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Home My WebLink About0025 MARYALICE LANE - Health (2) as modq THE COMMONWEALTH OF MASSACHUSETTS BOARDA WEALTH Apphration -fur Dig 'meal Workii Ton rnrtion Vanift pplication is he by made for a Permit to Construct (` ) or Repair ) an It divvidual Sewage Disposal Syst at - 2 .. / ;�A. -n-A.. --- - .... or!L o . ........... / ._ wr Addr ess ------------------------------------ ` ------ --------------------- I t..}+ --- -_� - -•--•----- nstaller Address QType of Building Size Lot----------------------------Sq. feet Dwelling k"'No. of Bedrooms.................�----.---_-__----.__.Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building __-_-----_________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) 0.' Other fixtures ---------------------------------------------------- W Design Flow ....................� a.._.__ allons per person per day. Total daily flow.............. c_ ---_� -.--.....gallons. WSeptic Tank . ...Liquid capacity/e'l If Length----------------- Width......---------- Diameter---------------- Depth......... x Disposal Trench— o..................... Width._.._._._ _ o�f Len _ Total leaching area-.-..__.___-_-___--sq. ft. Seepage Pit No. Diameter./ __---- el) h�6elow us '• Tot leaching area--••--------------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) W — /- aPercolation Test Results Performed by---------------------------- ------- •------------------••----•---------- Date..... --------- -------- -------------� Test Pit No. 1................minutes per inch Depth of Test Pit____-_______--_--_-- Depth.to ground water----------_'1__-- fZA Test Pit No. 2................minutes per inch Depth of Test Pit---_-•__--______-_- Depth to ground water__.-_._..---._-_--.____. 1+4 ------------------------------------- --•--- O 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 Article XI 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- .-- --•--------- • ---------------------•-----------•---•--•----------- ----------------------•-----••-- ' D e Application Approved B /r�u"______'______ _ LM�1'"- ,or _-------•--------•------•---------------------------------------------------Date ------- Application Disapproved for the following reasons________________ _____ --------------------------------•----.----•--•----------------------•----•-----------._-.--•--•-----•----•----•--•-•---•--•--•-----•------------ .------------..----- ^! Date � PermitNo......................................................... Issued------ ---...2........ . ....... ----------� - Date THE COMMONWEALTH OF MASSACHUSETTS BOARD QF HEALTH ........OF...... ..................... � � � � Applirtt#iun -fear Ii,41uia1 Morks Cnongtrur#ion Prrutit Application is he b made for a Permit to Construct.($) or Repair ) a I ividual Seyaae Disposal Sy at- 1 ! oca' n-A s ,,,,� or Lot -----�- ;!� �� --- - -- - --- - -- ....r._..__........ �""--_��`•-, --/�-„�,--- - ---�-��--`�'�--�-- ---•----- Ow r Address Installer Address UType of 'Building Size Lot............................Sq. feet �-, Dwelling—No. of Bedrooms_______________ ____________._.___-Expansion Attic ( . ) Garbage Grinder ( ) p-I Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other: tares ---------- ---------------------------------------=----------------------------- --------- ---- W Design Flow ___ ___ `__: 111oris per pees n.pe day. Total daily flow_____________�.t_ ._:'--------gallons. WSeptic Tank Llqi i capacityl gallons Lettl _______________ Width.-___-. lliameter__-__ Depth- _-_,___ ._ x Disposal Trench— d` ________________----- Widtll__. of L Total leaching area--_--_-____-______sq. ft. r Seepage Pit No__ Diameter _.___: ep h 'el:ow inle .:._. Tot leaching area--___--__-______sq, it. z Other Distribution ox ( ) mg tank Percolation Test esults }'performed b ................ ... Date = a Test Pit No. 1_______ ____mimites per inch Depth of "Pest Pit____________________ Depth to ground water---------- (14 Test Pit No. 2...... ___minutes per inch Depth of Test Pit____________________ Depth to ground water------------------------ ------------------------------------------------- ------------ ----- - ---- ---------------••----...................................................... . . 0 Description of S it______________________________ P . -------------------------------- ----•--------------------- ------•----------------------------- -•---•-----•-•--•----------------------------•------------------------------------•--•-- --•-------------- = -----•--------------- V Nature of Repa rs or Alterations—Answer when applicable----------------------------------------------------------------------------------------------- ---------------------------------------------------- •----•-•--•----------------------------------------------------------------- ----•----------------------••---•-----•------------------------------ -----------•-----------•---. . Agreement The and signed agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I 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. Slgne - -- ----•--------•--•------------- ---------•-- - ------ .✓ e i 0 1. �! to Application Approved By-------- -- •---------- `' f--�__/--7 •------ Date Application Disapproved for the following reasons:---_---_•-------------------------------------------- =---------#--------------_____-_---_____-----_---_------- ---••••••--------------••--•----•-•-•------------------------•-•----------------•-----••----••-••••••-•---------------••-•-••--•-•••---•-•---•••-•----•------•------------•----------••-• ------------ �d el Date Permit No.-e;:.; ;» rsued........................................................ p Date Ldr � THE COMMONWEALTH I MASSACHUSETTS BOAR HEALTH 4 ........ OF. ... r✓`.... .... .. '.. ... :....-..:.................. (Err#ifi �#r of f�llaptialtrr T S IS TO CERTI Y,'That. dividual Sewage Disposal System constructed ( " ) or Repaired ( ) bY•---• •-• -• -• = ---•- ------ /� �Installe� j� has been installed in accordance with provisions of : rticle I of Tle tat Sanitary Code as escr•bed in the application for Disposal Works Construction Permit No... j__ -_.. :_... dated----..j.�_�I _______. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION -SATISFACTORY. � � p , -�DAT _... Insector r THE COMMONWEALTH OF .MASSACHUSETTS BOARD OF HEALTH_ /i - . - �p f_ ......-.f.....f :�jL�'�....OF........... �, i�"�7-...-. � �LH � No L�"(� FEE.. ............ YnIndividual 1 rk� n r#i�it �rrmi# Permission ' reby granted---- .-- 4-- - -----•___. . . -- - -------------••--•----------___ tc Cons ( or Repa ) �pevQge Disp I ystem atNo..- ------- ----- ------ --------------- •• ••-•---- Street as shown on the application for Dispos orks.Construction P mi No... Dated----�-i2 Al__ — _+�__-__ ` Board of Health DATE ----- - - ---------------------------•••-- FORM 1255 HOBBS & WARREN.-.INC., PUBLISHERS ' L CF TH E Taw TOWN OF BAR.NSTABLE t, y 0 i BARISTABLE, y° MASS.39 i6gq. Board. of Health am P- 9ppA tfAI FROM THE OFFICE OF N IN 3 K M- 0 a Sewag-e-Pe-rm t-#$--7- i ur� RZ c•e R,f vEllage. �J�tr�i9>��14s3 Installer; 9q /9 yS /Y W.?Jot d4y'sT, W, if,Vrnsfw-��I" urLu er 49W 7,94h SOr! so ynr sasvNT�i /44 S 3 Date�omp lance ssue : -� �-o�,„ waT.� /yid r ��i c P R� -o � � Z" .`o � , `� N �b ' �, h