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HomeMy WebLinkAbout0252 SKUNKNET ROAD - Health (2) o�`� � C�. TOWN OF BARNS'TABLE LC ATION LbT ZS' S&UNXWE r SEWAGE #- 2�9 -99 -VitLAGE ASSESSOR'S MAP & I.OT INSTALLER'S NAME Sz PHONE SEPTIC TANK CAPACITY 1, 000 -- LEACHING FACILITY:(type) 1 .Cr (size) NO, OF.BEDROOMS PRIVATE WEL OR PUBLIC WATER BUILDER 0R OWNER Ll. e A DATE. PERMIT ISSUED: BATE COMPLIANCE ISSUED: - S VARIANCE GRANTED: Yes No ��'' t i V�e L0 CAT ION SEW GE PERMIT NO. I-o 5 s v n Fr r ,no VILLAGE I N S T A LLER'S NAME i AD-DRESS B U I L D E R OR OWNER J SA, IT- t DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED .6 i Fss..... .f1�:f. THE COMMONWEALTH OF MASSACHUSETTS t BOAR® OF HEALTH d. : ...........O F...15�9, ! I%! ..' .C..4:------------------------------------ Appliration for 11hipmFal Works Tomitrurtion ranfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ocation-Address ---------••.--- --------•-•----.or Lot No. ......... G .__.. .. N wa Z---•.................•---........... ...... -•-•---------••--••-...--•---•------•'----..--•--- Owner Address W M Installer Address .� Type of Building Size Lot.-__..s.6S.42.•-•...Sq. feet V Dwelling—No. of Bedrooms.................... ._ --__-Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building . No. of persons............................ Showers — Cafeteria Q' Other fixtures -------------------------------• - W Design Flow..................................6..�__gallons per person�er day. Total daily flow--- 0....._............ gall ons. lons. WSeptic Tank—Liquid*capacity/4,0, ..gallons Length___.___.4.".. Width---4- Diameter._......... Depth-5_49`..... x Disposal Trench—No..................... Width.................... Total Length................. Total leaching area....................sq. ft. Seepage Pit No............../.... Diameter....40.......... Depth below inlet... Total leaching area..20>......_sq. ft. Z Other Distribution box (✓S Dosing tank ( ) Percolation Test Results Performed by N ... Date..f•_3A=iS� .............. Test Pit No. 1......�.....minutes per inch Depth of Test Pit...... .3......... Depth to ground water.....^........ (14 Test Pit No. 2......Z._._minutes per inch Depth of Test Pit....�Ze..&,.. Depth to ground water_-___:- ---- a ----•-•--•••......................... ..--•••-......••--..........._----- --...................... O Description of Soil.... ��`y/j ��{(/!✓�- ._.�!' --.. '!ad4�+4.. `ci.-a. � ............ V ... .--- •---------------------------------------- •---------------- ....------------------------------------------------------ •------------------------------------------------------------ .--------------- --W VNature of Repairs or Alterations—Answer when applicable__________________________________________________________________________•-_________._--_-___. --•-•---------------------------••-•.....-••-•--•-•------'•-••-••••••-••-•-•-•-----•-•-••'•"-"-•"•-----•••-•------•------....----•••----•••...------•-----.....•••-•••--•--......••---"'-'--'----... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with /'1a•-• the provisions of TT�I,LE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha en issue and of health. Signed.-•• • ----- .................. Date Application Approved BY---••...... -- ............ .7 Date Application Disapproved for the following reasons:------••---•---••---....-•-••'-•-----------------•-----•----•-------------•----------------••--'•.............-- --••••••••••••••••-••-•-••-•••------•...............•-•••'---....••-••-••--•--••-.....'•'-'-'•-•---'-••-•--••••--..._.........._..••------•••---•••-••---••----•-••-•---'•---•••--------•-•••-••'-•••--- Q Date PermitNo.-......0--�.....�-/--Q......................... Issued....................................................... `- k I�o.._�J:--�-�---•- Fes$....� ...� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - w .....................OF...?� ,+c�nl5... v ApplirFation for Disposal Works Totw1rurtuan Prran4t Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................-........_...................................................................... .................................................. � Location-Address or Lot No. Ntr✓ _....�...•.. ___. .�... .. .S ...........•--•....................... ..___----••......--•---..........-•-••-••• ---•••---------............................... W Owner Address � Installer Address U Type of Building Size Lot."' =----Sq. feet ►-k Dwelling—No. of Bedrooms_________________ i-, _____________________Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building _______________________._.. No. of ersons__________._____.