HomeMy WebLinkAbout0063 ASHLEY DRIVE - Health CfAWV(fit
l 7z o 6S
S M E A
KEEPING YOU ORGANIZED
No. 12534
2-153LOR
SUSTAINABLE FORESTRY MIN.RECYCLED
INITIATIVE CONTENT 10%
Certified Fiher Souraicg POST-CONSUMER
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S4012M
MADE IN USA
^.c_T ORGANIZED AT SMEARMU
�_ r� L TOWN OF BARNSTABLE
LOCATION l,,"a_ SEWAGE #
VILLAGE '�`[����� ASSESSOR'S MAP & LOT/�--0 j
INSTALLER'S NAME & PHONE
SEPTIC TANK CAPACITY 14
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS 1-3 PRIVATE WELL O BLIC WATER
BUILDER OR OWNER V (?� f L,I o
DATE PERMIT ISSUED: /e29 v.
DATE COMPLIANCE ISSUED:
I VARIANCE GRANTED: Yes No
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33
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APPROVED Fxs..... ® ...
�t vN ron Department
THE COMMONWEALTH OF MASSACHUSETTS
�?nARD OF HEALTH
: DateTOWN OF BARNSTABLE
Alip iratilan fnr Di-lipwial lVork.6 Tomitrnrtiun JIrrmit
Application is hereby made for a Permit to Construct ( ) or Repair (X an Individual Sewage Disposal
System--
Locaat�'on/ \/d�drrss
Ad� lY�lV I"w e_r` � C IN /
._ .......................................... /� 3� 1 Sn��oIrAJGdd
ro $�Ns
O� �
.. w . � o. ---------...C!!t-J'V....�/i.C./..�........c
/L..t..t.
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling— No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Otherfixtures --------------------------------------------------------------------------------------...............................................................
W Design Flow............... ......................gallons per person per day. Total daily flow------------- ...........................gallons.
WSeptic Tank—Liquid,capa6ty_/ ..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 b Date........................................
,.� Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water--.__..______-_____-----
Li, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
R; ...................................... -------•---...........--•----•-•-•-------•----------..................................................................
0 Description of Soil............................ •-------------------------•---•----------------•----------------------------------------------------------------------------..........------
x
U .............................................. -•-•--•-•-•-••--••-••••••-•••-••-••••••-•---•-•-••-•••-•••••••--•••--••--••••-•-••--------•-••...•••••••--•--•---•••--••-•••-•-•-••••-•••-•---••-•-•--•---
w
x ••-•••----------------------••-------------••-.......--•••-•---------•----..._..-------••----•----•-----•--------------------...----•••-----•-•••••-••------••-••••-••--••-•••--•--•• _
U Nature of Repairs or Alterations—Answer when applicable._------.� �_--_-____ --------
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
y p p ' board of health.
S' •ned - --- -
Dote
system In operation until a Certificate o om lean has been is tied b� e� ��j�
Dare
Application Approved By ..............................:.............- . ..-.....--- -- .. ........��... t .:..
Application Disapproved for the following reasons:
b��
....................................................... - --_._......-.............---...-....-_-..----_.-----..------.--.-----__..--...--......--........................-'-....... ........................................[e
....................
Permit No. ........:........
Da
�' Issued ---- ✓.�'.-¢.. ......
q Dace
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Celr#ifiCa#E of Cnittlltianve
r
THIS IS TO CERTIFY,.-That the Individual Sewage Disposal System constructed ( ) or Repaired
by ............................................
at - - _........... ----------------------------- - -------------------------
has been installed in accordance with the provisions of TITLE 5 f The State Environmental Code as des ribed in
the application for Disposal Works Construction Permit No. .. ... ---_ ,1r. dated .; �-�...�.t '--_-.L
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE 60NSTRUEA AS A GUARANTEE THAT THEE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE....... -��' - ----------------- ------ Inspector ------._ --------- 1 ---------------------------
THE COMMONWEALTH OF MASSACHUSETTS /�c� — ,C3�
BOARD OF HEALTH
TOWN OF BARNSTABLE
No........f........./�" ;J FEE.-7C..............
Permission is hereby granted.............. a�CT0W-77 �!')- .5'-%-' ----------�--�---�------------------------------------
to Construct ( ) or Repair ( G) an Individual Sewage Disposal System
atNo................................................ ' S CE .`. t��, V C c' t
Street,
as shown on the application for Disposal Works Construction Permit N;/�-t.��-Dated----. 7`".-..;
................ c(/------ &5-- 'G .........................
l;a nd of Health /
DATE. /1 -� 4 /
................ •---------•--------........ t
FORM 38608 HOBBS&W4REN.INC..PUBLISHERS
d
No......................... FEs..... d............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Applirtt#inn for Diupnnttl Wnrku Tnnitrurtinn ramit
Application is hereby made for a Permit to Coristr uct ( ) or Repair (X an Individual Sewage Disposal
System-at:-�
Location-Address or t No.
-------------- -•-----•---------------...----....----•----••---•---
Owner Addre s
W a t a•rri �'J�Cn1 Ut/,V,,J 7(iS C�J c�Q�.._.._� ... /0, /W I u4S
,-I _---- --•-••--•-•------- --------------•--•--.............
Installer Address
Type of Building Size Lot............................Sq. feet
t-t Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Other fixtures -----------------------------------------------------
W Design Flow.... . ..-__---_-___--gallons per person per day. Total daily flow............�-���?..................gallons.
WSeptic Tank—Liquid capacity duo--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........................
fit Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a ----••-••----------------------------------•--•--•-••-••-•-•-----••---------•-------......-------•--.........................................................
0 Description of Soil........................................................................................................................................................................
x
U
w
UNature of Repairs or Alterations—Answer when applicable..--.-.--�:1�_-).--.-.-_--/0,491 'tiP__..__ ..1..?....__! �fr _Lr
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 - C. 1/� ."................... v/��®/.
,f Date
Application Approved BY ... . .1..�.................... -- ✓ ............. c Due
Application Disapproved for the following reasonr- ------------------------------------ /
-------------- ----------------------------------------------------------------------------------------------------------- -------------------------- ------------------------------------------------
Dace
Permit No. 91,x '� ` e^ / ^
...... ...:.. . ........ V/•�zyi` ........ Issued ..... ..-.../...... /.-..-Z-, _/-
Dace