HomeMy WebLinkAbout0150 PARKER ROAD - Health 150 Parker Road
West Barnstable
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
----------- ..........................
Appliration for Uhipos al Works Ta marnrtinn runfit
I" Application is hereby made for a Permit to Construct ( ) or Repair ( Individual Sewage Disposal
System at:
ocation-Ad reD r Lot No.
..... J......,� �p,� ........._....--•------------------•------ -�,�.�-° - ..............•...............................
.r5..�.__.....X� L ._ ' ,r ......... ... �r1 /....5.�/R Adages ��j�,rr/�.. .---- ---
Installer Address
Q Type of Building Size Lot...�t...........Sq. feet
U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers
a YP g -------------•-•---••-----•- P ( ) — Cafeteria ( )
Otherfixtures --•----------•----•-----•-----•----------------- -••-----.....•••---••••••---•••----••..................-••-------- .-----
wDesign 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 ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.........................
(14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 --••-•••••••••---------•----•••-•-•-••••----•••--•..._......-•--•............................•-•----.........................................................
0 Description of Soil........................................................................................................................................................................
x
w
x - ----- —
U Nature of Repairs or Alterations—Answer when applicable....._Q _ -_ _ --f.
. ..................
-----------------------------------------------
Agreement
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITHE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance e n issue y the boar health.
Signed._.. •• r .......`Z-v
Date
Application Approved BY .....--•--•---
•-----...-•-•----------------•---------
Date
Application Disapproved for the following reasons:................................................................................................................
----------•---•-----......-••-----••-----..•----------------------------------•---------•....-----...---•--•-••--....•••--•--•-•---•-•••-------.....-•••••----••------••-•••......-•••••-••--•---_-----
Date
PermitNo......................................................... Issued-.......................................................
Date
No-9 FEB . . .... .
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
-.----7:0. ...........OF..... :.A ..`�..f... .-�_.'��'. ............................
Appliratiou for Diipoiial 10orko Tomtrurtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair (' }'"an Individual Sewage Disposal
System at
i - Locatio4 Addlres� �gw„wor Lot No.
•--- .^::ei"-y3=-........ �[ !... !' ..................................... .......... °7or.......• 6^• ......................................................
Qpm r ,rj y �a� Address
.a +'awfi.�.!_].�t I .. ........ f4 f 4r` iwv/ `j
... ...a+: 3n..b.... I __I ..._..rY.�x.. ...... .......... . ...... ...... .....................
Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
'4 Other—T e of Building No.. of persons............................ Showers - Cafeteria
P-4 Other fixtures -----•------------------------------------------------'-------- .
................................
WDesign 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 ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I................minutes per.inch Depth of Test Pit------_............. Depth to ground water-----------.............
;14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P+ ------------••-•------------------••----••------.........--•------------------.............•--------.........................................................
0 Description of Soil........................................................................................................................................................................
W .....................................................------------------------------•--------•---------------•--•-
U Nature of Repairs or Alterafionfss—Answer when applicable....... k� ........... .............................
5�.d ..1K,>.� ` ^"'• Jr +f x*".h....... .. ...........^'...- ��"wwsa •.........__.----......._._....--•-•-•---•-..........................
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
operation until a Certificate of Compliance has' ee�"n sued'b-y the board.of health
Signed _ +
Date
Application Approved By................ -----... .........................................
Date
Application Disapproved for the following reasons: -------------------•---•------------......------------•----------------------..........
--`------------------------------------------•--....------------•---------••------------......------------•--•----•----------•----•---------------------------------------------------------•---•-..•--
Date
PermitNo.::..................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF......................................................................................
Trrtifirttte of Tootplittttrr
THIS IS . _ CERTIFY, That e Indivi ual Sewage Disposal System constructed ( ) or Repaired
by---------------------- -3; t. ----•------- --------------------------------------•----.----.----.-.---.-.---.-------------------•--•--------••--
In ller A o
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.--+i --- .3. .. d-ated-.----------------------------------------------
THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..............................................A IA14 ' ------------ Inspector............-.•'•..................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
303
OF.................................
,
No.. ...._....�..... FEE......
Disposa orko TUI n or 4' ion anti#
Permission is hereby granted---------- = 4�----------- --•--•------------------------ ------------- -------------------------
to Construct or Repair ( ndividual S wage Disposal System
atNo.---------- f....--•---- -- ......................... ---------------------
Street
as shown on the application for Disposal Works Construction Permit No---------------- Dated.............................
-- . . - ------------------------------ ---------------
Board of Health 1
DATE..........................
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS