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Home My WebLink About4360 MAIN ST./RTE 6A(BARN.) - Health `Yha �S b o �,,►�sal � o , p ,I {,NI 'I A Ili II i !Y a 1 1f 1 i f I 1 1 R No....l.....�� FEB.....`,.> ..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ApVftralivu for Uiinpm ttl Works Tomitrnr#iun rrrntit Application is her bey made fpr a Permit to Construct ( ) or Repair (✓) an Individual Sewage Disposal s -J...- = cam... Locaoio or Lot No. Iddress ° U Owner dr s _r"taller Address T of Building Size Lot............................Sq. feet Dwelling—No, of Bedrooms...... ..............................._-Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building _ _ ___ _ __ _ ____ __ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures -------------------------------------------------------------------------------------- -------------------•------------------•------•-••--•-------- W Design Flow...........14AP.......5.5-------gallons per person per flay. Total daily flow.........................4_q.gO........��Ions. WSeptic Tank—Liquid capacity.J$�2_gallons^ .Length-9-6_-.---- Width_..'__-5----- Diameter................ Depth...7._........ x Disposal Trench—No. ........I.......... Width-_.__1-------------- Total Length---*32,5... 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........................................ a Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ fT Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ j-----7--- p ---•�----D- ------ Description of Sotl- --• -"� 'O ,t'Qr -- - ---t.C�4....4M x ------•. w ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -- U Nature of Repairs or Alterations—Answer when applicable---c.:_F,4 aC t...Q. ........................... 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 been issued by the board of health. a ' �n n n Signed ... .�p .... ----------------------_-- ----- 3. Dace Application Approved BY �----- ..-.,�Da.te .. 4�.... Application Disapproved for the following reasons-...... ------------------------------------------------------------------------------------- --------------------------------- -------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- ...-..C./ -lam ........................................ Permit No. ' -(..', d............. ........ Issued .........................................................ice.... Daze No.... ..._._.... /Fn z THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for Mit-poml WArkii Tunutrnrtiun Prruld Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at ir � f Locat�iof�s \ddress =n or Lot No. Owner � dr ss W Installer Address T of Building Size Lot............................Sq. feet ..� Dwelling—No. of Bedrooms--__;-y----------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building !I��u1 Cafeteria -_ No. of ersons----------------------_--- Showers — ( ) a' Other fixtures . ..._.... P W Design Flow........... _. ......5.......gallons per person per day. Total dail flow-------------------------ei_9Q..._....gallons. WSeptic Tank—Liquid capacity_ C gallons /Length q__5_�.... Width-.�_*tom-_ Diameter-....._..__.... Depth_._......... x Disposal Trench—No. ........�.......... Width.._ �------------- Total Length__ 2:•5_-_- 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. 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........................ ? -------- -----------i••-5•---i---------- - - ---- .,---- a -- pA. ... 2._-�a...4------- Descriptionof Soil • U V ....••-••-•••••---••••---•-•-••-•-----------•-•-••--••------------------------••-•-•---------••----••--•••------••-•---•-•-•--------•--•-••-----•---....-•------•••••---•••...........-•-••----••-.----•- W .............................................................................................................................................................................. ....... U Nature of Repairs or Alterations—Answer when applicable.-__- _-atLt...Ur _ fi.Q ... 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 been issued by the board of health. Signed ... .d�C t Q... .� XM- -----61 31----- .--:...... a Dare Application Approved By ........... ........... ................................................... ..-: .r/...... Dare Application Disapproved for the following reasons- ---------------------------------------------------------------------------------------------------------------------------------- .........................�------------------.......-...--------------.......------------------------------------------- -----------..........................---------- --------------------------------------- ''� Dace Permit No. ..... ( 'nr----------------------- Issued . ......................... ........... . Da,e ___._______.______.__.__--- ____.___—_—_ ---___._—__.__ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Tiertifirate of Cant lianre THI S TO C IFY, Pat the Individual Sewage Disposal System constructed ( ) or Repaired byMu....C...(N11 ..........................--------------------------------...-------------------------......----------------------------------............-----------------...------- V � Insaalcr at .--- 3.�.�. i�' �E: M---------------------------------------- --------..._._---- _..._------- -----------------------------.....---------._........_...--------------------------------- has been installed in accordance with the provisions of TITLE U5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ...l.. .- -a.r----------- dated ..--------_..__...._-------------------_. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--------IC---------- ------/9- -------------------- Inspector ...------- ..........._.:...:- -------------------------- ------------------------------------------------------------------------- I I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH (� TOWN OF BARNSTABLE No.....!..��OC� FEE3 .......... Disposal Vorkp Tun_ntrudiun "amit Permission is hereby granted M,t1 -----•--------------------••--... to Construct ) 9 epair (� a'fr Individudewage Disposal System at No.--•-�3 � � --6 A-•--•mS ,-- (?�' Street as shown on the application for Disposal Works Construction Permit No.k-33--- Dated_--___ �._r.._ .-.._ .y.... -------------------------------- �1 . \,. IBoard of Health L V DATE-----•-------�--`---��---�•�-- ---------------•--•-----------._....... FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS