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HomeMy WebLinkAbout0841 OAK STREET (CENT./W.BARN) - Health 841 Oak Street West Barnstable A= 216-073 r r No...................... - MIP 5Z / �L Fizz THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE LTH rl ................oF..... .: .... Appliratiou for M-4miFal ur C�ua�u r r iun rruti A plication is hereby made for a Permit'to Construct ( V11"or Repair ( ) an Individual Sewage Disposal System at: 04AI, - J5...,-y r -�� �........... �,ocallon-Ad s , br Lot o. ......... r ..........�.�_...... .......�� �1 ............. Owner t Address a Address Inler �4 Type of Building Size Lot__W.f__,6(�...__..Sq. feet Dwelling—No. of Bedrooms................. ..............�__..._._.___.._._____.___Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ............... No. of persons............................ Showers ( ) — Cafeteria ( ) Q+ Other fixtures ----------------------------------- W Design Flow........ _/.............................gallons per perSen:peYday. Total daily flow------------------ .........gallons. WSeptic Tank—Liquid capacit/+%Psp_gallons Length_=&...'...... Width.....` ---- Diameter________________ Depth.._.__...... x Disposal Trench—No. .................... Width.................... Total Length.........._......... Total leaching area....................sq. ft. 3 Seepage Pit No...... Diameter._ 4 .­:5•- Depth below inlet...4.�.... Total leaching ageae .....�� Z Other Distribution box (� Dosing tank ( ) j �� j Percolation Test Results Performed by.__0 -�......----- -- �� �� Date..... Vater�-- - ,� Test Pit No. 1................minutes per inch Depth of Test Pit......._...__._.__.. De th to ound .._..._____7, .._.__ " Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •--•----------------------------•----------•----------.......------------------.... ------- .----------------- --...... .. 0 Description of Soil-------------t5 � �e U -------------------•----------•-----------------.-----•---•---•-•-----------... ---•-- ----- ------------------------- --------------------_-- = 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 TIT,! S of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be4issued b. the board of health. Sig -...(k!---= &:� ! Application Approved By-----... -• ....... ---- Date Application Disapproved for the following reasons---------------------•------•---------------------------------------------------•-•-•...... -•--•-•-••---•------ -•••-•-------•••••------•••-•---•-•----•...••---••--•••---•-...-•---•-•-------••-•--•••......------•••-----•------•---•-----•--- --•--•----••-••---------•--------•----•-------•-----••......--...-•---- q Date ....----•----••................. Issued----- - l Permit No........................ •--- --. �..........._...------ Date 0 7 No----------- /. -- THE COMMONWEALTH OF MASSACHUSETTS f'a ` BOARD OF HEALTH ..............OF...... -------------------------------------------- ApplirFation for Uiqpuual Works Towitrurtiun Permit Application is hereby made for a Permit to Construct ( (/5or Repair ( ) an Individual Sewage Disposal Systetp at r -- ation-Ad ess ' r Lot No Oirr /� Address // fl��r�r J ••-•-`.....:.....................•------- ..... �� / r.-----�Y!• ••---•....---.ealmlQ_wa_...-- s Address Type of Building Size Lot_._yl _.____Sq. feet Dwelling—No. of Bedrooms........ ..................................Expansion Attic ( ) Garage Grinder ( ) a Other—Type of Building -----------,................ No. of persons............................ Showers ( ) — Cafeteria ( ) e.: Other fixtures ------ ----•-••-••---- `....... ------------------------------------------------------------ Design Flow...........//(/........:...............gallons per perm per day. Total daiy flow.........3,30...___.................gallons. 1:4 Septic Tank-4 L'iquid capacity/000.gallons Length....... _-.... Width...0--____-___- Diameter---------------- Depth----- .._..__.. W Disposal Trend—i;,-No ......... Width.................... Total Length.................... Total leaching area....................sq. ft. x ..........- 3 Seepage Pit NO—--- ......... Diameter:-AGr_�_�___---- Depth below inlee....K 5.... Total leaching area...s,:K3 ....sq. ft. Z Other Distribution box ( Vf Dosing tank ( ) Percolation Test Results Performed by...._.._._.Ph,wdsl ........... Date..... �p ��._��s:..:___._.. Test Pit No. 1................minutes.per inch Depth of Test Pit.................... Depth to ground ater........__..J_ '.. -¢.t. Gz, Test Pit No. Z;:..............minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ------------------ . y . ........ r------------ ...._---- -------------------------------- •....... _--------------- D Description of Soil --- 6.7ne....... A_ ------.�p.-2 x W ------------•---------------------------------•-------------------------------. --•---..=--------------------------------------- ---------- ......................................................... UNature of Repairs or Alterations—Answer when aPPliclible....................._:__.__...:......_..___.___.___...._...._.__...._..._...._____..__.._....__. Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal Stiystem in accordance with the provisions of TL I r� 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i ed b the/board of health. Sign 1 Q!:_..._..JAk. ------------------• �..��..�2 ate Application Approved By..... . Date Application Disapproved for the following reasons------- --------• .•.--------------------------------------------------------------..._------ .............................•---.....---•=---------------•-••---•-•-----•'----------•-------....'•--•-•--------•---•-----•-------•-•--••--------•--•---•••------.....----------••......--•-•---_.._ Date PermitNo...................... ...::........................ M Issued..........................-------------------i --- Date THE COMMONWEALTH OF MASSACHUSETTS., BOARD OF HEALTH ..OF. ......................... Trrtifiratr of Tompliattrr THI IS TO CE IF,,,)' That the ,Individual Sewage Disposal System constructed (�'or Repaired ( ) by..... f .. . z--------------------•-----------•-•-•-•-•--•-----------------•---•---•-----•----- ----......_....-•-- Installer'"„" -ti-, I -•r if u has been installed in accordance with the provisions of TIT r j of The State anitary' Code as described in the application for Disposal Works Construction Permit No. --------------- dated--. -_---------------- THE ISSUANCE .OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE--. SYSTEM VILL FU CTIO SATISFACTORY. DATE_'_..._1. ...... .' j.. ..-......-•------...--•---- Inspector--- ---------------------------•-- ...-•--=` -. r t .� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No......._3_.-1.7..:: .:.�.... FEE...' , ' 0i15�jallal luorb T u t ` u permit Permission is hereby granted ....... . . -••--•---•------••-•-•-•..................•--. to Construct ( or epair ) an Indiv ual Sew is sy em at w tre as shown on the application for D j'sposal Works Construction Pe it Dated.._.. .. a, ` _ oa f ea • DATE-- = -. ------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS L 0 CAT 10 V//� (' SEW A G E PERMIT N®• VILLAGE INSTA LLER'S NAME i ADDRESS - J " R UILDE OR OWNER, i ® ATE PERMIT ISSUEDjS I DATE COMPLIANCE ISSUED 2 ;7 J I, S l j i • • i y a M L- S CL 062 /2 n caw 7 EDTIc .. �. ,. y • J2 .93 /tZ / 27.oY 126.7 6 , 2 /6/ _ � I e q f 9 How 2. .5G Lam . ✓ /O / CJ G -qL - ! O All r L oW SCHE V G. O mri em � foo . wash`c d �-o r,e EQuAG TO .SEP7-tG i In — a- 3Al id /y Ir .. G�JST. BOX - r } vrri � I / $ X / O lo` .f f4 / �' B. / D AL. SEPT G f1 � A washed/ �for,e. L 1 SYO/i E o-. 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