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HomeMy WebLinkAbout0050 PINEY POINT DRIVE - Health 50 6neA� poi 6t Rc k . �P�1 l TOWN OF BARNSTABLE LCr..°ATION SEWAGE # t _ VILLAGE (%,E4 ASSESSOR'S MAP LOT� � INSTALLER'S NAME & PHONE NO. 4 kc.C2-`I Co.vs — SEPTIC TANK CAPACITY LEACHING FACILITYAtype)_,0-0I) (size) NO. OF BEDROOMS PRIVATE WELL PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: I i DATE COMPLIANCE ISSUED: X101 -ji VARIANCE GRANTED: Yes No ��� © . t � C.i � `'�� � � "� � -�-`� '�r2W �� II E>OCATION SEWAGE PERMIT NO. `iIILLAGE INSTALLER'S NAME & ADDRESS B U I"L D E B OR OWN ER DATE PERMIT ISSUED 7 /-;7 DATE COMPLIANCE ISSUED --� • '--� .S �' t� t k � � �. t � �!`® x � i 1 t� ,� i s �©� ag. ASSESSORS MAP NO: C� l PARCEL NO:. Fmc. ......�� THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Apptiration for Biipusal Works Tonotrnrtiun .ernti# Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: ---•-••--••--------- ............................_.---•---------------•---•--•--------.....................---------•- flc - Location-Address or Lot No. � ?`�-----R0�-1 4-=................................................ ..... w ;,,� ::._.._................................................. Owner Address a �3 --•f ;�w ` ;: --------------- e ....... lL�_ ......- ...-: : G.......... 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 ( ) 04 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 ( ) i aPercolation Test Results Performed by.......................................................................... Date........................................ a 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.... '�....... =.............. ....--- a �g... C`0l nSS x -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- w U Nature of Repairs or Alterations—Answer when applicable...-AO----------- ........ 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. Applica .............................. .........V tion Approved Approved By .................. -------------.---------------........................... ..---- / " l-p----� Dace Application Disapproved for the ollowing reasons- --------------------- -------------------- ------ --------------------- --- --------------------------- re Permit No. . ... ---------------------------------- Issued .------------...--- --- Dam ............... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE r , Appliration for Uiipngal Works Tunitruition Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ,,{(),-an Individual Sewage Disposal System at: / • � `�1 1 201t) . _ ......... --•-•-----....---••.......... - ... ... ....... Location-Address or Lot No. _--- -------- ----- ----- --------•-•--- Owner Address fj Installer Address UType of Building i Size Lot............................Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 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. 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....................................... Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ..........................................---................................................................................................................ 0 Description of Soil....r)--l------...!vQa-------•-••-•------ - 1 0 �'� � �''�" U -----•----•-••-----•-------•----•------•-••--•------------•-------------••---------•-----•-•----•-•••-......---•---•-----------------•-------•------•--••------..._...•-••-•----------•---•-----••--•••. W ---------------------------------------------------------------------------------------•-----------•------------------------------------------------•--------------•-----------------------------•-•---. V Nature of Repairs or Alterations—Answer when applicable...a4.0-A----------(5a? `. _� _...... _E'ssl)��. .............. 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. ` t Signed .ca '1 :.-,.. - �� - .................... ----------� [��11........ Application Approved By .... J !'`-'r^�, .�`.` ------------------------------------------------------------ -------------/.. -..t L.... Application Disapproved for the ollowing reasons- ---------------------------------- .................................................. ....Date...-----........ --------- - ------ - -- -. -------`----------------------- Dare - PermitNo- -----------------f. 1----------------------------.- Issued ---------- ------ --------.-------- Dare 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH I TOWN OF BARNSTABLE C1elrttftrtt#.e of Cnmpltttnee THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by----------- --- `- -`2....---.--51w.�c.... --...-..------!�...aa......_.....r.. = -----......-------------------.......-----------------......-------------------------- - ........ Installer at ... S -e1..1.) 4 a�.e �' - ............ ------------------------_-------------------_----------------_------------------------- 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. ......._91-../,�............... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE r` . ''.. Inspector* ..................................... THE COMMONWEALTH OF MASSACHUSETTS ` BOARD OF HEALTH TOWN OF BARNSTABLE No.......Z� FEE. -S�................ Disposal Works 0-Flanstrur#inn rrutit Permission is hereby granted........ C. . '..._.: tiJt..... to Construct ( ) or Repair (�an Individual Sewage Disposal System atNo,-- Q�r.� .`1... --ram....�......................�.....----------------.... ..-- ��---------------------•-----------------------------.............. Street as shown on the application for Disposal Works Construction Permit No.___9Z__"`/`/"/.._ Dated_-_•-------------------------------------- g ---------------/ o --------------•-------------------•-•---••--.-- DATE----------------o ----:.-�-• ........... B— Health ' FORM 36508 HOBBS 6 WARREN,INC.,PUBLISHERS