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Home My WebLink About0210 HIGH STREET - Health 210 High Street West Barnstable A= 034 — 001 — 002 ° e e u � o 0 c THE COMMONWEALTH OF MASSACHUSETTS v BOAR OF HEALTH w-w oF...... . ....... ..v .. (� Apphration for Diipnsal Works Tonotrurtio# Par it ` Applica 'on is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual ewage tsposal System at: Location Address or Lot No. Owner ddress a .._..� ........... _ � ✓ 5................... =---------- '` .....fir. . `.ni... . Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms_____:_2...............................:Expansion Attic ( ) Garbage Grinder ( ) P4 Other—Type of Building ............................ No. of persons..................._-------- Showers ( ) — Cafeteria ( ) aOther fixtures -----------------------------------------------------------------------------•-------------------•--....... --------------------------------------- 5 allons per person per day. Total dail flow......... .�v d .._..._ lons. W Design Flow.--•--�------------------------•------g P P P Y• Y - •-----•-------- 1� 04 Septic Tank—Liquid*capacity............gallons Length................ Width................ Diameter---------------- Depth................ Disposal Trench—No..................... Width_:_.��._rr.�.__-__-- Total Length..........._/.�... Total leaching area--------------------sq. ft. Seepage Pit No----1-------------- Diameter.___.:- ..__7_.__. Depth below inlet...... ............ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank,( ) ~' Percolation Test Results Performed by----------------•--------•-•--........_----.:....._.....--••...--•---••_. Date........................................ 1.4 1.4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water--------------------- 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water___________-__-----___. C4 •--•-----•------••----------------------••---------•----••-•-••••-••.................••-••-••.•••............................................................ ODescription of Soil......................................................................................................................................................................... ---------------------------------------------------------•------•------------•--------------•--•-- UNature of Re airs or Alterations—Answer when applicable______l�" _�___-__ _._..lsz_ .......�. 5_ .. ------------ 09-- ------- Agreement: a - The undersigned a ees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i T"L: y g g p y`}of the State Sanitary Code—The undersigned further agrees not to lace the system in operation until a Certincate of Complia issued by the board off heal h ••�� , Signed......- A .....------•---••• -•-• ------J--�'1:c7. Application Approved BY......... . ----•• a---•-•-•------------------------- 3 e Date Application Disapproved for the f ollowin easons-................................................................................................................ .................:....................................................................................................................................................................................... Date PermitNo........ .1....... .a.--./-•••--•---•-...... Issued•.:...... -•• ........•.............................. g Date THE COMMONWEALTH OF MASSACHUSETTS BOA OF HEALTH Applira#inn for Uhip sal Works Tons rn.rtinn Vrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage"Disposal System at ---- Loca : j- - -.e .):. r. t: ��-' ....................•- �' �• K � �,. -........_.._.. ....-•-- ...._. - - tion-Address y. or Lot No. -- j r f :f G /�'...`f`7 ....................... ..............................1!t/ _.. ----------------------------------------------- Own ti Address a ----;a^*• -:.i.:r_ltn- '-=J =--•------•......................... ........... ''._"____._ ..!_.. s!r_ r::r:_C S---• �--�''1--c '-----•......_..__. Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms....... .................................Expansion Attic ( ) Garbage Grinder ( ) pa-, Other—Type of.Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) P4 Other fixtures .._..-••------•--•-----•-=-------• - w- y' __.... W Design Flow_______ems______________________ gallons per person per day. Total daily flow..._._:_�.__�::__________._____gallons. 0 Septic Tank—Liquid capacity............gallons Length________________ Width................ Diameter................ Depth................ Disposal Trench ............... No Width l l sq. ft Seepage Pit No. _ .._.__._ Diameter_ __ I ,7_.__. Dept below inlet....../' ...._.___ Total leaching area__________________sq. ft. Z 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........................ fi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fY+ •-••--•-----•-•••-----------•••-•••--•-•••-------•-•-•-...------•..........................••_••••--......................................................... ODescription of Soil............................................................-......................................................................................................... V `---•------•------=---------------------•--...__..._..----•-----•--••------...----••------•-•--------------•-----------..._..----•---•----••-•-•--•--•---•--•--•--•--•---••----•--•-----•-•-- ••--•----- W UNature of Repairs or Alterations—Answer when applicable � i fl �" '! 11v / fi!ft• ram-< b v �l' Agreement• k �.. �,..: .--c:_ �-ut, �:�- t,;, ,. •�,,! The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TT T E 5 of the State Sanitary Code—The undersigned furti:er agrees not to place the system in operation until a Certificate of Complian�r��isssu`ed by the ebboa r Signed-•-_. ✓� -_- -- ----. 5 t J... /y� ^F ........�...... Date Application Approved BY i ='`=`��"�� E �= •----------------- - Application Disapproved for the f ollowinJeasons:_____________________---------------•----•---------•---••----•----•••---•--•-•-•-------•-. Date-----...•-•••- -------------------------------------••--••--------------------•---•--•-------•-•••......._..__...._...--••••--------•-•---------•••----•-•---•---•---•--------•-------•--•-•••••-------•-•••••----•---- Date Permit No......- 7 "..__l_a_ .................... Issued.....----••---....•.----•................•-._..._--•--- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .�.-("J--11.�.!�:......OF......... c�. ✓�. c,.- :�� ............................... Qlatifiratr of Trrmplinnrr THIS CER - That the ndividual 'Sewage Disposal System constructed ( ) or Repaired bY-----•---_•--• ---..--_ �_: _.✓. � _..----•---•-----•-•-•----•-•----•. t------•..................•---•----------•-•--•--••-•--•-•--•----•--•----•------- f Installer t 1.— I t at .. ---- has been installed in accordance with the provisions of TT T E 7 of The State Sanitary Code s described in the application-for Disposal Works Construction Permit No....... 4_____________ dated--- ------------,ISSUANCE OF THIS CERTIFICATE SHALL NOT BE.CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE............. :..5...' d ---------....-------••------.....: - Inspector...... ...... ^ THE COMMONWEALTH OF MASSACHUSETTS. BOARD OF HEALTH F r �; - 1 ��. ..........OF.._-. 1�. s. .......................... � (J j\i o..:.:.................... .. FEE_._._.................. Permission is hereby granted-------------—.._..-------.................................. ..............................-•-=-- to Construct ( ) or Repair ( �.�-wr individual Sewage Disposal Syst at N0. - -'}' .�±-!e. _ .- ,,. 4. ' . `—. .-.,... .•°c_-G < ev.,.� ----•-------•-•••---- Street 7 t } " 7" as showy. on the application for Disposal Works Construction Permit No,! .... .l__`:______ Dated_._.wr/'.... n �t t. ............................ l Board of Health. DATE= --f - -------------•- ................._....... FORM 1255 HOBBS & WARREN."[NC_ PUBLISHERS