HomeMy WebLinkAbout0025 KALMIA WAY - Health 25 KALMIA WAY
CENTERVILLE
I..
No.....�?.l...... �/ Fss.....7 .....'
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
10.WA.......................OF.....7B.A.CG.t45 L&.----------......---..__..._.....----------
ApplirFation for Dhipati al Works Tonstrurtion Frrutit
Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual Sewage Disposal
System at:
....... ........V .�� A........W�- ......................... ............................................ ....................................
cati n-Address or Lot No.
......... CO..: ....... ...!�:-x... . --••- 0_4c .....................
a �115C1�Ownr Address
. ....
-------------------------
Installer Address 23 �t"J'
.< Type of Building Size Lot____--_.__�_ ________Sq. feet
UDwelling—No. of Bedrooms...............�3__...........___-.-_________Expansion Attic ( ) Garbage Grinder ( )
pa, Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Q' Other fixtures ............................... . .
W Design Flow.................... _.______.___.-.-gallons per person per day. Total daily flow_____._................_.332........gallons.
WSeptic Tank—Liquid capacity APO.gallons Length................ Width---------------- Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No----------,--------- Diameter.......14------ Depth below inlet---3:-�_....... Total leaching area.... .....sq. ft.
Z Other Distribution box ( ✓) Dosing tank ( )
a Percolation Test Results Performed by.. ..1 1�` _____________________________________ Date......
....z....:'... .............
1.4 Test Pit No. 1------2-_-----minutes per inch Depth of Test Pit.......tq'.5... Depth to ground water......l_Q.............
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water___________-___---.-____
•---•-----------------------------------•------------------.........----------------------------•............................................................
ODescription of Soil....................................................................................................................................----------------------•------------
W --------------------------------------------------------------------------------------------------------------------------------------------------------------•-----------------------------------------
UNature 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
system in operation,until a Certificate of Compliance has been issued by the board of health.
ned ---------- ------ �.� .7.,... . . /� ; -,---
�1 _ Dare
ApplicationApproved BY ----------------------------------------------------------`--------------------------------- -----....-------------------------------
, Date
Application Disapproved for the following reasons- ------------------- - -- -------------------------------------------- ------ -- -----------------------------------
Dace
PermitNo- -------------------------------------------------------------------- Issued ....----------------------------------------------------------------
Date
No. Fes$.... .`7..........`:.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..._.. ?.+!.A✓.f.?d......................OF............✓.:'.`, � Z�:(r ._.._.._._._..__....._............
Appliration for Disposal Works Tonstrnrtiun rumit
Application is hereby made for a Permit to Construct ('�) or Repair ( ) an Individual Sewage Disposal
System at:
t
.................._. �....!.... ....... ...Vet !� � -Py{ C
Location-Address or Lot No.
....------•---•............................... .......................................... .............---•--.......--,--........... - •-----•--•---.................................
Owner Address
W
U� Installer Address
Type of Building Size Lot---------et___--__.--.•_-._Sq. feet
., Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( )
a`4 Other—T e of Building No. of persons............................ Showers
YP g ---------------------------• P ( ) — Cafeteria ( )
dOther fixtures ..--•-------•-•----------------•-•-•-----•-••-----......•----........------.............-----------•--------------------------•-•---------------------
W Design Flow...................." ....________..-•..gallons per person per day. Total daily flow.........................- � 1........gallons.
WSeptic Tank—Liquid capacity Z�',•��._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..... ° .=.�I" __�._P"vC________________ IS,
S
------ -------- Date------=.................................1 Test Pit No. 1............____minutes per inch Depth of Test Pit.......'f .. ___ Depth to ground water_____.1. '.............
44 Test Pit No. 2................minutes per inch Depth,of Test Pit.................... Depth to ground water........................
a ----------------------------------------•-•-------•--............., ......................._..._......--•-•-••-•.........•-•••---------....................
0 Description of Soil------------------••-•---.............---•--...-----....._........•----...... -----------------------•------------•-•....------------------------------...------------.
x
c� - ----------------•----------------------------------------
W
-- -----------..............................................
---=----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
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
system in operation until a Certificate of Compliance has been issued by the board of health.
tined ..--... ..... ... r.`��
' ``�>, �� e��J - n y Date
ApplicationApproved By -- ------------------- ---....--------------........--......------------------•---...-... ----------.........................
Date
Application Disapproved for the following reasons- -------------------------------------------- --......-...------------------......--------------------------..-..-----------
------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------*--------------------- ------------------...-------------------
Dare
PermitNo. .. ........................ ... .. .. ................ Issued ----------....--- ........................
Date
THE COMMONWEALTH OF MASSACHUSE17S
. BOARD OF HEALTH
-- .. .......................... = -----------
Cer#ifirate of C�um}�ItttncP ` /
THIS IS TO CERTIFY, the Individu Sewage Disposal System constructed ( �) or Repaired ( )
by ��----- � ^�- ...................
Insca11
����
has been installed in accordance w Vi the provisions of TITLE 5 of The State Environmental Code as described in
�' 6.. . --the application for Disposal Works Construction Permit No. ..... ...... .... .7 ..-. dated --...
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FU TION TISFACTORY.
DATE----- .. .....- `4.................................. ........ Inspecto L--- 5 ----
THE COMMONWEALTH OF MASSACHUSETTS
r
BOARD OF HEALTH
"No-EX-7.... FEE--••-----••-••..........
= Rap anal for s �auitr ilau nutit
Permissionis hereby granted.................. ..... ..... ---------------_--..-•----------------------..-.------------.----------.-.-.-
to Construqt or Repair ) an Individual Sewage Disposal System
at No. A. ------`------- fi��' , !.E' --
-----------------------------------------------------•---------------
Street � �f, //"� r �
as shown on the application for Disposal Works Co tructio�n'Pt No _.._.....�_,.F_/_.._ D�ted____ _ .............
�-- --
� Board of Health
DATE........ '- fk1 ...............................
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS
T
TOWN OF BARNSTABLE
LOCATION LA G l Al,Ww G, Way SEWAGE
VILLAGE Cep,. rJ � ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO. J ?- Dvjce 3 6-
SEPTIC TANK CAPACITY co
t LEACHING F ACILITY:(type: L.-p t Ll, U A' (size) 660
ENO. OF BEDROOMS 3 PRIVATE WELL OR�UBL— IC T R
0
BUILDER OR OWNER �ck s$ 4
DATE PERMIT ISSUED: 1-2-
DATE COUPLIANCE ISSUED-
VARIANCE GRANTED: Yes No
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