HomeMy WebLinkAbout0053 LIETRIM CIRCLE - Health C' 1aC- �
/G 9 o15-S._...
TOWN OF BARNSTABLE
LOCATION SEWAGE # 7
VILLAGE ASSESSOR'S MAP & LOTAO(47-®��
INSTALLER'S NAME & PHONE NO. g6IS
SEPTIC TANK CAPACITY ------�
.LEACHING FACILITY:(type) C) (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER 0,9/G
BUILDER OR OWNER Le i vw
DATE'PERMIT ISSUED:
DATE , COMPLIANCE ISSUED: "' ' Y
VARIANCE GRANTED: Yes' No '.
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No....17.L-3-03 Fps....3..1::, ........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
, pphratiun for Dhnp ial Workri Towitrurtiun rami#
Application is hereby rpade for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
.............
�� I.�_.......I ocatOnress or Lot No.
�(� v er Address
a V`..D�U. s C..CA,kj � l iu e
Installer Address
d Type of Building Size Lot............................Sq. feet
U Dwelling— No. of Bedrooms......L?..........................._...Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building -..----- _-------------- No. of persons.-..-------------.-..------- Showers ( ) — Cafeteria ( )
Q' Other fixtures -------------------------------- -
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacitv............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........................................
Test Pit No. 1----------------minutes per inch Depth of Test Pit.-.--..------..----. Depth to ground water...--...................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..-..-------..--_.-.----
R; -----------------------------------------------------------•---------------------------•--......••••.........................................................
0 Description of Soil........................................................................................................................................................................
x
U ------•----------------------------•---•------------------------------------•----------------------------------------------•----•-------•---------------------•-----•---------------•-•-••......-----••-
----------------------------------------------------------------------------------------------------------------------- - --- -- -------------------------••--
U Nature f Repairs o. Alterations—Answer when applicable... S �/....1�>e 4?.--..Z .U.... ..........
-------•--• ��......P/=��-----............................................................................................................................................
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.
Signed
---------- - -- --....... /c/sy...
Dale
Application Approved By ................ ... ............... ...
.�..-.�j'.�✓..
Dace
Application Disapproved for the following reasons - -- --------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------- ----------------------------------------
Da"
Permit No. --------7-1-(.....3.o 3------------------- Issued .-------------------------
Dace
f
C.
No. :•y=•�?CJ.> FRs..... ..................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Applirativit for Dityo!3ttl Workii Tonitrnrtion remit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
.....------. 3 �...: ........................................................
ocation-Address or Lot No.
...................... ..................V. ._... ,-____.._..._..__ _.........__.__.._..._......_......_.........._._..._.._.....
W caner Address
Installer Address
Type of Building Size Lot............................Sq._feet
U
�., 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........................................
►4
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.......................
a' --------------------------------••-•--•-•-•--••...-••------•---•--••------......------.......................................................................O Description of Soil--------•------------•-----------------------------------•----------------•-----------..-----------••••----------•--••-•----•--------•---------------•-.....--•-.--•---
x
W i
x -------------------------------------- --------------------------------•------------------------------------------------------------ ----••-••-----•--
U NatureI f Repairs or- Alterations—Answer when applicable s_1..•b---__ --��.�2...__.. �...�_...�..�..............
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. /
Signed ------------ X:_ r = �
Dare
Application Approved BY - - ............'. ... . �.-.. -V-------------------------- -
Date
Application Disapproved for the following rearons: ...................... ......................................................... . ......... . -- ...........
. .............. ........................ .... .......... ... .............- ................................--.. ----------------------------------------
Permit No. -------� ---------------------- Issued ._. ................... . .............. Dare------
Daze
r
C1 THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
(111er#ifirate of CZomplianu
T IS IS"'T
Y0 ERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
}
b. ..Y.......... - 'L�>---------�f ✓------------------ .....
Installer
at ...- ��..... ..... -r-------_.....0_ c-P :� �� �----------------------..........----------------------......--------- -----------------------------------...-----------
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. __.1� .'...��. .. j_-.... dated ...... _..
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE. .. .T.."'--. ..'�--------------------- ------------- I n s p e c t o .
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
��j�L// TOWN OF BARNSTABLE
No.......1.._... D3 ^ FEE.:, --•--•-••--
�tool� ork� Tomitrnrtionrrntit
Permissionis hereby granted------------- --------- -----------------------------------------------------------------------------------------------
to Construct ( ) or Repair (),4 an Individual Sewage Disposal System
7
Street CYY ^�_
as.shown on the application for Disposal Works Construction Permit No._ .- �__ Pated....... __"6.: n/
•------------------••------.....-•----. -----------------------------------•.....
c Board DATE........................ -G / � ---------------------------- of Health
FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS ,