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Home My WebLink About0127 DONEGAL CIRCLE - Health 2 000`911 C 8n-r-crv►)le 16 9 - 0 33 r F TOWN OF BARNSTABLE t-ci LOCATION jaj ►DOAJP-(�,1-1-I SEWAGE # 77-Z '70 VILLAGE dPh1•74eXU 1 ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. Pe.4e-t1 6A Aj 9Pm( SEPTIC TANK CAPACITY 16�U o LEACHING FACILITY:(type) (size) /Oct NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER. OR OWNER �iQ ( ! � �it9C DATE PERMIT ISSUED:f 12 DATE .COLIPLIJkNCE ISSUED- 7 - 8 7 VARIANCE GRANTED: Yes No y-. � � �� .� n ., . �� ,� °� ��, _J ASSESSORS MAP NO: PARCEL NO: Ficic....2. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -------*-------- - -------------------OF......................................................................................... Appliration for Disposal Works Toustrurtiou rumit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: - ..)U 4 ...... ....... 0 ...�tAl..........Olt....................... .............. --------- ------ -------------------------------------------------- Location-AddLess or Lot No. O,,1 ............... GA AVj -------------------------------------- ................................................................................................... t, ( ..r Address ...............?-!�_ ...9� -------------------------- .................................................................................................. Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms ................................Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons...._................__.__.. Showers Cafeteria Other fixtures -------------------------------------------*---------- ------------*-------------------------------*---------------------------------------*--------Design Flow..............33.0.................gallons per person per day. Total daily flow---- ......................................gallons. Septic Tank—Liquid capacity............gallons Length................ Width__............._ Diameter________________ Depth......._......_. Disposal Trench—No. .................... Width.................... Total Length__..........___._... Total leaching area....................sq. f t. 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._...._____.____........ P4 ...........................................w................................................................................................................. 0 Description of Soil......................................................................................................................................................................... W ......................................................................................................................................................................................................... U ........................................................................................................................................................................I.. ........................ U Nature of Repairs or Alterations—Answer when applicable.______.AL------le-e-jo------jak-------1,eX---------------------_ ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed In' dividual Sewage Disposal System in accordance,with I the provisions of TL IL Ti 11 2 5 of the State Sanitary Code—The undersigned further agrees not to place the syst t in in operation until a Certificate of Compliance has been issued by the boarpf,health. Signed........... .......................... .................... Da!e71;, ,,, Application Approved By........ .... ................... ........... Z --------- ------- Application Disapproved for the following reasons:...................... ............................-------- ............................................. ......................................................................................................................................................................... .........------------------- Date ite PermitNo....... ------------------------ Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .................... ..................O F............................-............................................................. App iratinn for Disposal Marks Tonstrnrtinn Frrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .......�. c�_.1�e ?_ ...l.-•-•---•- .�V.=••----------••---------- -------•--- .................................................. Location-�Vress ..........................................or Lot No. y4( ii Owner Address -'-•••......--••--'........ .......•-•-......•••""......•a ------------------•---- Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms._......................................Expansion Attic ( ) Garbage Grinder ( ) P4 Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fiLxtures _________________________________ _ W Design Flow............... ___3..-a..................gallons per person per day. Total daily flow----_.......................................gallons. c4 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter___________._.__ Depth................ 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 ( ) 1.4 Percolation Test Results Performed by-'--------------------•-'---'--'---'.._...-------------------•'--••-_.... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water.........._............. �14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' •-••----•----•-•------•-•...............................•------'----•'-.........------------._....--......................................................... 0 Description of Soil....................................................................................................................................................................... x W x ------ -------------- -----------------•••--...---••------•----•--•----•••••---•••---"•'-••-••--'•----•-•--•-•••----•-••----•-•••---'•-•--_...............--•---••--•-•-- V Nature of Repairs or Alterations—Answer when applicable------ -:...-_-/��' ?---U-�s .------ -'� .................•...... - ..--•--••--•---'---•••••••-•---•-••••-•--•-•---•----•-••'•-••-•-•••-•••---••-•'-•-----••--•••---•---••-----•--•-•---------------------'----•-••--...---•-------•-•--•--••-••-------•-•----'--•--"•---•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT-1 '- of the State Sanitary Code—The undersigned 'further agrees not to place the system in operation until a Certificate of Compliance has been issu d by the boarfiof health. Signed...........:�,..r ,J=}= ----•--------- ----------------•----••-•---._.. /F Date Application Approved By....... °ate r --- - -�--�_ j-•--'........................................ --•--'......---'-...Date......-----•.. Application Disapproved for the following reasons_____________•______._____________._.___.___________.._.___________..__..________________._.___________.._......_ -•••-•-------•-•----•-•-....-----'--------•------------•--•'-'•-•------•------•---•'--.......•------------------•-____...-------•-----------•-----•-•••-'•--'-•-•-'•••---•------•--••--•--••----•-•----- _ Date PermitNo......5_Z:.__ 2_ ......................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1 t�(1 Tnrtif iratr of Trrntpliattrr THIS I� TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired J by------------_-•------e-L G'....? *....., -----------•-----------•-----------------------------•-'----•--....-•----•--•----._...----------------__._.....------''------•-'-'- J �, � Installer has been installed in accordance with the provisions of T T"E �of The State Sanitary Code as described in the application for Disposal Works Construction Permit ............ dated------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......................... -- _-.�5_�............................ Inspector........ --------------••-•---•••--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ,} /.. :Z' "-•-':.......OF......... r: '?:Y.'+ K .1 ..................................... N0.4 FEE........................ Bisposal Workii Tonstrnrtion , rrntit Permission is hereby granted............ ..... .-••...............•--------••---...---------....---.....----•--- to Construct ( } or Repair G\X� an Individual Sewage Disposal System atNo............................................................................................................................................................................................... Street S as shown on the application for Disposal Works Construction Permit No. %3,,9 .. Dated......................................... -••---------••-• - = - - R -- ----------------------- II DATE................................................................................ Board of Health FORM 1255 HOBBS & WARREN, INC., PUBLISHERS