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Home My WebLink About0012 DUNCAN LANE - Health (2) 12 Dc/ncan Lq ne C Q��'ti�'vi Ile I�tJ - Qz5 .` - . TOWN OF BARNSTABLE .^• LOCATION �V� •& SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. 'Y �v SEPTIC TANK CAPACITY CJ . LEACHING FACILITY:(typC-��7 (size) Zl x NOrOF BEDROOMS OWNER PERMIT DATE: 9 COMPLIANCE DATE:. ,�Zd� Separation Distance Between the: Y _ Maximum Adjusted Groundwater Table to the 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 exi within 300 feet of leaching fa ity) T Feet FURNISHED BY �/eq j , J ` fl•b cr `1z317 ° i. I OWN OF BARNSTABL�E�� ,LOCATION 12 ';Z�g-Pa LyJ SEWAGE # 9S- (� � VILLAGE ASSESSOR'S MAP & LOT/ /� INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY 1, 000 LEACHING FACILITY:(type) 2 V3 -(size)_ \ pOU NO. OF BEDROOMS PRIVATE WELL s';' PU LIC WATER BUILDER OR OWNER Y\N*,4W '"\IU V ��--- DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes _No I `bt �K �l 1 9A No..�.....C�.. I Fns ................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH' Appliration for Disposal Works Tonstrartion Errant Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: ;. --------------------------------- ------ Locatio Address - o t No. tLL Owner Address W `J_... .. .L� ................................................• - ?6 - -; 0.�1 i`£y----------------- 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 ( ) 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. 3 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. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-.-_-___-______-----__-. Pa' ----------------------------------•------------•------------------•------------•-----------•----------•-------------------------•--------•---•-------------- 0 Description of Soil........................................................................................................................................................................ x V ---------------••----.-----•-•---------------•-----••----------------------------•--------------•--•----.------------------•--•--------•---•------------•-------•--------------•----------- ---••- •-----------•----- ----------------------•-•-........---------•----------------••-•----...----•-•-----------.•-•--•.----------------- V Nature of Repairs or Alterations—Ans. er when applicable-___-*—%'>1�,__._____ 1-► 00 r--••• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TT T I Z 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance een issued b the board of h th. _-- _Si ned 4- •. g o/D�/ � 9 Application Approved B -_----- �j`H ------------........ Date Application Disapproved for the following reasons:--•----•-------•------------------------------------------------------------------------•-..................... --•-•---•••••••-•-•--•---•-•-•••--...••••---••--••-••---••••••-•••-•-•-••--••-•-•.............•--•--••-•-•••••••••----•---------••-•----••••••-•••----------•••--••••-_...-----•-••--------•••-•-•------ _ Date Permit No......................................................... Issued........ � D;.te r THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ! UJ- ..............oF.... '.� v�-� '�- .................................... Appfiration for Disposal Works Cnnnstrnrtiun rumit Application is hereby made for a Permit to Construct ( ) or Repair ( � Individual Sewage Disposal System at: lLLocatiop, Address d--ress r1�..,..a�w�X�`.. 4-NI--•-f�'� :� --- ---------------------------------------- ------ ------_ --------------t-....:'-o.-�---L.o-t---N--o ...- .•.•.-.-.-.-.-.-.-..-.-.---•----------------------------------....... fOwner .. ?6 � Address -V ........................................ J 15w1 . Instailer Address --•--------- UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a Other—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............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-.-__-_--____-__--_._--- ._ fs. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_____-_----__--___-_. 04 ------------------------------------------------------------------------------------••••----------------------------_---------------------------------------- ODescription of Soil......................................................................................................................................................................... x U ----•----••-•-•--•-•--••••••--•------•.....•••-•----•••-••••------•---•----•...••-------....•---••-•-•-----•---•--•-----------•-••---------••--•------•............................................... w Nature of Repairs or Alterations—Answer when applicable..._..13 , U6:D______ AK._--•--- �.......ai( P� ...... •------- --L.-!.. .-�-.�------.S-�S?F: -------------------- Agreement: " 7 The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with . the provisions of'ITi.% p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance een issued b ,�the board of he th. 1 -__Sigrle .. C=�' k�. Y.. Application Approved By � ��_._fr.--------------------------------------------------------------- •------- PP PP Date Application Disapproved for the following reasons:........................................................................ ----•••••--•--------------------•----- --......•••---•----•----•----••--------•----•---...-----•--....---•-•------------------------••---------.-------•-•--....-----•-----••----------------•-•--•-•-•-•--•-----•---------------•------•...__. .. «. r Date Permit No-------------------................................` . t...•...... Issued------.. `��` ---------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............O F.`'KS- 775� .` .'�s� ......................................... 01rdif irFatr of TuntpliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by . �11\1J---1A kC_\C_...� •--•--------------•--------•--- _-- Inst Ilex has been installed in accordance with the provisions of TITIE 7 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated_...-----_--...--_____.----.____�_._...._._..... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-----•......•----....1l..-....I_- :._¢ ......................... Inspector---------------------- ...................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................OF..�3trJ `?nrS,--............._......................... -� NOZ5.................. FEE..... .= ..... Disposal Works Tnntrndinn autit Permission is hereby granted----- --------�� \--<-•,---•------------------------------------• - ......... ---------------- to Construct ( ) or Repair ( f an Individual Sewage Disposal System Street as shown on the application for Disposal Works Construction Permit No�.........:%r_..1. Dated........7s}__ "tJ.......................... Board of Health DATE j ......................... `,FORM 1255 HOB S & WARREN. INC., PUBLISHERS