HomeMy WebLinkAbout0024 FRASER COURT - Health 24 FRASER COURT
Barnstable
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LO,�CATION SEWAGE PEIMIT tJO.
VILLAGE
[91STA LLER'S q,AME b ADDR-ESS
I3 OR OW3 ER
p DA-TE PERMIT ISSUED ( . ems
DATE C 0 M P L I A N C E ISSUE1F � —
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
r
Appliration for Disposal Works Tonstrurtion Vrrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal }
yst at:
..... ................. ---••-. ......... ............................................
—
r Locatioi Address or Lot No.
..L�-j-�.. ner ---•---•-•--•----•-------------------- o. ..........................................................
. ..........
a ._. .....-•-•.. .......................•----........_.......... �. ... . ... ..
µ v _Installer Address
U Type of,,Building Size Lot___ 4 ..�:---Sq. feet
Dwelling�No. of Bedrooms._�..............................•.___.._.ExpansLio�n Attic ( ) Garbage Grinder ( )
Other—T e of Building _-•- No. of persons --_--------------- Showers ( ) - Cafeteria ( )
Q' Other fixtures
d - ---•------
W Design Flow r__•. ......................................gallons per person per day. Total daily flow............................................gallons.
GG 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...................................
aTest 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........................
�+ l ................•-•...............................................
ODescription of Soil ---- -•--- ----------------..............................................
W ------------------------------------------------------------................................................. ------------ ............................
U Nature Repairs or Alterati s— Answer when pplicabOe_ _ __ _____/-1 D-O O
`' ------------------------------------------•------------------------------..--------.......
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iI: =. 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate-of,Compliance has been iss ed by the board of-health.
Sig •-- .. ---................... .........................._....
• -
Date
Application Approved � .•.•................ -----• ....?./`���_
Date
Application Disapprove or he following reasons:-•-••--•----••--•••••••-••-•--•-••-•--•••---••••---•----- -•-•---••-••••------•--•-••...............•-----....:_
.....................•-------•---...-•---•-•-•--......----•--•-------------------._......--..•.
Date
PermitNo......................................................... Issued.......................................................
Date
Nov.—ay.— Fps............._............._
`y THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................O F.......................................--------------------..............._...............
Appliration for Dispaa al ?Forks Tomotrurtinu 1hrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
. .. :: ,.� ........ .. ---------------------------------------- -------------
Location-Address or Lot No.
..... .... ...� .... .. ..-----•-••-•.............•............. .. ..........................................................
a er Add s .........
F Installer Address
QType of Building Size Lot....
U o,,.,.._..Sq. feet
Dwelling�NNo. of Bedrooms___.................. Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons..../------------------- Showers ( ) — Cafeteria ( )
Q' Other fixtures ..-----....-••-•...--•-••......•• .
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
9 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........................
Gx Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
O Description of Soil....... ........ ......SP_? _._
---------•-------------------------------------••---....
x
---------
U Nature pair or to atio — swer when a licable -"fad Q
� � ••-
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 issuedby the board of h It .
---------------------- -----
Application Approved B .:,:. _1:.._..�-�
Date
4 Application Disapproved/le following reasons:-----•---------•----•-------------------------------•------------------------------------------------••••..•----
.............................•---•---------------------------............-----------.................------•----•----•--------•--•--•-•-•------•-------•---•---••••-••-•--•-•----•--••--•.........--_...
Date
PermitNo......................................................... Issued-..................-••-•--•-...-•••••......------_.....
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HE L
ZG ....................OF.... ...:. .... ..............:... ......................................._...
(Irrtifiratr of Tautpliattrr
T TP-CE IFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
b ....... . •.....
.................................... ---- ------ --- - --------------------------------------.------------•-------
r Installer
at ab -•--...--•- ,. -tat m r r ......• ...
has betiffled in accordance with the provisions of TI:L. 5 of The State Sanitary Cod a scribed in the
applica Disposal Works Construction Permit No-----
----------- dated_....__ e ._� ........................
THE ISSUANCE OF THIS CERTIFICATE,SHALL NOT BE CONSTRUED AS A GUAR NTEE THAT THE
SYSTEM WILL FUNCTION 5ATtSFACTOIZY.
DATE................................
inspector 1e "
.,, THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEAL H
f ...................OF......
.
7..
..,,.,, No...�' � FEE.... .............
Disposall urkii Tuuuir iuri rruti#
I -r�-
Permission is hereby granted..... ...... 4Z�
to Construct ( ) or Rep ( an Individ. Sewage Disposal System
atNo.... Re X---•---. ...............:
Street
as shown on the application for Disposal Works Construction Permit Dated...
... 1 .........
•------•--------•------------------------------------------------------------------------••-••••--..----
Board of Health.:
DATE................................................................................
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
SEWAGE PERMIT p0.
LOCATIOti � • .
VILLAGE
thST A LLER'S NAME 6 ADDRESS
Q OR OWNER
Jo O.Ll
DATE PERAAIT 1SSUt0
DATE COMPL1A. RCE ISSUED - -
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