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Home My WebLink About0027 THIRD AVENUE (OST.) - Health (2) cis /�6 rd� _� �. o pp- LOCUTION 5EW&CIE PERMIT UO. IW T L R 5 M ZolADDRESS 7 BUILDERS 1.! A E AD RESS r _ 47 DIJ►TE PERKA T ISSUED '✓_�� — — — DATE COMPLI WaCE ISSUED : n 27 9p � y lli . 'P Fizu 1;4.2�...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 4 .........OF............. .. ......�. _ .- .......................................... AVV firation for Ui!ipwial Norkti Totw4rurfion Pprutit r�PFIIUaLIVIL is hereby made for a Permit to Construct or Repair a<an Individual Sewage Disposal Systern at* . ....IV.- . ................................................ ....................... %/- ,1 _0_c 2 L Add, .. .... ............ ----- C ..... r.... ------------------- ------- ...... ... - -------- ddres� -—-- -- ----- ------------------------ ....................... Installer Address /5-000 Type o Building Size Lot.... ......................-Sq. feet U Dwelling—No. of Bedrooms--._____----------------------------- -----Expansion Attic Garbage Grinder ( ) Other—Type of Building ------........0------- No. of persons...................... Showers Cafeteria ( ) P4Other fixtures ..... .....:?�------------------------------------------ -------------------------------------------------------------- Design Flow............................................gallons per person per day. Total daily flow__.fS"P---------------------------gallons. 04 Septic TLiik-l-Liquid capacitv/-O.QQgallons Length................ Width.._............. Diameter_-.----_..__;_. Depth-----------_--- Disposal Trench—No. .................... Width....__._....___.._.. Total Length..................- Total leaching area------------_-----sq. tt. Seepage Pit No.../---------------- Diameter------6---------- Depth below inlet................ Total leaching ft. 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...------_--_-.--.-.... 1:14 Test Pit No. 2................minutes per inch Depth of Test Pit.-____-_____-______- Depth to ground water_..--.-----._-..____---. ........................................................................................................................... 0 Description of Soil----- --- --------------------------------------------------------------------------------------------------------------------------------------- --- ------------ - ............................ ........................................................................................................................................................................... -------------------------------------- --------------------------------------------------------------------- ---------- -- ---------------- ----------------- ---------------------_ Answer U Nature o RepWrs or Alterations D.0en appli bl --- -----Z ---- ---- ------ -- ---- ----- 0, Agreement: C The undersigned agyel-s to install the foredescribed Individual Sewage Disposal System in accordance with the provisions of Article XI 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&lth. Si . ..... !(•- a -----------------............................ ------------------ Date ✓ Application Approved By---------- ------------ ................ S. — -,) ----------------------------------- --- Date Application Disapproved for the following reasons:................................................................................................................ ........................................................................................................................................................................................................ PermitNo......................................................... Issued. .................................... Date ---------------------------L No......................... FEs....4 ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD C?,)F HEALTH OF............_.: .... ..:. _... Alip iration -fur Dhiputial Workii Towitrurtiuu Pumit Application is hereby made for a Permit to Construct ( ) or Repair ( n Individual Sewage Disposal System at . -- -- ---------------------------------- -- -- ��_ -----____--____------------------•--------------•-------- - -------- --- --- Loca Add ss 4 or Lot No. --------- ----- ... s nee .. -�41 . ddres - 11 Installer Address !J o n o Q Type of Building Size Lot______________t_---____-__-__Sq. feet U Dwelling—No. of Bedrooms... __ -__-Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ------- --------- ------- No. of persons_-►-yam__---------------------- Showers ( ) — Cafeteria ( ) 0.i Other fixtures ___--__ ----------- W Design Flow............................................gallons per person per day. Total daily flow---/ !