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HomeMy WebLinkAbout0126 DONEGAL CIRCLE - Health 126 DONEGAL CIRCLE, CENTERVILLE A=169-084 , �1 1 i �I I .Slil ® c�� IN 3 UPC 17534 No.2-15 CORD,, KASTINGB.YN No..... .� .� THE COMMONWEALTH OF MASSACHUSETTS BOARD .OF HEALTH TOWN OF BARNSTABLE �ppliration for DloVoottl Workii Tomitrurtion ramit Application is hereby made for -a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: --------------- *m...----------------------...--•---------------------•----•----.......---•-------•---- =tion-Address — or Lot No. .•.... -� ------ ----- - --- ------------------------ ---------------------- �yff� `............ .. . er Address ... , . ustaller K � Address � T f 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. 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........................ L% Test Pit No. 2................minutes per inch Depth of Test Pit---------.---------- Depth to ground water........................ 04 -----------------------------------------------------------•-----.........------------------•....---.............................. ....... --••-------- 0 Description of Soil.......................................................................................................................----------------------=------------------------. U --•----------------------------------------------------------------------------------------•----------------....._..--------...------...----------------•---------------------------•------------------- ----------------------------------------------------------------------------------------------------------------- -- ---- ----------------- --- ................. ---- --- -----.. V Natur f Re airs or A tera ' ns—Answer when a able.___ ------------ _ Agreement: ' The undersigned agrees to install the aforedescri ed 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 yste on until a Certificate of Complian e has ben issued b the board of health. XSigned . .._ . -----..°------------------------ -- -- -------- .......................... --------'-tJ Dae Application.Approved BY ' ----- - ~ ..L........�... +5 Dae � Application Disapproved for the following reasons: ..................................... ........ -------------------------------------------------------- ------------------- ------------------------------------------------------- -------------------------------------------- --------------�----------------- qJ ce Permit No. .- l -'517--------------------------------- Issued -----------------8L .�...L...:-.fir. - ..._... Dace No...... � VFE19 ......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Ap.pliration for Diipn!ittl Workii Tomitrurtion rantit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ....../Age.. .. r. -1� � al-4. ` ----•----------•--------•---•••-------•.................•-•-------•.---- c II !/ lion- Address - or Lot No. -L-r� -- ................` .._. ...-- --- -- - ..................•..... -----'-----'------- ""'.__........___....._......................... ner � Address �j� 1 nstaller ��j f�� Address vT f Buildi Size Lot..........................•.._..Sq. feet Dwelling— No. of Bedrooms---- - ------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons.--.----_-.-_-__._-_--..-.-- 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 ( ) Percolation Test Results Performed by-------- ---------------•-•--------------------------•--•----•------------ Date........................................ W Test Pit No. 1----------------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................... 9 •-------••.............................•--•-----------•------......__....-----------.._....---------•--•-----------........................................ 0 Description of Soil----------------------------------------------- ................................. ....... ------------------------------------------------------------................. x vw ..•-------------------------------------------------------------------------------------------------------------- --- ................ �.. Nature f _e airs ®r A terar ns—Answer when a cable...__ - ' � &------------- •---. ------ --- -------------------- -............................................... Agreement:The undersigned agrees to install the aforedescri ed 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 X yste on until a Certificate of Complian e has be n issued by the board of health.Signed .......... / - � .-- ---- - - Date r Application.Approved By ------ ------- �.... .--.-..-.. ..e. .,..z..� ------------------------------------------------------------- ....... ..............5 `J Dace Application Disapproved for the following reasons- --------------------- -------- ------------------------------------------------------------------------------------------------------ ..........................................................�..............-...-....-..---......................................--.....-..-......-......------------------..------_.-- .----- -----...........Date.................. Permit No. . ....�-...':> ., Issued -..--. . .. ..-. .( I`�----------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Tomplianee THI' IS T CERTIFY, That e Individual Sewa e Disposal System constructed ( ) or Repaired ( ) by ----- :. ---- ----------- // Insrdler at ._......_-------la-L6........ ----- r - , ......................... ..._------------------------------------- ------------------------------------------------ has been installed in accordan with the provisions of TITLE 5 of The State Environmental Code as described in- the application for Disposal Works Construction Permit No. ..... ��'-.��. ----------- dated —,�'o- ;—?/ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE------..-._.---------------I � . ..........�.r:._...:..-r.-I... ............. Inspector -----...... ----- - -------" `---- ---------------- --- --- �J t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No TOWN OF �s ��I 7 BARNSTABLE FEE......- i� ntt f' nrk,9 Can from' n "rrntit Permission is hereb ranted.. _ Ito Construct �o epai (� &vidu Sewage sposal System ------ Street q as shown on the application for-Disposal Works Construction Permit No.-IU--51-7 Dated. .. . . " . ......... - ------------------------------------------------------ G' Board of Health DATE-----•--------------------e:.?--._r��.__::1.. ------------------•-- FORM 36508 HOBBS&WARREN.INC..PUBLISHERS "TOWN OF BARNSTABLE LOCATION (Z, } 1 SEWAGE'# VILLAGE � - D 8 ASSESSOR'S MAP.& LOT INSTALLER'S NAME&PHONE NO. �oZ SEPTIC TANK CAPACITY G©U LEACHING FACU.=: (type) (size) 1 NO.OF BEDROOMS - ` C BUILDER OR O R PERMUDATE:� a�L_COMPLIANCE DATE:�I j -1 b — Q 1 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility.. Feet j Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet j Furnished by C ' TOWN OF BARNSTABLE /.C, LOCATION ,z SEWAGE # VILLAGE ASSESSOR'S MAP & LOT & D S INSTALLER'S NAME&PHONE NO. L SEPTIC TANK CAPACITY ®� LEACHING FACILITY: (type) I (size) roL— NO..OF BEDROOMS BUILDER OR O R _ - PERMITDATE-- COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 4L CL ' f . b F-<