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HomeMy WebLinkAbout0282 PARKER ROAD - Health 282 Parker Road, West Barnstable A= 176-013 01-3 No......../-�X.--V/... Fala.......2. THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH �I - / _.......OF...... P. 1.� Appfiration -for Diiipvii l Earks Tons#rurthin Vrrmft Application is hereby made for a Permit to Construct or Repair ( an Individual Sewage Disposal System r v Loca Address r . ........ 4•..... ............. ......... ...... ............. Lot No:-•----------......----•------------------- er Address Address Q Type of Buildin Size Lot............................Sq. feet U Dwelling No. of Bedrooms.-._ _ Expansion Attic ( ) Garbage Grinder ( )Other Type of Building _- _. o. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ......... .....7 ......................................................................... w Design Flow.................................... ..... Ions per person per day. Total daily flow--------------------------------------------gallons. Septic Tank�Liquid capacit� _ allons Length---------------- Width................ Diameter__.--.--------- Depth................ w Disposal Trench—N �Vi 11 Lengt WIrehi rea------------- ------sq. ft. x - Seepage Pit No________ _________ Diameter.. _�2'- .=�! Depth elo chiug area------------------sq. ft. z Other Distribution box ( ) Dosing tank Percolation Test Results Performed bY------------------------------------------------------------ ------------- Date--------------------------------------- Test Pit No. 1----------------minutes per inch Depth of "Pest Pit._-.-_--___-_.__---- Depth to ground water._.----_-----.__----- �z, Test Pit No. 2----------------minutes ler inch /epth of Test Pit.................... Depth to ground water__ -._--__-.--..___... 0 t-------•-- * � � .............--•--•--•--• �= ��j Description of Soil �-C-_C... ...' '.... . ��----.. ..-. 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 provisions of Article XI of the State Sanitary Code—The undersigned fur r agreeo place the system in operation until a Certificate of Compliance has bee ued the o rd of h lth igned.- ......--- --- ----------------------------- .................................--••---•-•---•------------ D/L1. Application Approved BY - L �Application Disapproved for the following reasons----------------•--------------------------__ _•__--__..........._._._..-_............-_.___ ......_.----_- ------------------------------- ---------------------------------------------------- ----------------- •----------------------------------------------------------------- "-------------------------------- 1-1 /-7 0Date Permit No.. Issued. Date No......../ - FEE....... ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD F HE LTH ..... ...... oF...... ... ................. , pphration -for Dig uiiFal lVark,6 C onfi#raartion Vrrmft Application is hereby made for a Permit to Construct or Repair ( an Individual Sewage Disposal system ....... __• --------- ..�...____._ ...... •-__-•__ ____----- �.---__ - ..................................... c oca Address r Lot No. —r••... .------ - ... ............ .......••.... ........ ..................................................... e�rr�, ► Address Instailer Address UType of Buildin Size Lot............................Sq. feet -, Dwellipg�No. of Bedrooms__.. _ .. ._..____ __-_ Expansion-Attic ( ) Garbage Grinder ( ) a l� tt -_. aOther Type of Building . __.......:.... ..L-._ o. of persons.._:._____________.___...... Showers ( ) — Cafeteria ( ) dOther fixtures..--- ---------------•----•------------------------------------------ W Design Flow________________________________ Ions per person per day. Total daily flow----------------------------------------.---gallons. Septic Tank —Liquid capacity. _._. allons Length................ Width........_.___.. Diameter_:._._.._.._____ Depth.____-__.-.--. x Disposal Trench—N --------------------- Width.--._._____---- _ �� Sk..' :=':`' _. al hi . ea--------------------sq. ft. Seepage Pit No________ _________ Diameter_ / Depths ' eelc g 1. IF al`1 chin trea...__..__________sc ft. z Other Distribution box ( ) Dosing tank-( ) — 40 , / -- aPercolation Test Results Performed by----------- --------------------------------------------------------------- Date-------------------------------------... Test Pit No: 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water.._____._____.__---_._.. G4 Test Pit No. 2................minutes ,r"`inch epth of Test Pit.................... Depth to ground water__ . ---- r ••---------- -t.... . __T - �j' Description of Soil----:-- " =.------ `fi r/...---j - L"a C� U ----------------------- ----------- W V 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 Article NI of the State Sanitary Code—The undersigned fu r agre o place the system in operation until a Certificate of Compliance has be" u d boy the o rd of lthl r - igned- -. -- --- -----------• -- . •--- ` ,/ Date Application Approved By---- .. -- ---- ------ -- +�"t�'�'" '/r 7 7-j- Date Application Disapproved for the following reasons=----------------------------------------- ......................................................... ------------------------------------------------------------------------- ------------------------------------------------------------------------------------------- _..� Date PermitNo.......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH. ........OF......... ........ ... L........::................................ rtifira#r of 1,111,uMI111- ancr TO CERTIFY e Individua Sewage Dksposal System constructed ( ) or Repaired stall • 1.�{..� as ,applic tion for installed Dispo al accordance Con tr ction Perm t No Article/. oaf T . State Snit ay 7/../7/-7d�in the THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector----------------------............................................................. THE COMMONWEALTH OF MASSACHUSETTS r 'BOARD OF EALTH ..OF 7F FEE__ Bi ival 1 orkii Cn nis as i�wf rrnti# Permission is hereby grante - -------------------------------•-----•----....----- to Constr ( or Re air a ndividu isposal. to �t No.... - _- -------------------- ....'............. --�L z .. tree as shown on the application for Disposal Works Constructio e it N ..... ted..._ C DATE------------------------------------------ " INC.. PUBLISHERS Boar of ealth FORM 1255 HOBBS & WARREN, ¢ LA �3��2l, .�o f 7 y 174 G1 �5 © A t 7 �J