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Home My WebLink About0401 OLD MILL ROAD - Health G old m,Ii Rcy-,Ad , S M E A D KEEPING YOU ORGANIZED No.10334 2453L, MADE IN USA GET ORGANIZED AT SMEAD.COM i fik ASSESSORS MAP NO: �3 No. 7--��..�/ PARvEL NO: 00 a Fss..... a."........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7'owr1. OF......, ar»S4;U4L... -------•----•--------••------------------- y Appliration fur Bh4paaat Works Tumunrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair (�L) an Individual Sewage Disposal 40,.System at .............. -------------------------•-••---------•-----•----------- ----........._----------------------•- Location- ddress r Lot No. o��1I. �oRT `�°4 a��..1I1�(1 �' �s . r... ►1J.�........................ _.._ --------------------------------------------- Owner Addr s ��/ a A t 13 ..C�,ncq 36'a lYlr.... b r ¢ 4rh.¢ "' .�* V Installer Address Type of Building Size Lot...........:................Sq. feet U Dwelling—No. of Bedrooms---------------------------------- -----Expansion Attic ( ) Garbage Grinder ( ) Other—T e 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............gallons Length................ Width---------- Diameter................ Depth................ xDisposal 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........................................ aTest 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........................ P4 ------•-••••••--------•---••------••---------•••-•.................•-•----------•--------.................................................................... 0 Description of Soil........................................................................................................................................................................ U ------ •-------------------------------------------- ------------------------------------------------- •-•---•---------------- •------------------------------------- •----•-----------------•-----------• -- W ---------------------------------------------------------•-------•-•----------------------------••......• -•----.. UNature of Repair or Alterations—Answer when.applicable__4 d .J----I-oOQ--e�o�-•JQ .-�a+..w�-sS jzp,�_.-_--__. 0 re '-----------------------------------•----•-------------------....------------------------------------------------....................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iIT ,;. 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 -bey the board of health. —4igned ----••-- o4 - /1.13/te Application A roved B /V 0 p�PP PP y-- /D Application Disapproved for the following reasons-------------•----------------------------------------------------------------------------------------------•---- .................•-•.....-------•-------------.......------------•------------•------•---•---------•---.....----•-•••---•------••----------------=-•---••-•--•-•-------------•-----•---•-•--------•------ Date PermitNo.- e ----------------•--- Issued-..........................................D.a-....... _ Date THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M A�C(; I DATA No......................... Fx$....: _..: .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...... .'......... .......OF:...........................i...... -----------.._..-_.......................... Appli radon for Dispati al 10orhi Tonotr Lion rrmft Application is hereby -made for a Permit to Construct ( ) or Repair (4.. ) an Individual Sewage Disposal System at: _. i 1 1 ,,,,�i ... ;.F t Location-Address I or Lot N0 .... r . Owner t 1. t Address , a --•---------------•-•---..........--------------...............--••----•--------------------...... .....................................-............................................................ Installer Addresst QType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) HI Other—T e of Building No. of persons............................ Showers — Cafeteria QI 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------------------------------------.... 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........................ •---------------------------------------------------------------------------•---••------•-•---_............................................................. 0 Description of Soil....................................................................................... -------------•-------------•------------..............--------•._....._......•- x W ••---•--•-•-----••-------- •--•--...--••--•--••-••-•----------•--------•---••----•--••-•-•---••-•------•-•-•----. .....................................................-........................ r r � �. . d i V Nature of Repairs or Alterations—Answer when applicable_._�______.`___.___________=_________......................................................... r.r. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIME 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. f � - Signed .................................... .. .......................... Date ApplicationApproved By.................................................••-----.........-•---------------._._..........-- ........................................ Date Application Disapproved for the following reasons:................................................................................................................ ....................................... ................................................................................................................................................................ Date PermitNo......................................................... Issued..................................................... Date THE COMMONWEALTH OF MASSACHUSETTS ` BOARD OF HEALTH ................... ..................OF........................._l.r:..................................................... uprrtifirtttr of Tomplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (`e ) by.........................................................................................................................................................................................- Installer at..........................................................................-•-•-------------•-••----••----------•------•---------•--•----••-------•------•-------•--------•-----------------•-------- 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 No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO TRUED AS A GUJ RANTEE THAT THE SYSTEM WILL F NCT N SATISFACTORY. - f-------..---.----•---•--•------------. a DATE............ ... Inspector_... _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH !..:.....:..:.......................OF..--.---.........`........'-....._......__._.._..................................... 7 No. ,07,7�J._. FEE......................... . P��o� 1 !�rklvm ion rrmit At ...... .. � Permission is hereby granted...--- ---.._.. to Constructor Rep 'r ( ) an Individual Sera a Disaqs Sat �em ------- Street as shown on the application for Disposal Works Construction Pe it Date.......... ..... ........N.- ___ � i7t Board of Health DATE... � FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS q 0 ( TOWN OF BARNSTABLE , 7 LOCATION / % SEWAGE # � lr l 1 VILLAGE ASSESSOR'S MAP & LOT O INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) Z,00-6 (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC-WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED; VARIANCE GRANTED: Yes No �� `� ' it �� , �� -