HomeMy WebLinkAbout0071 PLEASANT STREET - Health (2) n� ���ea�c� ��-
f _ _ �
TOWN OF BARNSTABLE ,
LOCATION `7 / ��� airy%" � SEWAGV
VILLAGE &, —,%T kvvv.i S ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO.
STANK CAPACITY / �! a
L 6--
LEACHING FACILITY:(type) 4g-4— (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BOMPER OR OWNER
JAG
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
V
V.3
Y
No.... ..s .?.� F>$....2Q..............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�...`..... •`.�.................OF................... .."................--.......-_.......................................
Appliration for Disposal Works Toustrnrtinn Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair (V/) an Individual Sewage Disposal
System at: !� J t
do �A s q �
W• or Lot
------ ----
Ow r dress,
i �... dr! ------------------------------------
Installer Address
QType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers — Cafeteria
PA 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 ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
,.a Test Pit No. 1................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........................
---------------•----•-•------••-----........---•-----•----------•--.......--•--...........--•------....--------------------------------------•------•--•..._.
0 Description of Soil.......................................................................................................................................................................
x
V -----------------------
•--•--------------
----------. ---------------... ---------
---------------------------------------------------------------------------------------------------------------------
----------------------------------------------------------
UNature of Repairs or Alterations—Answer when applicable___,,.--'0j_o__ ..._--_��._ ®f.�r ...fir.`..
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issilad by the board J.
of 1 lth.
Signe -- ----•------•----- F ° ` ....................... •---
Date
Application Approved BY••-••... `rS `"� % °
Date
Application Disapproved for the following reasons---------------••----•--------------------------------------------=--------------------------------•-•.....••--
--------•---•--•----•------•••••••-----••••••-••••••-••••••.....•-••-•••.......--•-------------•--••...--••---------•---......---••-----•-•--•••-••---•--------•-••-----...............................
Date
PermitNo.----.. -'?------- - ------------- Issued.......................................................
Date
rr
No. --2 %5
THE COMMONWEALTH OF MASSACHUSETTS
BOARD Off' HEALTH
�--
.......... ....................................OF................-...
ApplirFatiun for Uhipas ai Warks Tontrnriion 11amit
Application is hereby made for a Permit to Construct ( ) or Repair (, )• an Individual Sewage Disposal
System at:
..... .......................... -- -- - ... . .--------• .
a-Location-Add`Rss f`j fk t ' j/ ,� or,Lot No-- ...
...........
........ L r ........................... ......... — •----=--.._.��....._._:..------. ---•----------------------•--------
Ow�%:� Address
w f
..---•------------------•-••-••--_•---- ............. -- ---•-•--•-----•--•••••--
Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
a`4 Other—T e of Building No. of persons............................ Showers
YP g ---•----------------•------- P ( ) — Cafeteria ( )
Otherfixtures .-•-•-•---------•-------•--•--------•--••------•----------••••••----------------------------•---•------•----
W Design Flow............................................gallons per person per day. Total daily flow..............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter___`t------------ Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
�r Seepage Pit No..................... Diameter.................... Depth below inlet........1.......... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed bY--•---•--------•------------------------•-•-•_......t�l_---•---------------- Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.............'*..... Depth to ground water-___---______•__-.___._-
04 Test Pit No. 2................minutes per inch Depth of Test Pit.............. Depth to ground water........................
-•----•..............•---•--...---•----......-----.....:.--•-----........------....-•------------------•----.....-••-•--.....--
D Description of Soil.....................................
x
UNature of Repairs or Alterations' Answer when applicable._.. _16�? I_ �~" _ f '
------------------------------------•-----------------------------------------------------------•--------------------------------------------------------------------------------------...-------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in-accordance with
the provisions of TITIE 5 of the State Sanitary Code— The undersigned further agrees not to,:place-the system in-,
operation until a Certificate of Compliance has been issugd by the board of(health.
Signeds�-......................'..`''L"'�»-��---�:....�-``-�-�--•--•.
Date
Application Approved BY ..116—� ---------------------•------- ......... ...... __
Date
Application Disapproved for the following reasons--------------------------------•--------------------•--------•----------------•---------------••--------------
----------------------------------•-•---...--------•-------------•---------------•----.......------....----.............................................................................................
Date
PermitNo-------- ,7•--- .............. Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
-- BOARD _OK HEALTH
............................................. OF......% `::"`.'........ ........................................
'rdifiratr of f"otnplitturr
THIS IS TQ,-CERTIFY hat tht Individual Se e Disposal System constructed ( ) or Repaired ( )
k
"`� V
!, by----- " ---`' }' -�". "---- . ............--- - .............
`\ I { M•- 'Insta 'C ; ^>
at `` -.`= -- t ,, 4. �•
t
has been installed in accordance with the provisions of TITIF±�, 5 of The State Sanitary Code as described in the k
application for Disposal Works Construction Permit No__________ __ _ _r _ ..... dated--------------..................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION/SATISFACTORY.
DATE....................... ��.__ !_ ��
--------------•----- ------•------------ Inspector----•--------•--------- -- ........................................
THE COMMONWEALTH OF MASSACHUSETTS '^ !�
.BOARD OF HEALTH - '`elf
r' .... 3' ""' +u±!.............OF...... -,«'.""�wr................_....•
No... =_ FEE.
Dispoo 1 arko iott"p"rrntit
Permission is hereby ranted....!K I-..L � %st,r
-
to Construct or% ail: an Ind Sr Disposal System
Street �.
as shown on the application for Disposal Works Cons ction Permit No. -, - Dated..........................................
g
DATE---------------d�`•-=- ...................................... Board of Health
FORM 1255 A. M. SULKIN, INC., BOSTON - _