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HomeMy WebLinkAbout0016 JACQUELINE COURT - Health l6 ct-n7*4rvf�� i 210 --178 a 110 FES.. )! C fMONWEALTH OF MASSACHUSETTS sio ® BOARD OF HEALTH TOWN OF BARNSTABLE App iratiou for Divi-puml lVor1w Tomitrur#tun matt Application is hereby made for a Permit to Construct ( ) or Repair �4 an Individual Sewage Disposal System at: ........ - ....... "i�!t1`T 'ILV� a'V ddress or Lot No. G ..--------•--------------------------- .........------.............--- ...... ...... r Address 96 -3 aze,s ► ,�� c�s�t�-�-c v,1 t�- Listaller Address d Type of Building Size Lot............................Sq. feet V 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. 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........................................ a ,.a Test Pit No. l----------------minutes per inch Depth of Test Pit-..------------.--.- Depth to ground water..--.................... (i Test Pit No. 2................minutes per inch Depth of Test Pit--.------...---..... Depth to ground water.---................--.. 04 ----------------------------------------------------------------------------------------------------......................................................... 0 Description of Soil........................................................................................................................................................................ W U ---•--•-------------------------------•--•---------••--•-----------•-•------------------------------------------------------------------------------...---------- ...................................... 0 Nature of Repairs or Alterations—Answer when applicable.-CL za'T -------C:),4_% !a✓ --------0",tA ------.vc-' i-&VL+� 5. ......- i -l-tom`...------- -----= 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 Co Nance has been issued by the board of health. Signed ...... .. -.�--�. .... ........................_-------- �............................ ..®....-....-.............. Date ApplicationApproved BY - :----- .Q...... .. . . . ........ .......... . ................ . ....--- - ................ Date Application Disapproved for the following reaso s- -------------------------------------------------------------------------------------------------------- ------------ .............. -- -- .. ......... ................................ . .. .... - Dare i T Permit No. ................ . . Issued .............. [�.. ....------------ --------- Date t TOWN OF BARNSTABLE LOCATION 14 v SEWAGE # VILLAGE ASSESSOR'S MAP & LOT,-2 INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) Y xl b NO. OF BEDROOMS y PRIVATE WELL R PUBLIC WATER BUILDER O OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: Q C�qy .VARIANCE GRANTED: Yes No 33��`' I3 fq LOCATION SEWAGE PERMIT NO. --or-* 16.. VILLAGE 1NSTA LLER'S NAME i ADDRESS f UILDER OR ow�tfR G Swr�r DA T E PERMIT ISS Y E 0 o DATE COMPLIANCE ISSUED °� l f r �� ? a THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TO�WN OF BARNSTABLE l THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( �� ) N cue �`e -------mow-s� by ..... - -- ----------------------------------------------- - .... - - ....................... Instal let l b tea.,-*-u-oJ.4�........ -----------.._.---_�.----. �. ----1 I - i has been installed in accordance with the provisions of TITLE f The State Env,- onmental Code as described in the application for Disposal Works Construction Permit No. .. ..."' " �rr _ dated ..... ..:. ��.1�'._... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTOLW6�AS A GUARA TEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..........� '' !' --.... - - Inspector . ' �_------------------------------- 1 f {•, r- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �jC TOWN OF BARNSTABLE No.................... .... FEE... 1 Permission is hereby granted_.._. � ........�'t?�?...................................................... .............................................. to Construct ( ) or Repair ( Z'7 an Individual Sewage Disposal System i at No.----,-L------••--KA, v4_L...�------C°O...........................................CCn�i �2 ......................................._/._..__r..... Ile Street as shown on the application for Disposal W rks Construction`Permit No._-*;/-, _._•__ Dated..r__. ...!_..._N�... _.. - ?.r--mot ,-t .................. BoaKd of Health DATE.................. ----/•-: -----;---•--- FORM 3830a HOBBS 6 WARREN.INC..PUBLISHERS 1 II, No.................,...... y �0 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF -HEALTH TOWN OF BARNSTABLE App iratiun for Uiupuuttl Works Tougtrnr#iun ramit Application is hereby made for a Permit to Construct ( ) or Repair kl:;,) an Individual Sewage Disposal System at: ..11z........ .©y �.>�. -------Co vt-'�" C �y v� !1 i .-•--••. .......................... r� Location-Address or Lot No. � l '�x�ci `---------------------------------------•---- --------------------------------------••••-•.......-••------ •------- ._..._. ..t..............._......._....... Owner Address a HNC f- `c C°4V•� '�z©s. �r �'`` C�SSL=,-r_v 1 t C7 IustalIer Address UType of Building Size Lot............................Sq. feet .� Dwelling— No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons.--.------.-----..--_------- Showers ( ) — Cafeteria ( ) d 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 ( ) 0-4 1 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..--.....--............. 0 a •--••---•-••------------•----------••--•-••••-••--------••••-•-•--••-•----••••......---•••----------......................................................... Description of Soil....................................................................-----•----------------------------...---------•----------------------------------•••...._....••--- x U ----•-•--------------•--•-----------------•-- ---------------------•--•------------------••-----------------------------•----•--•-------•-------•-------------------------...._............----•--•--••• W ------------------------------------------------------------------------------------------------------------------------------ U Nature of Repairs or Alterations—Answer when applicable.-CZ ,L�c P,TL' --.-.E?�l S;_iw�._...... tT7cr. 1w, ....... -..__.. 1 ......11.. �.�cic YS..... _.....- .}c�S .......... Z .............................................. 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 Corrp fiance has been issued by the board of health. Signed - ^. -----^--------------------------- .................................:.----- ..... j ' � Application Approved BY -:. --.....�"-/+���-......... .-i--- .. � Z/( , .............. .... Date Application Disapproved for the following reason --------------------------------------------------------------------------------------------------------............................ ...... .........---, r.......; - -..... ...... . . .. ��„/� Date Permit No. ............ ---------------------- Issued .......... r....Date' ------------- r � �