HomeMy WebLinkAbout0035 DEERFIELD ROAD - Healthr 3S Ck��akd ���,
2 ��v
No.. Q..= o
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
TOWN OF BARNSTABLE
Applirotion for Disposal Works %oustrnrtion rumit
Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal
System at:
..... _..... .------!�0....... S - ----------•-----•-----•................. -------•------------------------.....
Location. ddress or Lot No.
fVo�1�_i � . .................. oo . £------4� E. i.e,,. ,yQ. .x?!1!S�
wner Address
-- Installer......... `
! .........--'...... ......Address WOTD GOJ7lISr�✓ �� y...12.�. J �LS......�� �� ...
UType of Building Size Lot_ f.a0e)__Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
`4 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 ca.pacityZ&,O.gallons Length................ Width...._........... Diameter...-............ Depth................
x Disposal Trench—No..................... Width.................... Total Length.........._.___ Total leaching area--____----•--•-----sq. ft.
Seepage Pit No............./---- Diameter-____/-------- Depth below inlet......�__f_.... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................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........................
9 ---------•-------•------•-------•--•---•-----------•..............•-•--•--------•----•---••----••••.........................................................
0 Description of Soil------..... - .....--- --..�Gg------------ .......
x
w
------------------------------------------------------------------------------------------------------------------------------------•---- •----•---•-••..-••••---••---•------•----•-•--....._.......--
U Nature of Repairs or Alterations—Answer when
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 Compliancy as been issued b the board of health.
Signed ------- - ------------------ --------...............................................
Date
Application Approved By ... ------------------- .---------------------------------...---------------------------------- ---�1 , `�.?..-...�.G......
Date
Application Disapproved for the following reasons- ---------------- -------------------------------------------------------------------------------------------------------------------
----.....--- --------------------------------------------- -- ------- ---------------------------------------------------
C� Date
PermitNo. --------/r'` ------------------------------------ Issued ..............................................................
Date
c
/Z
�� LL
r' FB
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
! + TOWN OF BARNSTABLE
l • � t •
1 Appliratilan for Disposal Works Tonstrnrtiun Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair (4X/) an Individual Sewage Disposal
System at:
--•--= ! _f 1 7�G. -/ .aS7= _..............................................................................................
Location-Address or Lot No.
0....- .y --------•-`3`..------ ,J06!31Aj C � s.... - - -- -- ------------- --
Owner Address
?/� ��.--e.e.,' �... 24:_..
,-
Installer Address
d Type of Building Size Lot-......e5l.lad Sq. feet
a Dwelling
—No. of Bedrooms___________________�__------_---__--__•-Expansion Attic ( ) Garbage Grinder ( )
p-I Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
a
� Other fixtures --....................................................................................................................................................
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity,/&,0..gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No.,--.................. Width.................... Total Length.............. .... Total leaching area--------------------sq. ft.
Seepage Pit No.--___--__-�'___ Diameter-._..zz ....... Depthibelow inlet......Ke_.........
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........................
9 -------------•-------------------------------------------------••---------------------•-•------...--.........................................................
0 Description of Soil..........!�1.=c::........_.. !:g`... ...••.=------ �— `' �.._s 1-Z'A �
x
U ---------------••••----•--------._.._..--------------------------------------------............---------••-•.--•-----------•--------------•---•--•--------------------------------••----•--------•--••-
W
-----------------------------------------------------------------------------------------•--------•----•-----------------------------•----•--------------------------------------------------.......--
U Nature of Repairs or Alterations—Answer whhe�n pplicable___ U�?1 �.�' ( zs9 •_ GL•--,--eKzS
'
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 ----- ---------------------=�------ '�--------------- �� '� Q-----
Date
Application Approved By ----------------------- � .a,- _.,, -------------------------------------------- g
.... -7-.... Date
Application Disapproved for the following reasons- --------------------------------------------------------------------------------------------..........................................
.............................................................................--........................................................................ ..........................----------------------- ----------------------------------------
Permit No. 21... Issued
Date
Date
` r
THE COMMONWEALTH OF MASSACHUSETTS i
BOARD OF HEALTH
TOWN OF BARNSTABLE
Te>r#tftrate of (gumlltttnre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( 5e )
by
G1x7Z7L0�;77 . =CYQ I� 1. ....................
-----------------------------
Installer
at ............................................................
�a r ................2 ..- .........................................................
has been installed in accordance with the provisions of TITLE 5Af The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ...... .5.... �,.!t............ dated --------------- ---------------------------
THE
ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A"GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..-- 2 - 1-?� Inspector ...............................-............. ------ ...................................
..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Disposal Works Tunutrttrttiun f rrutit
Permission is hereby granted...........SoUa ��-s. t............... ................... --•••••---....._
to Construct ( ) or Repair (�_) an Individual Sewage Disposal System
atNo......................... .......... Jf!c' - � ...._.....4Q......................................................................................
Street
as shown on the application for Disposal Works Construction Permit Nor\:_--A---_. Dated..........................................
.............................•_� ----------------------------------------------------------------
Board of Health
DATE.....................
FORM 36508 HOBBS 6 WARREN.INC.,PUBLISHERS