HomeMy WebLinkAbout0022 PUTTER LANE - Health I
L9-CATION SEWAGE PERMIT NO.
14 7-
We' L L A G E
I N S T A LLER'S NA /ME & ADDRESS
BUILDER OR OWNER
E
DATE ' PERMIT ISSUED �7 7f-
DAT E COMPLIANCE ISSUED Al /3` 7�
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TOWN OF BARNSTABLE
LOCATION <� SEWAGE #
VILLAGE C�t�tct2v\L� _ ASSESSOR'S MAP & LOT
INSTALLER'S NAME PHONE NO. g_- "e 1,,4,A s Sg .0Ta
SEPTIC TANK_ CAPACITY e X\�j\-� y\_(7'7M
LEACHING EACILITY:(type) Pk7'(size) (o r�
NO. OF BEDROOMS_-_-PRIVATE WELL UR�Z'UBI_IC
BUILDER OR OWNER V "
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Applira#iun for Dispo'sal Works Tons rurtiun Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( Q_a r-individual Sewage Disposal
System at:
........: ..� :::� . ?-:.� !r ........... .....................� ►.V� I................................
- Location-Address or Lot No.
--_._O _:....�Ltoc c:- _---• ---------------------- ---. `- ------------........----.....------.........-------•----
.01
�� Addre s
-----------•----- -----•------16 _ _O1!D ........
Installer Address
UType of Building Size Lot--------------------_.......Sq. feet
Dwelling—No. of Bedrooms.......a� ...............................Expansion Attic ( ) Garbage Grinder ( )
`k Other—T e of Building .............. No. of ersons...._.....,..._.........___. Showers
Pk YP g --------•----• P ( ) — Cafeteria ( )
� Other fixtures .........................
Design Flow.......5- -. -.......................gallons per person per day. Total daily flow.... _. ....................gallons.
W 'Septic Tank—Liquid capacity............gallons Length................Width................ Diameter................ Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Diameter....l.... Depth below inlet....42.1......... Total leaching area..................sq. ft.
Seepage Pit No.------�--•------ - �--•--••--- P
Z Other Distribution box ( ) Dosing tank
a Percolation Test Results Performed by.......................
------------- -----------------.,_-----•-. Date.....------------------------------
P -
Test Pit No. 1................minutes per inch Depth of Test it.__.............._.. Depth to ground water.._.-......._.__..._._..
f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
04 ..--•-----•-••---•-------•----------------------------------------------------------•-•-•-----.....•.........................................................
0 Description of Soil--------------------------------------------------
W
U --..._..-•--------••---•..............•--- ---...-••-----•-•------....----- -----------------•---- ------------------....------------------•-----..............._......._.........------.-•---
--------------------------------------------------------------------------------------------------------------•-------------------•-------...------...-----...----........-------•----....`--------_..
U Nature of Repairs or Alterations—Answer when applicable... ;;V.'—...... ._.�Y ---a � ......
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
,the provisions of TITLi: 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Complian issue board of iealth.,
Signed.._--�- .G- = ." ,.
•Date
Application Approved BY ....._.....E c.c :�-----------------------------•------=. �` ,:_ 6_ :.
Date
Application Disapproved for the following reasons------------------•----............_------------------------•••------•-•...---•----....._•-•-•-........-••--•--
................................................................................ ..............................---------•----•----------------------• ...................................................
Date
PermitNo.......... .-_ 7. ..................... Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
1..........................................OF. ~ !(?E'`G` .! -. ....................................
i
Trrtif ratr of Tamplinu rr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by---------------------------- rf�x ,_ - r -----------•-•---................--------•---.......---........
Installer
at.... r' s_.._ l,?T'' _ ,2 �'v0r.v---��----------------------------- ..............................-
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------u9.---.-7Z ?..---...... dated.................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
r,
DATE............... -.-. _�` ....__?�.. ......................... Inspector........... _�.................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Ory 7. 71M. ce tr ..........OF...
No.-•r- = d
Rovaasal Varkii TIunotrnrtion '"amit
Permission is hereby granted....... -.f^�`� ..._J� .�.�. ...................................
to Construct ( ) or Repair ( L)—an Individual Sewage Disposal System
at No. r�� I- t.p'''_�!Z l._14............................... .C'_"'-'..`"•T-----------------------•----------------------------•......--------
--•--
street -7
as shown on the application for Disposal Works Construction Permit No.':/.y!�'_. Dated..........................................
.................................0-... .............................................................
DATE................ ................................. Board of I[calth
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................
. ppliration for 11ispostt1 Workii Tonitrnrtion VarAit
Application is hereby made for a Permit to Construct ( ) or Repair ( l)—an•-`Individual Sewage Disposal
System at:
........... ...___.._ ...... -- ..._...._.........._..... - ... ...... �._. _ .. ................
Location Location-Address or Lot No.
....................•. -- Address
Owner,.
In `e ?`C�:C�: .. / 1!lJ ya _dM o r 5a oh. .�
.................. ........................................... ...--$1-----_._.---. ..__ _. _. .........._............._.....--••---...__.
Installer Address
Type of Building -� Size Lot............................Sq. feet
Dwelling—No. of Bedrooms.......=" ...............................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building
W Other—Type g ............................ No. of persons............................ Showers ( ) = Cafeteria ( )
d Other fixtures ::....
W Design Flow.......: :�......................gallons per person per day. Total daily flow....`z .1' _...................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.......I............ Diameter....10C......... Depth below inlet....U........... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
1.4 Percolation Test Results Performed by.......................................................................... Date........................................
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........................
W' ---••------------------------------•---•--••--•------------.......-----••---•---•--•----------------..........................................................
0 Description of Soil...........................:............................................................................................................................................
U
W
x ----------- -------•----....--------•••••-•-----•--•-----••-••---••-------•••--•--------••---------•----••-----•_----•-••-----------••--•-------••-•----------•----•----------------• r-----.-----
U Nature of Repairs or Alterations—Answer when applicable_.. ! ...... ��.... !ice:.. ..��..............
........... ly—�' = 7� C eo,��.- "--t '� ��z�5< .•- ca l
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
L
provisions of iITL U 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
eration until a Certificate of Compliance has been issued by the board of health.
Signed....... .:
. Date
plication Approved By---:....•--..-- - .:.- .....-•----•.................. -.� ,. Date
plication Disapproved for the following reasons:.............__'---------------••----••--•--------------:..-•----.........---•--------...._......--....•--.......
-•-----•------------------------••-•-------.-----------.----.-.---------------•---------------•-------------------------- ------------•.....-•----------•-•---•------••••------•---------
Date
PermitNo........... K- 7 ---------------------- Issued.......................................................
Date