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Home My WebLink About0114 STRAIGHTWAY - Health (2) ZJO 0 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appiiratinn for Disposal Works Tonotrurtinn Urrutit Application is hereby made for a Permit t Construct ( ) or Repair ( k--a--n Indivi al Sewage Disposal ys s 1=• at ._ .. � (��I�,.......... - -------- -------- ------ .._ �............. . ----vie-.....� .. ----- ation- d �.-__.. Lot No. - ................ .._..... -------------- ---- W ... ................�........ ... w••r ..- . .............. �• - A r s --�.1T L a ------------------•- Installer Addre s d Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria aOther 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........................................ W ,.� Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a+ •---•---••---•••-•--••-•••••------•-••--....••••....---•-•---•-•--•..............•--._....------............................................................. 0 Description of Soil...............................................................................-----------------------............................................................... W - W ----------------------------------------------------------•-------------------- •----••-••••-••-----••-•--------------------------•----•---••--•-•-•---•••••---•-•-•---•••-•---•............----•-•. U Na ure of airs or Alterati a An wer wh applicable--------------------------------------------- ------------------------------------------------ Y ---------------------- Agreement: The undersigned agrees'to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of,TITLE 5 of the State EnvirP ode—The undersigned further agrees not to place the system in operation until a Certificate of Comp i ue the board of health. Signed -- --------------------- --- ----- ---... .--- -----" 10 Date Application Approved By .............. -----.----- - ' Q----- Application Disapproved for the fo lowing reasons- ----------------------------------------------------................................................................................ ...............---- --------------------------------------------------------------........................----------------------------------------------------------- ..................... ---------- -........................... _ Dare PermitNo- ----- c --------------------------- Issued ..... -------...------------ ------ -- ---------............. Date No....?e. Fss.... .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ,Appliratiun for -Bispnottl Works Cnnngtrur#inn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( k-a'n"'Individlual Sewage Disposal System at:� ....�.�........__ -- -- ............ ` ....... ....................................................... - ------ ---- ----- -------------- L. tion or Lot No. ----------------- ddr � ...............== - ................ 1 Y.... . ..................... Installer Addrel . Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ---------------------------•----•--•--------------------...... d ' W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. P4 Septic Tank—Liquid capacity............gallons `'Length................ Width................ Diameter................ Depth................ xDisposal 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........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------- fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water----------------_....... 9 -----------------------.........................................-........................................................................................... ODescription of Soil..........................................--............................................................................................................................. U ....................................................................................................................................................................•...................0............... W -------------------------------------------------------------------------------------------------•-•- -----•--•-••---------•-•-------•--•---•------•••••••.....--------•--•-•-------•----•----•-•-.--- Z. Nature of 'e airs or Alterations—Answer whe applicable......................................•.._..... ............................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environ nxa Code—The undersigned further agrees not to place the system in operation until a Certificate of Compli'lnee has , is ue the board of health. - Signed . ..... ..........22....90 Dare Application Approved By ---------- --- � �ng ��.��. ------------------------------------------------------------------ -Application Disapproved for the fo oeasons: ................................................................................... ------------------------------------------------------------------------------------------------------------------------------------------- -- ------- --------------------------------- ---------------------------------------- - Dare PermitNo. ------�6)- 1-9-V--------------_--------- Issued .... :............................................... ------ Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1 TOWN OF BARNSTABLE Ger#tftratr d (fant 1tttnre ThNPIS CER7'I T That the Individual Sewage Disposal System constructed ( ) or Repaired by--------- .................. ------- ------------------------------------------------------------------------------------------------------ � _ Installer at - - has been installed in accordance w' h the provisio s f TITLE 5 o e State Environmental Code as described in the application for Disposal Works Construction Permit No. ............ .. -.- .. dated .............A............................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED S A GUARANTEE THAT THE SYSTEM/ /WILL FUNCTION SATISFACTORY. . DATE k ( ._�(- /.............................................. Inspector 2�..(.. - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No.... �) - ... FEE..... Disposal �k�-19 i iun �rrnttt Permission is hereby granted...... .._ ;s--� _: --�- to Construe ( s �_e'pair (.lam a t�:ividual Sewage Disposal S stem at No...II •_.. ` .T �" :art;�! � ." � N Street as shown on the application for Disposal Works Consthuction Permit No.� 1 r.).& Dated.......................................... ............................. ----------------------...---•-••••.._........._._--•••.Board of Health DATE.............. ...-. =.l. .................._................... FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS