The URL can be used to link to this page

Home My WebLink About0027 SEA MEADOW CIRCLE - Health (3) a1 cS� ��oW Gn,�,Ce. � Co-h�erv�Ve �= ay�o - aato � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE , ppliratiun for Uiipma1 Marko Tows rnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at Lo ation-Address or Lot N .M.�r,..... - ............................................... .................................................... ...... ............_.. Owner .•••---•.•-•--.-----.•-•_.--.•--Address ................ .-. ........... Installer Address d Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............./----------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures --------- W Design 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-----.-------.-_-.---- Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.-:..................... a -•-•----•-----------•••-••-----------------•••--••--•-•-•---•---•------...-------------------•............................................................... 0 Description of Soil...............................................................................-----------------------------------------------------------------------------------•.... x U ----------- ----------------------------------------- --------------------------------------------------------------------------------------------------------------------•------------------------- 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliancehas been issued by the board of health. Signed ...............................:: Dare Application Approved By ------. .1- . ---------------- ---------_-_---------.......... .----- ...... �� Dare Application Disapproved for the follows g reasons: ...."'-------'--------------'-- ------'--- '-............------....-'-------------"------------.------............."------------. ----- -------------'--' . '.............---------'--'---'- -- ...........---...---------------'--- ...............................--------------..- Date .n. r Permit No. 19--. ......---'-------------- Issued ........................Date-------------------------------------------- ...... �r 6� FES... /7.�.._ .......... THE' COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Disposal Works Tonstrnrtion Frrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ./ J/(\�j ..Lo-ation-Address --.--.-. — • ___---.---•-----•.••....or Lot N ..�.e...... .............. .................. ------- _---------------------------- ._......................._.......................... Owner ................................Address Installer Address Type of Building ❑❑ - Size Lot............................Sq. feet Dwelling—No. of Bedrooms............L�................. !__....Expansion Attic ( ) Garbage Grinder ( ) '_lPLO Other—T e of Building ............................ No. of persons............................ Showers — Cafeteria a � Other fixtures -------------------------------•-•--•----------------•.--------•--------------------------------------------------............---...---------......... WDesign Flow...........................................,gallons per person per day. Total daily flow............................................gallons. W Septic 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a --•••--•••-•-•-••---•-------•--•••-•••--•-••••••••••••••-•••••••••.............•----------••----........--•••-••---••-•----•••••-•-•••....................... 0 Description of Soil...............................................................................------------------------------------....._......----------------------------------•••--- V ----------------------- -------------------------------------------- ----------------------------------------------------------------- ------------------------------------ -•••... ------------- W ••-•••-•---------------------------------------•-------•---------------------------•-•-•-••------••----••-••--•---------------••----•-•----•-••••••••••-••-•-••-•••-•-•••-•••---•-•--•-•-•--•---•-••--- UNature,of Repairs or Alterations—Answer when applicable.............................•.__._._..._......__.........___..._..................._........_. -----•----------------------•------------------------------•---------------------------------------•-----•------------------------------------•----•---•--------...-•--•---------------•-----•----_-••-- Agreement: i The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complianc rhas been issued by the board of health. r Signed ... -------------------------------------- Date Application Approved By .............. .. . .. - t• 1 gl / Dare Application Disapproved for the ollowin reasons: .........................................................................................t.. ---------------------- ----------------------------------------------------- ---- ----------------------------------------------------------"-----------.............................................. ....----------------------.... Dare Permit No- -------------Y/,r---- - ~ --_-_------- j Issued -------------........-------------------------------........------ Dare )y THE COMMONWEALTH �OF'MASSACHUSETTS C, BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of (1ZGraptin re THIS IS T CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by....--.... -........ .. ........................... n Installer at ................... 7... ....... .��C' ....... ..,P r _ '�s ..-- - ".......-..... has been installed in accordance with the provisions of TITLE 5 ptThe State Environmental Code as described in the application for Disposal Works Construction Permit No. .... ... .......---6--/).............. dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................................-- _...9 ------...---------------------------------- Inspector ........... ..................................................... ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE / No..... /-.f�� FEE..l.��............. r � R-s-posttl Works (9 Uptrttrtuan pamit Permission is hereby granted....... - 't"m=......1x9-+ ..... -•------------------------- ---- --------------- --------------- ...-............ •--- to Construct (,**ICY or Repair ( ) an ridividual Sewage Disposal System atNo..........D 'Z...... - •-------•---................... Street � as shown on the application for Disposal Works Construction Permit No...._/' ��._ Dated.......................................... .................................. _._ ................................................. ` r Q� / Board of Health DATE -- :/ ....................... FORM 36508 HOBBS&WARREN.INC..PUBLISHERS