HomeMy WebLinkAbout0067 LOOMIS LANE - Health s
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t , TOWN OF BARNSTABLE
LOCATION( . �e)6v+n� "��e SEWAGE #
VILLAGE ASSESSOR'S MAP & LOT -„3Q. 166
INSTALLER'S NAME & PHONE NO. L44-WP f-f�C(��
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) 73 (size) D5�
NO. OF BEDROOMS PRIVATE WELL OR BLIC WA 70'
I
BUILDER OR OWNER �� v
DATE PERMIT ISSUED:
m
DATE' COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No I�
�J
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Terlifi ate of (111omplialtce
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by ..........................................�...h4....!}- _..... ..;... t.rv..t� ...- -_ .. �'r.� ..............---------.:.................. ..............................................
In-.11• ET......;
/n.``7.....L ..................................................-.....C. A-:T"' . ----------
at ............................................... .. ....
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. ......../`u dated ..........._............ .......
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE ...............- l ....................---........... ---.-----------. Inspector ....... .:._....... ..... ------------......--------------------------
\iy THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
No...,.......-...... FEE........................
r
Permission is hereby granted-----------------------e-,A /• _e— -.-.-q/t • -. f /
to Construct ( ) or Repair ( t/)� Individural Sewage Disposal ystem +
r
Street CC� r
as shown on the application for Disposal Works Construction Permit No,l._7�1 .___ Dated...........................................
�y ......................... ....................
DATE.............................1� . .. ?• Board of Health ...
FORM 36508 HOBBS Q WARREN.INC..PUBLISHERS
,4 Fes, i
No.73-.2-S-3 F..3.0............
THE COMMONWEALTH OF MASSACHUSETTS
F BOARD OF HEALTH
Cun,�a�+<at�t��• ;)e;;artmetft
�_y S3 TOWN OF BARNSTABLE
App irtt t Tvr Diripwial Wnr1w Tomitrurttutt ranfit
Application is hereby made for a Permit to Construct ( ) or Repair ( n. Individual Sewage Disposal
System at:
' Locrti n-Add - .............
or Lyt No.
�a•ner Address -_
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 ( )
04 Other fixtures ...
W Design Flow............ 1,� ..................gallons per person per day. Total daily flow.._ ......................gallons.
Cd Septic Tank A-Liquid capacit�.OCOgallons Length---0.......... Width._Z5 ....... Diameter................ Depth................
Disposal Trench e-?.......... Total Length---4DQ ..... 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. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
f? Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a -----•----------------------•...._......-•---------•---•-------•-----••-••-••-•-------•-----••••-•-•.........................................................
0 Description of Soil...=....................................................................................................................................................................
x
w
UNature of epairs r Alterations—Answer when applicable._.--: ..._�-• _ ..g4-C-10"W
................ ............ ....------------------------------------
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 ' sued bv the boar of health.
Signe ... . -- - -------- -- - cc
.................... 7.
Application Approved By ........ � ,_,�;.-, �..-..�/.�.. .z�....
. ... ...............�--��---�--......------...................................-...... Dace
Application Disapproved for t e following reasons: ........................... .......... . .. ..... ............................. .. ............... .........
................................ ....................... ....... ......... . .... ............................................................------....................... ........................................
r� Da re
PermitNo. ............. - .... % ........ Issued ........................................................------------
Due
I
/r�. � ✓�-•-�..,.i.�.rVV•.�-�.:-�.�4�tr���r..�.vr�_�./v..V..�w+-•v�_[__�_y_,�wV� � � . -^�.. �.. via.,...v-.V..� .'y-- - -W`.v. .....•.. _... .. -
No..J._. 2> _ l Fizic ...��. ............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�� 7J G_y S3 TOWN OF BARNSTABLE
Appliratiuu for Uiripmial Works Tuuutrurtiun Itrrmit
Application is hereby made for a Permit to Construct ( ) or Repair (--4 Individual Sewage Disposal
System at:
�. ._ -------------------------•----
�� Location-Addc ss / or Lot No.
W ------------•----•---•------ --••••----- ----- ------------•---
Owner Address
W -••••---------------C.. ` t ..t _...,..fl---��-r�`t t(.. �.... l� f?� t /( �/ �. !/1 1 I r
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 ( )
d Other fixtures- -------------------------------------------------- ............
W Design Flow........... ...`5 ..................gallons per person per day. Total daily flow.--� .-._----._-.-.--.-.---gallons.
9 Septic Tank-L Liquid capacity!g.�_gallons Length...%........ Width_. "------- Diameter----I........... Depth................
Disposal Trench—No..2-fit �h,Width.....q.'-.-----.- 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
Test Pit No. 1................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........................
9 ...---•---•-----------------•-•-----•.......-----•--•-••---...------•-----.....-•---•--...--•-•-......_..-----.._............_..---------.._..---------....--
ODescription of Soil.................................................................... --------------------------------------•-----------•----------------------•----....................
x
w
x -------•-••----------------------------••-------•••---------------------.....--------•--------••-•------------••-----•---••---------••-----•--------••--------••-•••-••-----•-----••---.......---•......
U Nature of fRepairs or Alterations—A--}n—swer when applicable---.-- - ..w''.f. •_�.. .......
.--.S r jV........................+.! 1
�/.."--.!u.C�til........... . ............. �_7/ .. .P/ k? C_ _A-2 ? _C _...Y. ..._-..._
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 boardlof health.
Signed'`Wit..... ,...., ........:........ ......... .. . .' .........` .
Application Approved By :......_ .�..... � � >��e
ate
Application Disapproved for the following reasons: ................... ... . ..... ..................... .................. .......... .... ...........
...................................................................... ............................................ . .................... . ........................ . ........................................
Dare
PermitNo. ............. �..,...... ,. ..-��----..... Issued ......................................
Dare