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HomeMy WebLinkAbout0006 NECK POND ROAD - Health 6 NECK POND ROAD OSTERVILLE A= 140 - 093 / I Board of Health Town of Barnstable No...2Y..sj0� P.O. Box 534 Yuis....... .............. 4 THE M"V BOARD OF HEALTH .0_.W_d.............OF..........5.1,eA).S.T./&L-C..................... Allpfiration for Disposal Morko Tomitrurtion Famit Application is hereby made for a Permit to Construct (X) or Repair an Individual Sewage Disposal System at: ..........P.!E_9jK....... ....... ........................ .........................................H..-45................................................. es�sl or Lot No. o:::,ion .............. . .................... ................................................................................................. ow S 2:L. .............P.....9.. !��................................................... ..=...... Installer Address Type of Building Size Lot.__7 --------------Sq. feet Dwelling—No. of Bedrooms............... ........................Expansion Attic Garbage Grinder 04 Other—Type of Building ............................ No. of persons....._....__................ Showers ( ) — Cafeteria 04 . Other fixtures ...................................................................................................................................................... Design Flow...............4�,57..................gallons per person per day. Total daily flow......... ..... Ions. ®...... ...._.._..._ Ions. Tank—Liquid capacity/942tl.gallons Length---4........ Width....4....... Diameter________________ Depth_._ ......... Disposal Trench—No..................... Width...............___.. Total Length.................... Total leaching area....................sq. f t. :V4 8------ -fr. C Seepage Pit No........./.......... Diameter../Ai_5'..'.. Depth below inlet........&-. Total leaching area.6.W�A •ST. Z Other Distribution box ( )Q Dosing tank ( ) Percolation Test Results Performed by....4fg .....t.......W.a C ......( 5;: Date... �-1 --------------*-------- Test Pit No. I....15�_minutes per inch Depth of Test Depth to ground water6Pi7_._dPj,7_ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground wat6PPRO.................. ........................................................................................................................................................... 0 Description of Soil.......................................................................................................................................................................... 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 TL I TL!L- 5 of the State Sanitary 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 .. ........ZL0 A p V/'_ ........ L . . . Date .... ApplicationApproved By........... .................................... ....................................... Date Application Disapproved for the following reaso .............................................................................................................. ......................................................................................................................................................................................................... Date PermitNo........................................................ Issued....................................................... Date ----------------—------------------------- r V� 'No--��V_�0_4 Fxs.... ............_ THE COMMONWEALTH OF MASSACHUSETTS r R BOARD OF HEALTH ,' . �•..................... for Disposal Works Tonstratrtiun Vantit Application is hereby made for a Permit to Construct (9) or Repair ( ) an Individual Sewage Disposal System at: Location-Addres`s• or Lot No. Own �!( ........ ......... ,� .. ' Installer Address UType of Building Size Lot..Z�.__ Q.........Sq. feet f �. Dwelling—No. of Bedrooms...............�'........._...............Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ................... Design Flow-•-------•- ��...................gallons per person per day. Total daily flow....... Ions. WSeptic Tank—Liquid;capacity/9.00..gallons Length..'......... Width-_4_'....._ Diameter................ Depth._...._. x Disposal Trench=No:.................... Width.................... Total Length....................}Total,leaching area....................sq. ft. Seepage Pit No-------- ......... Diameter../.Q.,__':�_.'__. Depth below inlet....... `..____. Total leaching area�6.L-.4..sq-ft.0 P6 Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by...Gr-o�....-I....... FCC.(EEk'..__._-� Date.. __-_.`� "�'�_ ........... � Test Pit No. 1...�_�....:_minutes per inch Depth of Test Pit..!5:�.��..•. Depth to ground water .�.....=AJ -' (� Test Pit No. 2..............!.niindies per inch Depth of Test Pit.................... Depth to ground G4 ' ----•...............••••-- 0 Description of Soil•..................... ? -----•--------•------------------------------•--•-------------------------------------------------•-------------•......---....._..........--•- x - c, w .. x ------------------------------------------------------------•-•-- 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 been issued by the board-of health. Signed•-_Z� ....................... ..........................Date _ ApplicationApproved BY............................................................. ----------------•------------------ -------••--••-------Dace.-•--•-------- A Application Disapproved or the following reasons-------- - -----------------------------------------------------------------------------••----•---•••••- PP PP f f 9 ----- ......................................................... Date PermitNo......................................................-• Issued Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF TrrfifirFatr of TnntpfiFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by--------------------- .............•--•----•---•--•--•........•••-----••--•.....--•••-----••-•---...._..••---............... r �a� Installer ---------•--------- at If _ �le -------- ----- ... . a has been installe m accordance wi ons of TITLE: 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..-_ dated-_-------_----------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT E CONSTRUE® A GUARANTEE THAT THE SYSTEM WILL FUNCTIO S ACTORY. / DATE........................•• Inspector. ....-• .....................................................q,.---------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . ...........................................O F............-......... FEE.T--r-'........... gispwiat Narks Tonstrndion frrutit Permission is hereby granted.............. . _-•-•.. ......_ N,. •---- - ---•-------•---------------•---•-------.-•------..-..-•------------•--- to Constructt„(//) or%Repair ( ) an,Ind Individual Sewage is ystem at No................ !� �r - � ------------------ " f as shown on the a plicat n for Disposal Works Construction Permit No------------..._---_-- Dated.......................................... - DATE.---------1 --• .................................................. Board of Health -••--.. FORM 1255 A. M. SULKIN, INC.. BOSTON N, )ky y® 93 d AT ION SEWAGE PERMIT NO. VILLAGE � m INSTALLER'S NA14E A ADDRESS /oz c- Alri D U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 1 i ,. �� ��� )'ky ' YO-13 S0 4 AT ION SEWAGE PERMIT NO. VILLAGE 1 j INST A LL R'S NAME i ADDRESS r j Q e UILDE R OR OWNER 0 DATE PERMIT ISSUED DATE COMPLIANCE ISSUED ,. 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