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Home My WebLink About0076 OLD MILL ROAD - Health s C Ipp III I I� I M d LOCATION S [WA-6E PERMIT NO. VILLAGE C) L) INSTALLER'S NAME i ADDRESS ' P kiEW► s R U I L D E R OR OyXER I r � i I DATE PERMIT ISSUED OAT E . COMPLIANCE ISSUED IV y r .I t a i d I / 0 0 i t —row,v i { No .J/. � d U ._ Fss��............... THE COMMONWEALTH OF MASSACHUSETTS BOAR® 9F HEALTH 77 Appliratiun for Disposal Works Tonstrnrtiun Famit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal Systemat: l. . .. • ------ L, �' .: ...............................................------------- caa,4.ndd-r-es's or Lot No. w Address �J a !1 x�7............... 5 .. -•----••------.....-•---....._..-•------•--------•--••--•----•-------•------•---. Installer Address Type of Building Size Lot......:"_...................Sq. feet Dwelling—No. of Bedrooms________ __________________________________Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of ersons____________________________ Showers a Other—Type g ---------------------------- P ( ) — Cafeteria ( ) A4Other fixtures -----•---•---•- ------••------•--••----------•--•••-..----------•----••---•----------=-••----•-----------------•-•--•............................... W Design Flow..............__3�_.............___ ..gallons per person per day. Total daily flow___-___3_a_a..........................gallons. WSeptic Tank—Liquid'capacity_�d4�v.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No_ ____________________ Width..... .......... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-_------------------ Diameter.....61.X __ Depth below inlet.................... 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........................ M --•-----------------------------------------•-----••--•••----------...._..------•--...•-••..._--•---........................................................ 0 Description of Soil----,.................................................................................................................................................................. x U •--••-••--••---••-•••-•-•----••••--------------••-......_.-••--•••.._.........---•-•-.....---•----•-----...----------------••-•------------._......---------•••--•---••-._.....---...---•-•------------- x ------------•---•----. .............................................................................. ---- ----•-.............. ----- •� U Nature-of irs or Alterations—A swer.when pplicab -- ��-�____________ _ 5 —'��g�....... -- ------ -------- ---- �? Agreement: V_ ` 0 The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITI.E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ' suW•by the b rd f health. Signed- - ._ .... f /C , Date ApplicationApproved By............. = =---•................••----------.....----------...-•------ — -----------� . y= '..... (/ Date Application Disapproved for the following reasons:.................................................................................. ............................ --•----------------------------------------------•-••-----------•-.......................................................-.............................................. ...........•-•-................ Z�C Permit No.... ........ -6••�-••-••---_.. Issued-•-••••--••••--------- Date Date ��, No.................._...... Fn$ :.. . ::....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H TI-1 �J'rr Appliration for Dispnsal Works Tonstrnr#inn rranit Application is hereby made for a Permit to Construct ( ) or Repair (4•j"an Individual Sewage Disposal System at: //P .....«-- le-t1l -- 4r. / x -- oc tiionn-#ddress ............................................................... 'Lr`�.eUZt �-_• * �'_' --•------.... r Lot No. 0 r j7•• o ner Address ............................................... ...... ..'�`.....' ....... ..............................._..--------........ Installer Address Type of Building Size Lot...._M.....................Sq. feet U Dwelling—No. of Bedrooms.-_-,,,---------------------------------Expansion Attic ( ) Garbage Grinder ( ) a'4 Other—T e of Building .... No. of persons............................ Showers YP g -----------------===-i- P ( ) — Cafeteria ( ) dOther fixtures .....................................................- - ..-•-•-••---------•-•---...