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HomeMy WebLinkAboutUntitled THE COMMONVI OLTH OF MASSACHUSETTS BOAR® OF HEALTH ........................T.M. ........OF........Ba=table-...................................................... M Appliratiun for Disposal Works Tunutru' diun runtit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ..60 Sixth Ave. . West Hy 02672................................. ----•- ..... ._........_. Location-Address or Lot No. Charles Bunker .. .5.2..Sixth_.Ave,......[hest_--EyanrLi5-P-QZ_L,••NA-----02672 Owner Address a .. & .. Cesspool Service, Inc . _128.-BishODs--Terrace.,_--�iya is}__M.Q.-.--42(0-__• Installer Address Type of Building Size Lot...............•._..._...._Sq. feet Dwelling—No. of Bedrooms___.--_2..................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e W yp of Buildin g ............................ No. of persons......3.._.____.._......._ Showers ( ) — Cafeteria ( ) dOther 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........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.-_-_-__________-----__. 4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ...........................................--------•-........................................................................................................ 0 Description of Soil.....................................................Sand--•-•---------•-•-------------•---------•-------------•------------------------•••--•-----•-•-••......--- x w -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-•----•••-••--••- U Nature of Repairs or Alterations—Answer when applicable._--.---ilistal_ati an--.of-a---1,000---gal•I.on_,--•pr_em4o_a.st, .. .tare.... ackeri..laaeh.pit...(.Ovexfd,0X)......---•--•----•----------------------------------•------•---------------------------------------•--•---------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITIE 5 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 rbof health. Sig •... ..... .. ... -----� -----...................... ............7l !......---- .-_ Daty ApplicationApproved By...................... -. • ---•• --•-• ................................................ .............. /07/-_8..-------- Date Application Disapproved for the f oll reasons:-----•--------••----------------•---------------------...------------------•--•----------------.....----......_ ........................................................ -- -•-•-•••....----•--•-••--------••....._...._......_....---•-------•----••-•---•••••-•-----•.................._....... ......••. Date 84 PermitNo........................ .............................. Issued-----------------9/07/........................... Date A r r THE COMMONWI�LTH OF MASSACHUSETTS BOARD OF HEALTH ......................T.I wM.........OF......._Eram- Gtahle-----------------------•-------.........••--....---••--- Applirntion for Disposal Works Tonstrnrtion "pamit Application is hereby made for a Permit to Construct ( ) or Repair (R ) an Individual Sewage Disposal System at: ................................................................•------------.....------.....---- Location—Address or Lot No. lJYn�7 es_Rte�.. ........ -•--••------------------•-----•---•-•---•-•--•- 52..Sixth.Avg..,-u!Est..Ii3r�nisla�zz�t,... d..__A2E2 Owner Address ............................. I9B.pishnpa__TarmeaL,...Eyannis,_-_YJA....Q2LQ1..... Installer Address Type of Building Size Lot............................Sq. feet U g— .____.::.:Expansion Attic ( ) Garbage Grinder ( ) Dwelling No. of Bedrooms______ _______________________ aOther—Type of Building ____________________________ No. of persons.:____3.................... Showers ( ) — Cafeteria ( ) Otherfixtures ---------------------------------•-------------......_....-----------------------------------•-•--------------------------------------.._......._.__.. 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........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.................... G%4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water............_........... ----------------------------------------•------...•--..------------------------•--•-------•-•------......................................................... 0 Description of Soil......................................................Sand x W -----------•-----------•--•---------•--------------------•--.._...--•----•--•-----------------------------•---._......._-•-----•-----•----•-------•---••• -----•---- i �....--•---••••-• -• ----------• > U i Nature of Repairs or Alterations—Answer when applicable -040 aid c Te--cast •-store---packed••leaGh--pit•--(ove-r-f -ow-),••------------------------------------------------------------------------------------------------------------------- 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.issued by the board of health. %� Jf 'f Signed.---L/•=-- -.,. � .. d�__►�'.,�...��.:.. 91�7l�' ,+�r' -- - Datf Application Approved BY .�•-= --•-- ---.: .->......................... .............��7/................ Date .._.._._._. •• - Application Disapproved for the f oll ons___________________________ _ / ........................................................ -- t _.._....-----•------......------------.._..----------•----------------------------------------------------------------------- ------- / / Date Permit No....................................................... -------------------------•• Issued_ 91.07/ 84 - Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................Town....O F............BA.xm BA.xm.stab.le............................................... 'rrtifiratr of Tomplitnr�e °r r THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( X) by------A..�;..Ii-•-0e,�s�oal 5� , � e., 128 p i�t�vps ee, 1I3r1s T �� ©�601-------------------------- Installer at--------6Q-Sa�ctl�--Aue�T �d �t I�13ra.ra spo 't, fA-----0267-2--A--Cbar1es"B=#e--------•--^__________ has been installed in accordance with the provisions of TILE 5 of The State Sanitary Coc�g�s7It ribed in the application for Disposal Works Construction Permit No---------,, dated_.-------_y.....__.___//_---�___..................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT,3E;6ONSTRUED AS A ANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...............................9JO.7/i34----....-•-----------------•---. Inspector............ -='----------------....._...---------------._...---------•--------- THE COMMONWEALTH OF MAS CHUSETTS BOARD OF HEALTH ..............Town..........OF..........Barnstable No...... = FEE__$ 1_r5.-QA Disposal Workii Tannsfrnrftion famit A & B Cesspool Service, Inc. Permission is hereby granted -------------------------•--*------------------------------ to Construct ( ) or;Repair (X ) an Individual Sewage Disposal System at No.___.60...iixth.Ave_.,.. es1_.4ra=;Lspaxtt,.._kA......0,2.672.__-__-Charles._I'lunk.>er_............................................ Street as shown on the application for Disposal Works Construction Permit_No..8-4-._________.rDated----------------4/Q7/ ......... v` Board of Health DATE 107 'W FORM 1255 A. M. SULKI N, INC., BOSTON �..f Y .