The URL can be used to link to this page

Home My WebLink About0112 WASHINGTON AVENUE - Health 2$� Id 1 lv d oo e THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 2 TOWN OF BARNSTABLE Appliration for Disposal Works Tontitrnrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: ........ -- .._...-----•- ----- ... - - ---------------- - ._...... • .._...........------- L t dress or Lot No. Ag.� dt Y-- .. iti i✓Fr t T T ..------•............... ...••---•--- ... - -... Owner Address a ...............�'-.'`---_.. - T........................................... -- -1..3_ ...................................................... Installer Address Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms.............6........................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building _______________ No. of persons___._--_.__._________._ Showers — Cafeteria Q' Other 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. Seepage Pit No------_-----_----- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) , Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a1 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----_-_---_K_____----. --------------------------------------------------------------------------------•---••--••----•_...•......................................................... 0 Description of Soil_____________________________________ x �., w ---------------------------------------------------------------------------------------------------------------------------------------- - F------ V Nature of Repairs or Alterations—Answer when applicable--_ -S-_-6 O -T----_p�---•_.�G. Y:SS__._ ...---------••---------•-------------------•-----•-•----•---------------._.._..-••-----....••••-...--•--....•-•--•••----•--•-•---•-------•-------•..................................................... 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 bee su d by the boar of health. Signed - By APProved = ' v Application Disapproved for the following reasons: 7 - Da te ----------------------------------..................................................... � Q - - ------------------------------------------------------------------------------ F J/r_ ... . Date Permit No. ---- --- ---------- Issued Date THE COMMONWEALTH OF MASSACHUSETTS ir, I BOARD OF HEALTH • v TOWN OF BARNSTABLE App iration for lliopngal Workii Tonstrnrtion thrutit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: • -_.. ................. .......................... ............................................................. ---.........•--- Loc�t��A-6ress � T T or Lot No. .� y i� Owner Address �6Z c,,� ------------------------------ "s T 1 3 ...---------- Installer Address, UType of Building / Size Lot....!.......................Sq. feet Dwelling—No. of Bedrooms............2 ?..........................Expansion Attic Garbage Grinder ( ) 134 a Other—T e of Building .. No. of persons............................ Showers — Cafeteria Other fixtures ------------------------•----------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W Septic 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................mmutes per inch Depth of Test Pit.................... Depth to ground water........................ rz, Test Pit No.,2................minutes per inch Depth of Test Pit.................... Depth to ground water---_____--_--__---. --- P4 •------------•-----------------------------------------------------•--------........---••------••--•......................................................... 0 Description of Soil...............................................................................---------------------------------..................................................... W U ---------------------------•-----------•-------...-•--------------------------------•----.....-•----.....------......------------...---------------•----•------------.....-----•-------------------•---- W ° UNature of Repairs or Alterations—Answer when applicable._—?_5- 0___5�._.1.....p`_..___ Y-s.......... ----------------------------------------------------•...... 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 i sued by the board of health. Signed y...-.... c ___ Application Approved BY -------..-G .......��---------�✓-----�:'1•"..Z"--.- ------------------------------------------ ---��'.'�'�."'^��'q Date Application Disapproved for ithefollowing reasons- -----------------------------------------------------------------------------------------.............................................. ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------=----------------- f Date Permit No. t om'... .................... Issued .................................................................... " �� Date r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Tertifirate of Q-11'ozitylinure THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by------- r : '.....-/ �. T ............ - --nsta------er--------------------------------------------------------------------------------------------------------------------------- ,� at ...........: .:/......`�?............/ /. '�#=' r----..r�.------.... C✓r.� ./--n.�a.:..... ;7.......................................... F ....... 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. ....... dated ..----.-� -------.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................... .... .-. y`-. -d........ - ........ Inspector ................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No... i!j..`....,...e ' FEE............... Disposal 18orku 01111notrnrtion Vanfit Permission is hereby granted.-------- tg_'?.... .._! .....-------------------------------•-•-------------........--•-•---.......--------......-•---.......... to Construct ( ) or Repair (,,,)-an Individual Sewage Disposal System at No.......................r/ .........!?�.rx�..!.; ` .. 'i ..��......._._�'� �_aq ._.... . Y i�-�a .T.... = == - -- Street as shown on the application for Disposal Works Construction Pe w j o. '' ated........ .................................. Board of Health DATE.. Via -'' .. FORM 36508 HOBBS&WARREN.INC..PUBLISHERS