••-•-----•--•••---......- ;---------•---•--•--•--•-•••............._. WDesign Flow..............,.!X.....................gallons per person per day. Total daily flow___--_0-- 41....................,......gallons. WSeptic Tank—Liquid capacityZ4�..gallons' Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width_____.. _...__..... Total Length.................... Total.leaching area....................sq. ft _.: Depth below inlet_.:__.._.____.:.___. Total leaching area.__:..______._....sq. ft. Seepage Pit No.....:............... Diameter.__.�.:x Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed bY.................... ............••-••-••-----•-------..._•••... --•--- Date........................................ 0.4 Test Pit No. I................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............................................... x •-•....•••---•......••----.....••---•......-•--••--...-•-••----••-.... DDescription of Soil.....--............ - .......................................................--•-----------------------.....---------•-•------------------------......-------•----. x U ....._...-•-•--•-----•--•--••---••--••-------••-••..............•-------------•---•.....----------•-•----•--•----•-•-------•------•-•--•-----••-----•••---••----•-•-•----•--•-••.........--------•-....-- Uw ----- ------- -- ---------------- .....-- � Nature o t Irs or Alterations— saver when phc le �'c� ' ��' ".. ......` ----- � <� �-� 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 beens u y t health. f Signed,,.-, `t" ✓ f J Y. T__ _ Jy .......... .................... ..«_... ApplicationApproved BY =-------------------------•----......---._....:-•------------------------•••••------• ----•-•.... - :_ Date Application Disapproved for the f ollowing reasons---- ---------------------------------------------------------------------------------------------------••------- -----------------------------------------------------------------•-----=---...------------------•--•-- '................................-------------------------------------------------•------------ .7 Date r t/ PermitNo.- `...............�------•----/---------------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL ........ Croy.t?'/ OF4.. � ...' TA Trrtifiratr of Toutplianre THI TQERTIFY, hat the-Individual Sewage Disposal System constructed ( ) or Repaired (4�)--~- .:. by ._... ® viitalier10------------- -------•-- ----:----_----- at �'' `. L 'S s i-� - •--------- -/ ------------------------------------ has been installed in accordance with the provisions of TITLE 5 of„The State Sanitary Code as described in the m .(..,application for Disposal Works Construction Permit No......... _._.. f___..___. dated....................................... ..... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............. I --..g�_.._..-••••--••-••-•---•••---••••. Inspector.................. .......... THE COMMONWEALTH;tOF MASSACHUSETTS rq; BOAR F,.":� HEAJ-T No �:� : ✓GJ'o'" ........'OF ,!G Zr ? ?�7� ' A Permission is hereby granted....... y ''!......:...... ...................... ---------------•----------------- �.-------•--- to Construct ( ) or;Repair « a Indio al��jjS ge Di p... ;© System , Street _ w as shown on the application for Disposal Works Construction Permit. No:RT:�2pl Dated .3 ..!..--...-.r ...................................................- -f - '-= - I �= /•. �J �y f�r Boar .Reatth DATE.. ----• ................................................................ FORM 1255 A. M. SULKIN, INC.. BOSTON " r—Al72- ,v d TOWN OF BARNSTABLE UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS* ASSESSORS MAP NO. PARCEL NO. /�_�, J ADDRESS; VILLAGE �ll� NAME t._ lQ�Y1 anw� CONTACT PERSON r PHONE NUMBERrQ— LOCATION OF TANKS:. . CAPACITY: TYPE-OF' FUEL.' AGE: TYPE: LEAK OR CHEMICAL: 'DETECTION SYSTvJAM DATE OF PURCHASE OF EACH: 1. 2. 3. 4. 5. _ DATE OF FIRE DEPARTMENT PERMIT: 1' 5 3i V TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS Icyn k p fewnt i4*n c6 19(o I— housQ b `LY)d(437 . PLEASE PROVIDE A SKETCH SHOWING THE LOCATION 0 TANKS ON THE BACK 0F THIS CARD. Os 51.E Q o �d W11 Jack o-� kov� L O CAT ION S E W A-G E PERMIT NO. VILLAGE hlaf et 6 0 � 0 �i A I N S T A L L E R'S NAME i ADDRESS ry 0 U I L D E R OR O ER r DATE P ERMJT ISSU E D DATE . COMPLIANCE ISSUED ' ` 000