----------------------.------gallons. Septic Tank-#L Liquid capacitylO d_gallons Length---------------- Width................ Diameter---------------- Depth,_;___------ xDisposal Trench—No_ ____________________ Width-------------------- Total Length__--______-______-_ Total leaching area.._____..__._.._...sq. ttt. Seepage Pit No._�_________.__-___ Diameter_.___�,2---------- Depth below inlet...... _______-___ Total leaching areal-----�._.__sq. ft. Z Other Distribution box ( ) Dosing tank ( )- �•` M R a Percolatioriti,,Test Results Per by------- __.._. � ;:___:'___________________ r r: Date----•------- --------------------------- a Test Pity} No. 1................minutes per inch Depth of, test Pit_.-______________.-_ Depth to ground water.---_._._-_-----.--_-_. ;T_1 Test Pit`No. 2................minutes per inch Depth, of est Pit____________________ Depth to ground water------------------------ ------------- 0 Description of Soil----. . U ------------------------------------------------------------------------------------------------------- ------------------------ W --------- --- -- ------- -- - - ----- ----- ------------------------ ---------------------------------Y U Nature o Rep• •rs or Alterations Answer hen appl' ble._ Agreement The undersigned' a es to install the Aredescribed Individual Sewage Disposal System in accordance with the provisions of Article XI 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 litalth. Signed_ t - Date ApplicationApproved By----•--•------- ...........-.................................................................. Date Application Disapproved for the following reasons----------------•---------------------------------------•--------------------------------------------•-•-••------ ---- --------------------------------------------------------------------------------------------- ,.�;� Date Permit No. Issued--(--�--'-------------------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HfjkLTH 4 { .. .........OF........................ .............. ? :... WhIrdifirate of TIMP iaurr THIS IS TO CE,4TIFY, That the Individual Sewage Disposal System constructed ( ` ) or Repaired ( ) by--••-•------------- -------.--------------------•--------- --------------•---•-------------.---•---.-------.------------------. nstaller at--- � " ` '� ........ ,�t• ht' ............................................................................................... has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.......... _ `' .......... dated....... ..w �................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. fl DATE...............................................-------------------------------- Inspector------------ ---...----------•----------------•--........_. THE COMMONWEALTH OF MASSACHUSETTS BOARD OR HEALTH ..........OF.......... ...w ................................... (/+• No.-- ----------- FEE.......... Di-rupulittl Porko Cnuuitrurtion rermit Permission is hereby granted = ./. ............................................................. to Construct ( or pair ( an Individ 1 S wage�Ptsposal System -• - .fit Gt at No.-•- 1 �'"' ..... .. � --- ---- ----------------_--------- -----------------------------------------•---- Street as shown on the application for Disposal Works Construction Permit No- __.--- , Dated__-_- _:_ '.- ..!-------------- �- Board of Health ' DATE-------- `� _ �5.....------- f FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS a �. -. .,� .. .. - � • .;.mot ,e��.,: '., �,.,..'` TOWN OF BARNSTABLE - UNDEERG.ROWND- FUEL AND CHEMICAL STORAGE REGISTRATION r OWNER AND INSTALLER INFORMATION ADDRESS: ,o ! . MAP NO. 0 PARCEL NO. .0 OWNER NAME:/ A(, R 1 C F VILLAGE: Jrj f i✓1 f P INSTALLATION DATE: /, 4 C� r am' BY: X /j ADDRESS: CERT. NO. TANK INFORMATION 14 LOCATION OF TANK: AAllk-.-G N CAPACITY 7.S' TYPE AGE j g FUEL/CHEM I CAL TESTING4CERTIFICATION C ] PASS C ] FAILI DATE LEAK DETECTION C CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION C ] YES C NO DATE TO BE REMOVED FIRE .DEPT. PERMIT ISSUED CX YES C I NO DATE .CONSERVATION C� CHECK IF N/A DATE BOARD OF HEALTH TAG NO. ]C ]C ]C , ] DATEiC y6../ :PLEASE PROVIDE A SKETCH .SHOWING THE,,TANK LOCATION .ON, THE BACK OF. THIS.CARD