HomeMy WebLinkAbout0138 WALNUT STREET (M.MILLS) - Health � 3 � u�1 �u� S
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LOCATION /` � SEW E PERMIT NO.
1
VILLAGE
INSTALLER'S NAME & ADDRESS
10HN A. AALTO BACKHOE SERVICE
150 .Walnut Street
iWest Barnstable. Mass. 02668
BUILDER OR OWNER
Sty e
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED � � y� 7�'
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THE COMMONWEALTH OF MASSACHUSETTS
/_ BOAR® OF HEALTH
App iratiou for Digpn.ial Workii T.>w4rurfiutt ramit
OApplication is hereby made for a Permit to Construct ( ) or Repair (,;,-<an Individual Sewage Disposal
System at:
!f!V/.cl�.!� .................................../ba_-- 1. .c... ...
fz�s Location-Ad dress � r.L / ........ � ............
a ..........f r;. ............................... ............... ..---
��/�� Address
1r �...... - ----------------------------------- -------------------------------------------------------------------------------------------------•
Installer Address
QType of Building 3 Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder.( )
Other—Type of Building No. of persons............................ Showers — Cafeteria
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........................
(T Test Pit No. 2................minutes per-inch Depth of Test Pit.................... Depth to ground water........................
...............--`--.......----------------------------•--•-----------------------------•--.................................................................
0 Description of Soil......................>'..............................................------------------------------------------------------------•-------------------------------------
x
U -------------------------------••-----...-----------.....----------=-
W .........../.................................................................... ------
UNature of Repairs of Alterations—Answer when applicably--___-----__ F _ �aa : ...... _ ...............
................................................. . . -----.---
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iIT;j-Z j 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.
igned_.. ... -----• -- ........... .......
Date
•Application Approved By••------- l- �..----•-•••--- .... 2p =.........
Date
Application Disapproved for the following reasons:----
-------------......
-• ----•-•---••.........................................••-•-•.... ........•.....
..-•----------------•------•-•------------•-•------------.......-----------------•------------------------••--••---••-••-•••---•------------•------•--••--•---------•-••-•-------•••••-------------..._.
Date
PermitNo.......................................................... Issued. .....................
Date
j
Fim..........................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..............................--Al....... .......OF..........
Appfiratiou for Ili-qpoiial 10orkii Tonvarurtion Vamit
Application is hereby made for a Permit to Construct or Repair (?<an Individual Sewage Disposal
System at:
I -5re
......................................................................................... ..................................................................................................
locali7/21,d or Lot N
................................................................... ...............V,/'q,/,/..Am�....... ......... A............
P'09 n, Address'
,
.......... .........
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder (
PL4 Other—Type of Building ......... .................. No. of persons_____.__._._________.__.____ Showers -7 Cafeteria (
P-1 Other fixtures .........................................................................................................................................................
Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
9 Septic Tank—Liquid capacity............gallons Length________________ Width_..__.___._____. Diameter................ Depth__._._____.___..
Disposal Trench No_.................... Width_____....__.__._.___ Total Length.____._____......___ Total leaching area...................sq. f t.
Seepage Pit No_____________________ Diameter__.__._.__..._.._._. Depth below inlet____..__.._.......__ Total leaching area..................sq. f t.
Z Other Distribution box Dosing tank
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutesperinch Depth of Test Pit___.._________...___ Depth to ground water_______________________.
Li, Test Pit No. 2................minutes per inch Depth of Test Pit______._____________ Depth to ground water__..___..__._____._.___.
.............................................................................................................................................................
0 Description of Soil........................................................................................................................................................................
�4 ,—*1— 7----------------------------------------------------------------------------------
----------*---------------------------------**---------------------------"-------*---------------/
----------------------------------------------------......................................................------------- .......... ... ..............a............
U Nature of Repairs or Alterations—Answer when applicable_______
.................................................................................................... ....crA...............................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal,Sys'tem in accordance with
the provisions of TITLE 5 of the State Sanitary Code—The under�igned further agrees not to place the system in
operation until a Certificate of Compliance has'been issued by the board.. health.,-,7�',�-.
..... ............... ........................................................... ................................
Date
Application Approved By--------- r . ........... ... ............ ...........
Date
Application Application Disapproved for the followingreasons .............. ...................................................
. .........................
.................................................................................................................................................... .........................................
Date
PermitNo.......................................................... Issued......................................... ............
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD 0 HEALTH
................ .......OF......... .... .. ..................
(It'rtifir"ate of'Zoutpliatta
T HI CERTIFY, Individual Sew4g,e,.Dispqsal .System constructed o
IS 70 CERTIFY r Repaired
by....... . ........ ........................... ---------
........ .... .........
--- .... .. ..;.... . ...... No.__
4
. .............................................
.......... ........
at.....
has been installed in ace an;ce with the provisions of TI P _�o T Sanitary Code as described din the
The State
dat
application for.Disposal Works Constru&tion Permit No......... --- .. .......... ed
THE'ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRIJ%AS A GIJARANTEE THAT THE
SYSTEM WILL'FUNCTION, SATISFACTORY.
.............. .... Inspector__..-. ...., ,
DATE._....i-.'J15.��-,.t.................
icy .................
t� THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............. 216ell. .OF........ 444-.4. ... .........................................
No. FEE........... .........
Disposa Workii Toll ludion Vir-ftfit
.................................................................................
-
Permission is hereby granted--.---.---- a,
to ConstrueR a' Individual Se DiA sten
9q � F ! ...................................................
at No. ---------
441 40 -- =Ze .
Y
Street o
as shown on the application for Disposal Work§Construction Permi 0...... ted.......s _- ........
.1,
...............
...............
Board of Health
DATE......... �,Xn.7f................ •...................... 7',
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS