HomeMy WebLinkAbout0005 GOOSEBERRY LANE - Health 7'1 Q h,T
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LOrAT ON SEWAGE PERMIT NO.
YIL`LAGE ol
I N S T A LLER'S NAME ADDRESS
rn� 4, .c. . �.e.�
`V
f,'U I L D E R OR OWNER
QAt
C --
DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED
I
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FRONT
46
Board of Health
Town of Barnstable
No.. ..�-- ..._. 9 P.O. Box 534 Fes$...................
HyarMsg,CAN'fV;(M§Rq:T tWLASSACHUSETTS
ROAD® OF HEALTH
......O F..........................................................................................
Appltration for Utopos al Work strurffou Vamit
Application is hereby made for a Permit to Construct ( 41or Repair ( ) an Individual Sewage Disposal
System at: �--
.---•.L or Lot No.
oc ddress �_•_-_••••--•-----------------
!-Y ��- ----------- -------- ----- -----------.------......------------
.-----------
-
Address
t,l� ,7�� S feet
Installer Address
Type of Building Size Lo �.. ................ q.
Dwelling—No. of Bedrooms___..................................Expansion Attic ( ) Garbage Grinder ( )
a, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures --------------------------------_.
W Design Flow........,:. . ..........................gallons per person per play. Total daily flow.......... _.................gall ps.
WSeptic Tank—Liquid capaci�6 fa.agallons Length___-...... Width..., .._....... Diameter________________ Depth_ -------
x Disposal Trench—No------------------•-• Width............. Total Length.................... Total leaching area___.._.______ q. ft.
3 Seepage Pit No........-/-------- Diameter..�b__..�_. Depth below inlet_49_ &2... Total leaching area_..zRZ X;se -ft.
Other Distribution box ( Dosing tank ( ) -
Z Percolation Test Results Performed by._ 1... .....> �_ _. `` _'Date___�� �f�_ ........
Test Pit No. 1:�`�_minutes per inch Depth of Test 134/3.�-f. Depth to groun water..... ms'5
(i Test Pit No. 2................minutes per inch Depth of Test Pit-------............. Depth to ground water........................
a ••........ . -•-•-------•-•--•-•----•-•-------•-••-•---...... ••••--•-------------•.........................................................
0 Description of Soil----.. ....•..-- -----• " ---••-••---
x
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 rovisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
op ra 'on untif ertificate of Complianc has en issu by the boar of health.
tu
ica on Approved By.._...•_. _._
_-- -
Date
Appl' tion Disapproved for the following reasons:-----•.................•------•---•-----•---•----•---•-•-••---•------•-•---•-•--•--•-•---------•---••-•--------
..................•-••----••••---••-•-.....--•-•.....----._.....-•--------••-•--•-••-••---•-----------•------•--•--•---....•----------•----•-----•-----••------•----•---•---•--••---•••---•-•--•--•-----
Date
PermitNo.......................................................- Issued_.....................................................--
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.................._... ------------......OF...............1......................
Appliration for traction rrmif""
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at
-.. ......---•-...... --- -- ------------------ ,....... ...... --------- ..................................................... ..... -.......
�' Location`-Add or or Lot No
Owner � Address
Installer Address
Type of Building Size LotZo,..//-5.............Sq. feet
�-, Dwelling—No. of Bedrooms....3..................................Expansion Attic ( ) Garbage Grinder ( )
a4 Other—T e of Building No. of persons............................ Showers
YP g -------------•-•------------ P ( ) — Cafeteria ( )
dOther fixtures -------------------------------------------------------•------------•--•-•-----•------------•-----------•••-••-----•--•-•-•--......---------------•--
W Design Flow.......�- 35..........................gallons per person per,day. Total daily flow..._..... . .........--......gallons.
W Septic Tank—Liquld ca.pacity:�A.<>sQgallons Length... ..�. �.
............. Width ..._...._ Diameter._.____......... Depth.� ........
x Disposal.;Trench—No. .................... Width..............'
...... Total Length._.....;..........._ Total leaching area....�........:sq. ft.
> Seepage`:Pit'°No---------f-----__. 'Diameter... <�.,_�.__ Depth below inlet .�._Q.... Total leaching area55'-'/_-5/S_q ft.
Z Other Distribution box ( �� Dosing tank
'-' Percolation Test Results Performed
W by. f ' Date /,` ___� :.� . ------/---- / '�
Test Pit No. 1-Ts:��..minutes per inch Depth of Test Pit... Z-...... Depth to ground water-.-_'" "..
rZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
9 •------------•--••--•-----------•------•------•-•--------•-•---.....•----•..................................................................................
D Description of Soil.......:'- OCT......... -'�` ` : .._.._ , % -'f'^-�
x --------------------------------------•--------------•--•--------
U ---------•------•-•--...------••-•---••-•••----•-•--•--•--------------------•--•------....•....
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 TITI.L 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operat' n ant' 0eirtificate of Complianc has been issu by t e boar of health
--wF-- —`-.5 reel' '�1. ..........................
•-- ...
.`
ica n Approved B 5 -`= == �
-------------------•---••-- D --
ate ---- ---
Appli tion Disapproved for the following reasons-------------•-------------------------------------------------•-----------------•---....._..---•------••......--
--•--•--•-•---------•---•---•----•------...--•-------------------------------------------------------------------------------------------•------•-•---•-----------------------•----••------•-•...------
Date
PermitNo.......................................................... Issued.....................................................--
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF.....................................................................................
vrrtifiratr of Toutplittnrr
THI I O CERT F/Y, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by........ ...: K.. • .......................................... -----•-----•-•.................••••-•••-•••---•--•....-•••-••-••••-•••-------•..................---•--
Istal
has been installed in accordance with the provisions of TTLE 5 of The
I Sanitary Code as described in the
application for Disposal Works Construction Permit No..... ........... dated-..... �-c ....................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS RISE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE t O - 2-4
....................................:...•-••••-•---•-•••--•-••...... Inspector.............. ................ . ... ............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH f
errOF...................... ---.................................................................`„•............
No.. .::....... FEE........................
Disposal , ork� npstr ion rri tit
Permission is hereby granted....... __= t ;. ...............
�� �?.�.�. '�...._..
to Construct (V) or�Repair ( ) an Individual Sewage Disposal Sygem
at No.. --- ---�r-----( _.4'-.. ---- --•-
Street
C
as shown on the application for Disposal Works Construct inE ,. --No..................... Dated........ ..................
DATE....... 0---7----7-------T---
...................................... Board of Health
FORM 1255 ?A. M. SULKIN, INC., BOSTON
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