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Home My WebLink About0020 PERCHERON WAY - Health 20 Percheron Way ' A= 174— 001 —056 44 W. Barnstable l I a i i r No....74::w .4Z v FEB THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....._... � LI-IQ........OF...... .. . .. L4- .1 ..f---------_------- Appl ration for Di,oputial Worko Tonutrurtiun Permit Application is hereby made for afPermit to Construct ( or Repair ( ) an Individual Sewage Disposal tvSystem at......»»..•---LQ�-- Z Y C "- .....__� - .... -- .........-------- or ..... ...... � ocation-Ad�irepf L No. ...»..... ^ ...._.... _ t r� a .......................... '� erLtlTrP .............--.......... ....................... !..�Q............. ...5 _ �t�C�_�.✓...................... Installer Addres Type of Building Size Lot../7.�.S ..Sq. feet .. Dwelling—No. of Bedrooms.........-3............................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers a YP g ••-----•-••--•-----•--•-•--• P ( ) — Cafeteria ( ) Other xtures .----•-•................•-•••-••--..... d _..._.._...-•-- Design Flow............ ......gallons per gepeeti ey day. Total daily flow........... .30.................,.�. to s. WSeptic Tank—Liquid'capacity. gallons Length._. ....Cg._._ Width:... 10.1. Diameter................ Depth.5....`"... x Disposal Trench—No. .................... Width.................... Total Length........._......... Total leaching area....................sq. ft. 3 Seepage Pit No.........(........... Diameter........I ..... Depth below inlet.... ......... Total leaching area_ZG_;?.....sq. ft. Z Other Distribution box ( Dosing tank / Percolation Test Results Performed b. ...._..�:�.�767k ._.. __..,�...... - 0 ,.a Test Pit No. 1 G-2.....minutes per inch Depth of Test Pit....L ..__ Depth to ground water...........*....... L4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ••---.......-•----•---•-•......................................•---•-•----...._........_.... Description of Soil...... .......... ....3 --.............. UW •--•••---•-•--•--•------•--•-------...-•------•--•--•------•--••-••----•-------•-•••--......-••-••-••-••-----•-••---....•-•---...••--•-•----•---••••---•-••-••--•...••-•---•-••.................•-__.... 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 LITL: 5 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. Signed.... (� ,0) D (1 ................................. --J� .. ........ Application Approved By........... '�.�._ --• �?t�.. 1....... Date Application Disapproved for the following reasons---------------•------.....--------------•--------------•---...--•-------------..........--..................».. .....................................•-.....-•--••-•-•----•---....-•-•--•--•--••-•--............----..................---.•...-----•••-•---•-----•---.........---•----..............- .......... Date » Permit No....... ? ....................... Issued................................••--••--•--........... Date Fzjc #� THE COMMONWEALTH OF MASSACHUSETTS s Jkt � ABOARD OF HEALTH o ,�pfiration. for ovonttt Works Tonotrttrtinn rantit Application is hereby made for,fa Permit to Construct (�)t or Repair ( ) an Individual Sewage Disposal Systemat:.,• _..............................[ /_.9 f__ ..�' � V v................___ . . ..... T ........ .... ......... )Lon-nd ._.. rc -=f _/ _..... � 11.�� .......................... L -------------------------_.......,.�.. .._.... . 1. - - ---..... 2 .. ......:�� :.............:.._........ Owner `, ,/ '-"�d'ress fs1J I �i) r S 6,9 /C ....... ............................•-•-•----•-... ...........................vP •...Y��7-?Cr�l�r r............................. Installer Address /- �r Type of Building Size Lot....................ry--.---Sq, feet U Dwelling—No. of Bedrooms..........3............................Expansion Attic ( ) Garbage Grinder ( ) aa Other.—Type of Building .._....._.. No. of persons............................ Showers g ---------------•• P ( ) — Cafeteria ( ) Other fixtures ......................................&2.. W Design Flow............ ..... per pers6n ,er day. Total dai�y flow.........�� ..........gallons. WSeptic Tank—Liquid capacity. gallons Length._ .C�.... Width:. 1._Q.. Diameter:............... Depth.5...`f..... x Disposal Trench-No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No---------/----------- Diameter........ ..... Depth below inlet....._C�?......... Total leaching area.Z L 7.....sq. ft. Z Other Distribution box (k.) Dosing tank 0.4 Percolation Test Results Performed by T....Y.- ............................. / S_•�7 � _... Date---..:�.��..... .....--•-----.. Test Pit No. 1:G:2......minutes per inch Depth of Test Pit.......&�.._. Depth to ground water........ c� ... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...... ......._..--..---- a !� ...------...•-•••••-•..................... Description of Soil.....J....._..� . 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 he provisions of:ITI..:. f h t p S u 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. Signed...........Q........ ./... ...................................... .......... Date Application Approved By............ 1 f .��. ................ }............................... / .-_5?1...... v J Date Application Disapproved for the following reasons:-----------------•-----•------------------------------...--••--------------.....----•-.......•-•---=.......... ...............••--..................t..---......._...---•-----•••-••••.....------......•-••-------•......------------•----•--•-----•-•-•-•-•-•....•-••-----••-•-••--•----••-•-•-•--•.........--••------ ��yy te PermitNo.....1. .- ....�--• ---� --•--------------------- Issued------...----------•------==-......................... Daze THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... C9rrtif irittr of Tantpliattrle ' ` THIS IS T CERTIFY, That the Individual Sewage Disposal System constructed (� or Repaired ( ) by-•--••.................. . `N ........ � ........-----•--------•--..................---•---•---••---•---......._.......---•-•----..........................----•.-- Installer has been installed in accordance with the provisions of TITS j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A'GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..... ..--�-- -�--- 1�--•------------------ Inspector.------------..................................................................... ------------------------------------- ------------- _ _ _._a_ _......_....____.... -------__-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No... Z�Z.` j FEE... ....... Disposal Works Tonotrudion 11amit Permission is hereby granted ---'- ---:---.----------- -------------.------------.......................... ........................ to Construct (<) or Repair ( ) an Indvidual`Sewage Disposal System at No........................�c/ - t/� �_.,-r 01 0"Al l /y G�s ---- �f'1. ------1 .:_PA�1 'al.... ..........................................................._.. _ lSt,ieet �� as shown on the application for Disposal Works Construction Permit No' ...__'.._..._..,1_ Dated.......................................... Board of Health DATE_......................•---•-- -••-••-•-- -------•---••-•-•------.----.. 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