HomeMy WebLinkAbout0108 ROBBINS STREET - Health __38 ROBBINS ST, OSTERVILLE
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THE COMMONWEALTH OF MASSACHUSETTS
$y 7 BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratiou for Di-ripo!ial Morkii C omitrurtion ramit
Application is hereby made for a Permit t Construct (' ) or Repair ( ) an Individual Sewage Disposal
System at:
.1Y t o f3 ISIA; 5' 'S% !>s;-
-���-•---•-------------•----•---•-•-• ----------------......-•---•--•-----...........----•-----•--
Lo�`[lion-Address or Lot No.
i.
...........------------••-•----------•------------------------•-•....._....._______... .........
/, owne Address
Installer Address
UType of Building Size Lot....... ._•. ......Sv.-feet-
Dwelling—No. of Bedrooms________________I _______..___-.__..._._Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons..........------------------ Showers ( ) — Cafeteria ( ) —
Otherfixtures -.._.__---�•--------------•--••-----------------------------------------------------------------------------------------------------------------
W Design Flow---------------------............
5. ___.gallons per person per day. Total daily flow-----440............................gallons.
WSeptic Tank—Liquid capacitvlS=oPgallons Length_,"'C '4..... Width_4> 4-__ Diameter.__.._-...... Depth_s.'F.._
x Disposal Trench—No. _._....__.__._._... Width-------------------- _Total Length.................... Total leaching area....................sq.'ft.
Seepage Pit No------------- _._. Diameter------/.3........ Depth below inlet-------'%-......... Total leaching area__}_'�__�-.___sq.ft
Z Other Distribution box ( Dosing tank
Percolation Test Results Performed by.. �.... __ 2________________________ Date... �
1 Test Pit No. 1------- -----minutes per inch Depth of Test Pit-----1.Zt Depth to ground water...:.............
(i Test Pit No. 2................minutes per inch Depth of,Test Pit.................... Depth to ground water........................
O Description of Soil-- 7___d_f-••••--�f4?- ••-•••• .a✓ ...---------
W
UNature 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 Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has ,een 1 by he oard of health.
Signed -------- - --- ------------^ ......--.....-....... ...-..... ` //
.....-... - ....-...
.. -� .e✓r��� Date
Application Approved By ----..-...- � V...� q
-- -—-- -�..-----------------------------_..._.....-----------....---------- --
' Dace
Application Disapproved for the following reasonr: ......................................................................... ....- .. ... ........... ---------I---------
-----------._--------------------------- -------- ------------------------------------ -------------------------------------- -------------- --- --- ----------------- -------------- ........................................
- Q _ qc� � q Date
+ Permit No. 9--s............ ..�..... ............ Issued -...-........ ...--....�Q- l :3 .......
Dace
THE COMMONWEALTH OF MASSACHUSETTS
$y BOARD OF H-EALTH
TOWN OF BARNSTABLE
1 Appliratiun for Bi-tipuiiul Work,6 Tomitrnrtiun Errant
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
P o r3�-S S US'
............JZ.......................................•-•-'--•• ................................... --•----------------------------------��------•--•-----------------------•---
�- Lorition-Address or Lot No. C
Owner �. Ilk .__.
Address
Installer ^ Address
Type of Building i �Size Lot_.-.�3.3._ ______S-q-feet-
0-4 Dwelling—No. of Bedrooms________________ '__________.___._...__Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Builtliu .............:........_..__ No. of ersons........_..__--___-_--. --- Showers —
a yp g p - ( ) Cafeteria114 ( )
Other fixtures � '-------------------------------------------------- •_
W Design Flow.__-._.....•______________________.?__.gallons per person per day. Total daily,fiow.t..: ................................gallons.
WSeptic Tank—Liquid capacity_&4P.gallons Length!'/....... idth• Diameter_._.. ...... Depth_s .._.
x Disposal Trench=No. ....................F Width.................... Total Length-------------------- Total leaching area....................sq. ft.
Seepage Pit No.............z.... Diameter_-._._..!-�......... Depth below inlet.......5:___.____. Total leaching area_.S y -....sq. ft. .
Z Other Distribution box ( d) Dosing tank ( )
~' Percolation Test Results Performed by..�Lc-_ 'Q�'E—___ 'f�'z
a ________________________ Date__-3'_� _ S_ .............
04 Test Pit No. I------'—..--__.minutes per inch Depth of Test Pit------/-_Z'__.__ Depth to ground water....---______-....
44 " -Test Pit No. 2___.............minutes per inch Depth of Test Pit.................... Depth to ground water........................
_.._ ---•-•................•-•-
D Description of Soil__...__T S__...__�C.'�'v,._.T______. !`?"!�
V .......................................••---••---••-•-•••...--•-•-•--•••---••••-._...--••._..._...--•••••----------••...._._..._.._...--•----- .........................................................
-•-----•- -•-------------•--------------------•-_--•-----•-------------------------.___-•-•--------------------•--------•-------.-._----------____-_-•--•-••---------•--_-----••--••._....--•-......_._. f
U Nature of Repairs or Alterations—Answer when applicable................................................................................................
--------------------------------------- -------------------•--------------------------------------•-------------......-_----------------------------------------------------------.._.._........----•---
Agreement: '
The undersigned agrees fo 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. l
Signed ......... .. / �? jl�� -
Dace {�
Application.Approved By ---- -.._.- .. __................. ..._.. -~. -P--1✓� -
t\ Dace
Application Disapproved for the following reasons- ------------------------------------------------------------------------------------------------................................
------------------------------------------------------------------------------------------------------------------------.......---....--........----...----------------------------------- ----------------------------------
G .... Date
Permit No. ---------..1....�.............L. 5 �-------...------.- Issued n....
Dace
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
`LQrtifirate of 11�omplian e
THIS IS TO CERTJFY, That the Individual Sewage Disposal System constr cted ( .-) or Repaired ( )
by ( ori...Cn �s�`-... ... 6 s. wr,-� ram.. _...
Installer
at ----------------------- ----`� _?� - ... .T:... -6 - _-....
--
has been installed in accordance with the provisions of TITLE®5 of The StateEnvironmental Code as described in
the application for Disposal Works Construction Permit No. .:.d-. .--........f.-.>�-/-------------- dated .-_- __- o.....�`5"
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU A AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE----- - � - - - Inspector --% - ......._....... ...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
cc}} - qq - TOWN OF BARNSTABLE .
No.---.._i_S.......1.� � FEE.......
�t��ns�tl nrk� �nnu#rnr#uan �rrmi#
Permission is hereby granted-------
�j......T�' ...__.C® SruC �C� �f
to Construct or Repair ( ) an Individual Sew�aa e Disposal System
--------------------------------------•--•--•-----•--__
Street e
as shown on the application for Disposal Works Constructio P-egllt No..?Y:__/Y/ Dated..
•__________________ Board of Health
DATE._._`�`__._.`_�""._./_U_._`._.�.r.._._.L'�._'_...._
FORM 36508 HOBBS A WARREN.INC.,PUBLISHERS
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