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Home My WebLink About4441 MAIN ST./RTE 6A(BARN.) - Health 4441 Main Street y A=356-002 . Barnstable ' � � o a o o . 4f THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /�lop ...... Own.........0F. .. of �k.--------------------------------- 441 ppliration for %yoottl Workri Tonotxnrtion Prrmit plication is hereby made for a Permit to Construct ( ) or Repair (L_} an Individual Sewage Disposal stem at: Loc i .Address or Lot No. r12qx�))CA, ..'�t.................s.....--.... ......... .. ....--•---------....------------ ---------•--•-----........-----......-------- Owner Address ------------------- Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ............................ . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic 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........................ f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---•------ -------•- ...................... ODescription of Soil---------------------------- � .... -- - - - -............................ x W ----•-------- ---------- ------ -- --------------•-------------------•--------------••-•--------•----•--•---•-----------------•----•-- ------ ............................ . V Nature Repair r Alteratio s—Answer w ica e..... _ _ Q-O-_. � __�C?�i_. ..... ._�..._. . Agreement: The tin ersigned agrees to install the aforedescribed dividual 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 ben issued by d e board of health. ,F J Application Approv ..._ --_ _ to Application Disapprove r ollowing reasons: ................... ......................................................................................................................................................................................................... Date PermitNo--------------------------------------------------------- Issued-....................................................... Date I FRic THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............I.0,W.,0.........OF...:..t � ` ....................................... Applirtttiun for Diiivuiittl Mirkii Tunitrnr#iun Frrmit - Application is hereby made for a Permit to Construct ( ) or Repair (L,.)- an Individual Sewage Disposal , System at ......... ............................... __...-•-----•-----•-----•................•. --....--••--•-•---•-•---•-••-•---...... yy� Loc t?bv Address or Lot No. ----•----•-•----•------•--•------ ...................................................... n. Owner Address a � t �` f'' C1. '?_; . ' C:..... ........r� .: �'€ .... ----------------------------------------------- Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ---------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W Septic 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........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....................... O Description of Soil .yo. -------------- ----------•------------- x W -----------------................................................................................................................................ ••-- f.... U Nature of Repairs or Alterations—Answer when applicable.......... j 'Jf�1.. __. .. ..: ....�..... QE --------------------------------•--•-------•----•----------•--------------------•-------............---•----•-••------------------------------------•-----------------------------------...........---•- 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 b en issued by the War of health. Vd ,t r� Application Approve ---- -----• ------. ............................. ............................... - ate r '... .. D e Application Disapproved t owing reasons---------------------= .........-•--••-----------••-----••-•-------•------•-------------------------•--••---•---------........------------------------------------•----...••--•----------------•-••-•--•---------•-•---•---•--- Date PermitNo......................................................... Issued.......................................................... Date THE COMMONWEALTH OF MASSACHUSETTS 6,2 �ta/ BOARD OF HEALTH =`t . 3:: �rrtif irtt� of f�um�rlittnr�e , THIS S O CERTIFY, Th t the Individual ewa e Disposal System constructed ( ) or Repaired ( t�-- y- z. I taller �-� o!' i"r-� has been installed in accordance with the provisions of TITL�E " of The St to Sanitary Code44f scr' the application for Disposal Works Construction Permit No....... "'l/�__. dated.__ . . _.. t? - / � THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM W14 FUOiCTION SATISFACTORY. DATE...y .. ... .................................................. Inspector--- --- ------•--------------------------•---------------•---------••----•-•-•-•- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .A�� ......... . ............OF....� . F?� 'sl&-bk................................. No. FEE /.. ... r. T Disposaty�Works Tono#r ion ra-wit Permission is hereby granted-�-`-•/.=----•-. ............................................ to Construct/ 1. ?.�..or g(.� r(:� In divi � .Sela�ae i o System l r at No.... L 1� l� Street as shown on the application for.�;Di'sposal �t�orks Construction Permit No........... ..... .. Dated.......................................... D EIY. .. Board of health AT ._ ••_••---•-- FORM 1255 A. M. SULKIN, INC.,.BOSTON