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Home My WebLink About0081 ISALENE STREET - Health �s I I -�aicne- I�A' i No...Y46�^-. FIeB..... ..--'... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA LTH t� .. �... ......... ...OF......�iPt 210 Appliration for Biopniial Works C umArtutiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ...:.. �............... . . K •- = C �lla ---.. ... a! Sd �es°s ................................... r . 4 Loc�tio -I res or Lot No. 1:7 �vt �Sd --------------- ................................................ ---------------Y._....---.........--•--- ...................... ........ ..... Y °A Owner A r ^' .. ........ t .................................................. Installer Address dType of Building Size Lot.................... .....Sq. feet U ,.., Dwelling—No. of Bedrooms................ .......................Expansion�ttic ( ) Garbage Grinder ( ) Other—T e of Building ��,�-Q-------- No. of persons........................... Showers — Cafeteria a Other fixtures -------------------------------•.. ___._. Design Flow_w g --_1.1.0...........................gallons per person per day. Total d* flow ........................gallons. WSeptic Tank—Liquid capacity,......gallons Length__._........ Width................ Diameter---------------- Depth...f-._.-....... 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 WJ 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 c, --- 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 iITL% 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by he bo of heal h. Signed....... •---•-•.... --- ..-- ...................... ................................ Date Application Approved By•••-•---••.-- -.-.-------••---------•---•-----•-- ------ V V Date Application Disapproved for the following reasons:.............................................................................................................. ---•-•-•••-•---••---...--•-•---------•.....................................................••-----------.._......------•--------------------------------------------------------------------------•--... Date PermitNo----- ------------------------ Issued....................................................... Date TOWN OF BARNSTABLE LOCATION tl Z ec,[f v,j S it SEWAGE # '3 q Z-2-O VILLAGE ASSESSOR'S MAP 6z LOT INSTALLER'S NAME 6z PHONE NO. DQScald 7?f- (c 17 SEPTIC TANK CAPACITY 1 , 060 9 w it"'3 LEACHING FACILITY:(type) Leltc-� 04 (size) 1, (JC)y 901 lldt,S NO. OF BEDROOMS 3 PRIVATE WELL OIPUBLIC WATER BUILDER O OWNE 7 � ` G S'✓�' �� DATE PERMIT ISSUED: �l DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No coo � ,r� w � �. Qw ti• C7 I L R 9 J No...�1..fj�.... ld Fz$....4 _ ..". 4 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE LTH i r p ---- ..U'.,/�...................OF.....'.i. �L�.... .:� �/ - . ''... C Allpliration for Dispoiittl Works Tonstrurtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: _ /I 1 r Loc tion-Address , ( or Lot No. S t {� .�,on- 7 {,vat{ �1 W __ � /....��{` OwnerAdd�ess�t.�! �•t/�.�I� a ......----- --------------•-•••......._...........----------......_..-•--•------• :....... ...... M Installer Address U Type of Building Size Lot............................Sq. feet DwellingNo. of Bedrooms...............a..... .Ex ansiont ttic — ----------•------ 'p � ( ) Garbage Grinder ( ) WOther—Type of Building ..... ��:J.`t......_.. No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ------------------------------------------------------.---•-.....----••-•--...._......••----------.... ........ W Design Flow......j.ho............................gallons per person p r day. Total duly flow........:?.�.�.........................gallons. WSeptic Tank—Liquid capacity l.:0(.....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......rG........... 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........................ f=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R+' .--••--••--•-----------•-•--•-•.................•--------•-..._.....................•-----....---.--......................................................... 0 Description of Soil...................... .. __ (`�j ..--••-•--•---••-----••-----------------•----•--•......�-0-� Ad -•--•-------......---------- ----.....----•----------.. .....----...-----..........-•---------.......... W ---•----------------------------------------------------------------•----------------•--------•-------------------------------------•---------------•-------•----------......._............._._......... U 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 Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beer} issued by he by of heal lh Ile Signed._ 1` Date Application Approved By............. :.. -------•--•------------- -----•• ...nJ---?._.:..�.K__- �- --)•- Date Application Disapproved for the following reasons--------------------------------------------------------------------------------•-------........_..............:. ..---•-----••.....................—..----------------------•------.......------............................. - ...--••----- Date — PermitNo..... ....�:.le.'.................._.... Issued......................................................-- Date THE COMMONWEALTH OF MASSACHUSETTS + BOARD OF HEALTH .......L. .w1........................OF.......�j..jh. �t TGL. ." ........................................... Trrtif irate of Tomplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by......... �.......0 a -11...................•--------.._..._..-----••---------••----..................:......----.....--•------•- ......_.._..----.......... ......._ y 1 A f14 /. Installer t' f � -.. l .._. at--------.-- .......... ... ?."...-...... ...--.---....--••-•------•-••--......---------------•--.-- = C has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit �'o.._. ^_)'.�..0........... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......................S. r_��-.G..'.D ........................ Inspector............. ..................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA TH I OF......................` ..f, .i. No..... `1r. C1 F=...c �....""::. Dispilli tl orks (10 otrttrtion rermit Permission is hereby granted........!.^-..... S C.. l� .............................................................•------------........----•--•---•--......................... to Construct ( ). or Repair (/0 and Individual Sewage Disposal S stem at No...---.•. --------- .-Q;r... :...�T V i t •. `� "� .. _G..l�.�..a . 1" `...........................................................••-•--•-............... Street as shown on the application for Disposal Works Construction Permit o..�: ... Dated.......................................... ............................ ....:-"_._........................................................... DATE. Board of Health FORM 1255 A. M. SULKIN, INC., BOSTON