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Home My WebLink About0045 FALMOUTH ROAD/RTE 28 - Health (2) �A = 3 � i - os3 No....�.._.__._._......1 Fas.......:10.... ::... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratinn fur Di ipwial World, TouBtrnrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair (-ran Individual Sewage Disposal Sy `....S ....- f'....J.6................................................. .....------. ---- -----------------------...._--- Location-Address or Lot No. .............. ...............................•--- __......................__..... w C' J C® Owner Address IustalIer Address Type of Building Size Lot............................Sq. feet ., Dwelling—No. of Bedrooms...........!r!n---------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ------------------_----_-- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) at Other fixtures ------------------------------- - - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width---------------- Diameter................ Depth.............. 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........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ...---•----------------------------•----•-----------------------•--•------------•------...........--......................................................... ODescription of Soil........................................................................................................................................................................ V W ----------------- --- ------------------- VNature of Repairs or Alterations—Answer when applicable.--.- 3 f_........_/'.....1 j_ .®....... .. � ... (S�iw _ . ....... ........d . ........�� ................. �f �_.t ...._... _ e 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 Compliance has bee issued by he bo rd of health. Signed ----A.............. . . . ............ ..... ......... I..... .:...1. Application Approved By .. ... .......... ...... .. .... . _.... .. ... .. .Zj Application Disapproved for the following re r n.r: ................................................................ ............................................... ... ..... ---............................................................ -------_-- ................ PermitNo. ............ ...................... . .. .............. Issued ....... ..- 6. . . ....................ate...... No.. ... Fint r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diripwial Wi ork,i Tonitrnrtion firrutit Application is hereby made for a Permit to Construct ( ) or Repair ("l-an Individual Sewage Disposal System aJa* • 1 1 ....-----�..--.....-/�...... CA 1) 't P _ Location-Address or Lot No. w A C O Owner Address .... Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms---_-__--_-_—______________________----Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) 0.1 Other fixtures ---------------------------------------------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 0y Septic Tank—Liquid capacity............gallons Length................ Width---------------- Diameter--- ............ Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 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. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ----------------------------------•••••-••••--•••••••••••••..__...--•••-•-••.........--'----•-.....•......................................................... 0 Description of Soil........................................................................................................................................................................ V W .....----••-----------------------------••••--••••••-••--••---------•----------•---•-••••••-------•----•----------...---------•-----•••••.....-•--•...----•----......_..---•--••-------•---•----.....•. U Nature of Repairs or Alterations—Answer when applicable..... 1?3 1�!41...__.___.._. .'...._��:. .v_...... ..P16".o... Agreement. �� v 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 Compliance has been issued by the board of health. Signed c ,y, .. ............. ..... ......C' .._.... ......... �. �..�...... �. � . Application Approved By ............�.............. %. ... -------- /L1J' 4:.,......................... ........... .... f' �..I .. /Dare / / �.. Application Disapproved for the following rea�6nr: - ...................................................... ----------- -----------------------*...............C......3 .......................... ,� Dare Permit No. ...a............ ............ ��................. Issued .......0�r- �D re...�-......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE k"LlPrttf ra e of (111nmyliattre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by .................. hc a I / at ....... ............. ............. rdcr 1� .....'11 . .� .......................................f 5 .... � � . - -V. -----_ --- --------..I<. has been installed in accordance with the provisions of TITLEi of The a e E vironmental Code as described in the application for Disposal Works Construction Permit No. . . ...'.... ................... dated ....._......................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT CONS TAR AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 1_ DATE....................... .. .../.� ........... .. .._.... ----. Inspector ...........V. ...... ..._....._..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No.y TOWN OF BARNSTABLE FEE.....;..?C�...�... Riipoottl norko Ton,atrudion rrntit Permissionis hereby granted..................!/-/�ca-----------------•------------------------------------.---------------------•-----------.------------ to Construe ) or Repair (✓'S an Individual Sewage Disposal System 1 atNo............. / a S ------ - ------------- Street ( �...1....... P_a',Ijed-•----..... . .1. ...,.1_.C�as shown on the ap lication for Disposal b�'orls Constructioner t No._ _.�.. �' V ��.!......... .._. 2 lq4 .................... Board of Icalih�p DATE............ 1?f FORM 36508 HOBBS R WARREN.INC.,PUBLISHERS