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HomeMy WebLinkAbout0063 KEARSARGE AVENUE - Health T eac ' � Ave, Chin I-f+ v'�E t r �.� TOWN OF BARNSTABLE 4y LOCATION ��� Ir�n 5 _SEWAGE # q(o' VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. "3-1.96SOA "771- id�{tT SEPTIC TANK CAPACITY 1,500 LEACHING FACILITY:(type) 2 Le" (size)1rb06 JJ6ks NO. OF BEDROOMS Li PRIVATE WELL ORCPUBLIC WATER BUILDER OR OWNER CO, DATE PERMIT ISSUED: �j� 311 97 DATE .COMPLIANCE ISSUED: s7 VARIANCE GRANTED: Yes No ��� �` 1.� ��4\ ,�O I F 2 +YI V` ��,� � ` 1 y3' ` � I 7,8 V � ��a �� R `` ` 4 yt I p �/o I �� I � M �, � No._' !- -j F$> C7 c3c THE COMMONWEALTH OF MASSACHUSETTSy BOARD OF HEALTH l_ou>r✓...... .........oF . . . l?11.,i,ST1 ...........----..............._......---.. Appliratiun for Diupnsttl Works TunstrWiun 11rrntit Application is hereby made for a.Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: �TLAZI w .. .. ..........c v.<..: .... N5£: ............... v. ......,� I_,pEatio A�ddr�ess or Lot No. ................v_..__.... N�Ij.C-S�. -•'°r ar•`� c •....................... ......................................................_........................ _.............._. y,Ownez Address ........... 1 J..........!g ' Q�::S.�I.IL.......................................... .................................... ..........:................................................ Installer Address Type of Building Size Lot.....j�....o..�.._..Sq. feet+ Dwelling—No. of Bedrooms............................................?--� Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ............................ d ............... W Design Flow............<�5.........................gallons per person per day. Total daily flow................ .ca...............gallons. WSeptic Tank—Liquid capacityLo_ra.-,;a.gallons Length....... Width......rX........ Diameter................ Depth.-)7 ....... x Disposal Trench—No..................... Width.................... Total Len Total leaching area....................sq. ft. 3 Seepage Pit No..../............ Diameter...,/Z-...... Depth below inlet...../.......... Total leaching --f�- Z Other Distribution box Dosing tank ( ) -L«2`�` P• . a Percolation Test Results Performed by........ ...... •--• .......I........... Date �g-'s......... Test Pit No. 1..- "Z—...minutes per inch Depth of Test Pit., . ... Depth to groun water........ 5.4.0-4 44 Test Pit No. 2.....—'Z—...minutes per inch Depth of Test Pit.�f Zo_�'.. Depth.to ground water..............,?........ O Description of Soil.........c,S ....P�� . ....... ... ............... = 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 Rrovisions of TITLE 5 of the State Sanitary Cod —The un ersigned further agrees not to place the system in a Certificate of Compliance has is ued by th board of health. Signed.......... ....... c�...:. «� Date Application Approved B ..._...(.........Z...._�.a.. Date Application Disapproved for the fol ng reasons:--••...............•------•----•-----•--••--•--....-----•-••-----------•----------------•••-•......•-•--- PermitNo..................................._................... Issued..........----- THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA No. ......v..... FEB....... _. r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............. ............OF.......................................................... ......-..................... Apphratinn for Dispnsnl Narks Tonstrudinn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ....t': :___ �_..:....... .. ........................._........ ......................__...................... ......._:...... ...._..__.... •Location-Address or Lot No. a: . ••-•---•--- __.•___•... ...__..- ... ....................................... ...................................................... ^---•-----....---------. Owner Address ..._........... W e t? 15>,V • C I Initaller Address Type of Building Size Lot.:... 2N... ...Sq. feet f U �. Dwelling—No. of Bedrooms...........:................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ........................................................................................................................................................ Design Flow..... � ....... gallons per person per day, Total daily flow...............:? .v............ gallons. Septic Tank—Liquid capacity� ,..;.gallons Length......=,�'.... Width...... Diameter..... .... Depth...-,.,. .. x Disposal Trench—No. ................... Width.................... Total Length..............:.. Total leaching area_...................sq. ft. 3 Seepage Pit No...:_.Y............ Diameter 2....... Depth below inlet_._ .`...... Total leaching area.. ....sq..ft._ Z Other Distribution box (L) Dosing tank ( ) 1 �"�� %` ,a `" Percolation Test Results Performed by x;s!. ?.._ / Date. /� / ..f� ... Y ................. .... Test Pit No. 1..:. -. .....minutes per inch Depth of Test Pit ?:* ... Depth to ground water ... fsl Test Pit No. 2....: ......minutes per inch Depth of Test Pit_ ., .".. Depth to ground water................ ........ ... . 1 .. - -- J :....... ......y O Description of Soil. .. bl A 1, ....... W ..........................'...----------.................. ..........._.............................................................. - ......................................... .......................................................•-.------..-•-.----..----•--......................................................................... Nature of Repairs or Alterations—Answer when applicable......................... p'...--............._._......:..................................... - =_ . r Agreement: The undersigned' agrees to install the-aforedescfibed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary.C de—The undersigned further agrees not to place the system in o ation until a-Certificate of Compliance lr�s-b ► issued by t e boa d of health. w = ign .._..... ... ..._ .._- ... ApplicationApproved By.............. ........-••--•--••-•......---•-••. .-......._._....---- ....._................a-......... Date Application Disapproved for the fof reasons ... _..._....____ ...............................................................--•_.. ... = .— .._... _ '... ....._ I Date Permit No.................................._ _........ Issued..... - --..... ...............-•.. ..........-- it .7`ti 1't�•"1"w" •—.�.a. _? '' � ' .. .. _ -' _. .. .. .. �S�" .. - Date s t I THE COMMONWEALTH OF.MASSACHUSETTS s ` BOARD-OF HEALTH a.....',. OF..................................................................................... - farrtifutttr of Toutphana THIS IS-.-'TO CERTIFY, That the Individual Sewage Disposal System constructed ( of Repaired.( �) by..._..... :ll,�{' .r�.+. y - -------------------------------------------------— at..................... J has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated.........:...................................... , THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE° /SYSTEM WILL FUNCTION SATISFACTORY. ------ DATE......... ....... .............. Inspector..----- -•-•--............................•-••---•---.....--••--•----............ a THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �6 ..........................................OF..................................................................................... �j No......................... FEE .`�.0......... Dispos f Works Tonstruction Vrrntit Permission hereby granted .....R.)...K........5 R-Qk1£.14.---------•................................................................... to Const�>�� �or R�pr ( bats h4 tfFA Se� �ispoeDQT -C at No............. T 1'�- 1� Street as shown on the application for Disposal Works Construction Permit No . 6. .,.�Dat==-- :-•-- ••-•........................._ Board-of Health FORM 1255 HOBBS WARREN. INC.. PUBLISHERS I y r 7_0P O� �o✓%J , 5-0 4 c715 r. � � ..� .s: �i _r 44 34 — _ 3c-1 t �^ IV O TL E,K7-&A -ID ALL AF'PL/CRES(_E t P 9 P T �, SCALE- " O' MA"A4 0 L. E G©V E,QS TO GaI/THI AJ HORIZ SC/9L& s /O _ E — OF �I/a.,r`sHED G,eADE . 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