HomeMy WebLinkAbout2440 MAIN ST./RTE 6A(BARN.) - Health �� oo
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THE COMMONWEALTH OF MASSACHUSETTS
APPROVED BOAR® OF HEALTH
8WM8b1$Cw=n0fiQ30MMRCM TOWN OF B A R N S T A B L E
nr i►ipniu1 Hfurkii Tutuitrnrtion Permit
Application is hereby made for a Permit to Construct X or Repair ( ) an Individual Sewage Disposal
System at•
.... 4-------(3... X 1� ovh �c��......53' fti.�f � 1 .............•-•-- ---.----.--......
cation-Address i or Lot No.
Owner Address
-------------------------------------------------
nstaller Address
UType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms....... -------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons------.--------------------- Showers ( ) — Cafeteria ( )
a' 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.
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.......--...............
GZq Test Pit No. 2................minutes per inch Depth of Test Pit............----.--. Depth to ground water........................
a ----••-••--•------------------------•---------••------....------------•••.....................------.........................................................
0 Description of Soil........................................................................................................................................................................
V ...............................................-...............................................................................--........................................................................
W
x ------------------------------- r: ..............................
0 Nature of Repairs or Alterations—Answer when applicable......U_P&R. S.E-------7-0.....��. _L6..�..�..
-•------------------•--••-•---•----------------------•••---•--•-•--•••••-•-•--•----•---------.------------------•.....--.....------------------------.......-------••--•-•--------------................
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 Compliant as been i sued by t e board of health.
Signed ...... ... -- ...... ..........................:.................... ..................................I......
Date
Application Approved By .............c� .... ..._................... ,.�. ..
Du e
Application Disapproved for the following reasons: ...................................... . .................................-- ........ ...................................
......................................... ....... . . . ...................................................... .............................. . ..... .I................. ........................................
Date
PermitNo. ----------7-3---- .,,�` .3.......... Issued .............................................. ....................
Dace
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NO-1 3 ....
- THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
fir t on for Di!i~ niui Wi arkii Tontitrur#inn ramit
Application is hereby made for a Permit to Construct (X) or It pair ( ) an Individual Sewage Disposal
System at:
�vo llaj�t s7� ,� �fa4/ ,
--..n2........................... _--- --• • - -�I/l__........... •-•• •••---•-----------•--- •---- ---•_-•• ...-•-•--•----•--•------••-
---- ----- - - -
----------- ---
C, O pcatioti-Address or Lot No.
r..... _.... �._._e1_m-------------- --_----------------- ------------ �?m ..........................................................
Orcncr Address
ae�l -------------------------------------------•-
nstaller Address
UType of Building Size Lot............................Sq. feet
..� Dwelling—No. of Bedrooms._-____,3-_________________________ -----Expansion Attic ( ) Garbage Grinder ( )
Pk
Other—Type of Building ________________________ No. of persons............................ Showers ( ) — Cafeteria ( )_
d 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 ( )
.a Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I................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........................
P4 •---•---•........................•------••--------------••------...•----•••••-•••-•.....--••••-------••-•••-•-••••-•-••----
DDescription of Soil........................................................................................................................................................................
,x
U --------------------------- --------- -----------------------------------------------------------------------------------------------_---------------------
w
V Nature of Repairs or Alterations—Answer when applicable..._U..P6R.A_.D_F._._.._ ._.___7�.7 _ ? .. .
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 Compliant has been ' sued by [he board of health.
Signed .... - ........................................ .......................................
Dare
Application Approved By ...............
..... - r.�. ..+e�..,\. .. ....
J Dace
Application Disapproved for the following reason . . ...... .... .................................................................. ..........................
- ..... - - .... .............................. .......... .... --...... -.......................................................
_:.-..
�^- � Date I
Permit No. T �... '`7................................ Issued .. . ---------- ......... ...... ---
Dace,
, —® —dam.--------— _ — -
1
7d THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
C�er#ifirate of 0111ntttpiinure
THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by - ..- 1N .�.A�. _ ------- p......_................ ........ ....._ ...................-..........
..r
J.- - -
..._. h,;die.
at ............. u.a.. ----...M .r t,�i.............. .'t°:-.........oQ�tllt�l. ..... .. �.- .... .- -- - ........ ... . ............... ............
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. -._�3.-._M��� ._.... dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU5P AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE _,1... ..' -J... .. .. ..... ..........._.._.. ....-. Inspect .r. - •............. ....... ------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Permission is hereby granted-------- \.�e?*e...._.�C'A_ ,�!e -X. ."---------- ------------------------------------------------•--•----..._.............
to Construct ( ) or Repair (x) an Individual Sewage Disposal System
Inm f`a• �r e c,c J—N.-------------------------•----------------------------------.._......_.......
Street
as shown on the application t t y for Disposal Works Construction Permit ____________ Dated_._.__._.-._��._.�._y..__
Boar Health
DATE:............. - �'A ��-----------------._._.__..------_.....
FORM 36508 HOBBS at WARREN.INC..PUBLISHERS
TOWN OF BARNSTABLE
LOCATION c L Q% %l,�i���M�ir SEWAGE #
VILLAGE _ ASSESSOR'S MAP 6 LOT Z ti 7_6o 1
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY �.521zhd?—
LEACHING FACILITY:(type) , — ® (size) vO
NO. OF BEDROOMS PRIVATE WELL OR UBLIC WATE ,
BUILDER OR OWNER , o
DATE PERMIT ISSUED: ��p
DATE COMPLIANCE ISSUED•
VARIANCE GRANTED: Yes No l/
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