___.__..._. Showers a Other—Type g , P ( ) — Cafeteria ( ) Other fixtures ���-...... -. ------------------•------•---•--•----••----____________-•------__-•------•---------------------•----•--- ------- W Design Flow..................................- ___gallons per person per day. Total daily flow... . ---------- ___._______.gallons. W Septic Tank—Liquid capacityl���..gallons Length__ '%_:'__ Width...4'�1 . Diameter......=_.... ---- pth_=..A.:..... x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No............../---- Diameter-__- ---------- Depth below inlet... Total leaching area.. .......sq. ft. Other Distribution box (1/) Dosing tank ( ) Percolation Test Results Performed I.-e................. Test Pit No. I......�__--.minutes per inch Depth of Test Pit____1.3........ Depth to ground water________ ____________ 44 Test Pit No. 2....... _____minutes per inch Depth of Test Pit.... `.. Depth to ground water------''_____.__- W ••-•---•---•--------------------------------------•--••-•--------••----------•.....------........_ D Description of Soil--- '� �`�= _`,>�.v'`7. �>9,✓srf;=�-�- - �=' ................................. xi - .........................................................____..................................................._.............................._......................................................... WW .... .................................................................................................................................................................................................. 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 provisions of i T: "1;`' p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has een issue oard of health. r Signed..-..: • - -•-----•-= "" Date Application Approved By............. ............................................ ..... Date Application Disapproved for the following reasons:.............................................--•---------....--------------------------._......------.......... --------------------------•---------------••------------•-•-•-•----------------------.......................... .......................... PermitNo--------------------------------------------------------- Issued-------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Trrtifgratr of Tomplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (>,r) or Repairedby ( } ................•-----•--•--•----------------......---•--•---•-......•••--••...._._ I Iler at -I 5-• a.s . . ...----•-•-----------•------------------•-------------------•--------------...................... has been installed in accordance with the provisions of TITiE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......... '-. ------`7�--- ........ dated-............................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. I,— DATE-•--•--•--•-•-•----••---..0...........-•---g-�•--•----•---------------- Inspector.........---- ................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH y�. 1:? .t,2: .......OF.........--1 �.::1:<:?: � . �:j.. NO.... ._C�.:'•..C`�! FEE../.:,-.....^ l..... Disposal Vo4r1kis Tans ruction Vprrutit Permissionis hereby granted.............................................................................................................................................. to Construct k) or Repair ( ) an Individ al Sewage Disposal System a atNo........6- �- �v n ----- - --------------- �, Street as shown on the application for Disposal Works Construction Permit No.._ .,. Dated.......................................... Board'ot Health DATE.............5---..........' t� ... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS it ! '}''ter p J 49z 4-9.4: i87s3 . i t.. T. !8 650.E �' lu„i,L inZG' , d .4__ ,_ 1 O 1 } poCe I Q PRo oSEO T Z 4 eC. 50.0 a4101 J i �OO !w�' T E R �, I-6 'x 6 ' oad d 0 2 t V E LIAR. S�i 20/ dg T I- b 24' i z { I r -i 4- 90wn1' C� ,�'fi 33. wide41. .. � _� ! 49 , .C'o t 26 i t CGt e 1 I 0 + -3 Ad,G'Cape Date 1-31-89 ; �9 /dc✓ibo�i l oacl .; �eptic Jedi�n SZ° 7 1 odat no t- �E .ated �tow 330g13d f � each-inc aAiea 201 o t es Piw e " 201 d. ! 1 i , a�ac�iyp 1000 , r ' 42 d 1- V. , + -1;- , i1 i f � r � ' ff1 i_ Ske tcA Ptap 'o'g'.Calid Dui CV iuL , i s-I - f3 tot, 2S ai dhowrt or! a`p�ti �co tdeed._ - �cn p lrn bl� .202 p� `R -t ; £�eua.royvs ahe on an c..�.s.ml jcla t Je�.t ;r 72 Zatz: r,;, t�-_ �CLf J?/YLCK74.e .�oG/GCL o? l7PC.t�CCt j I\ (',ade 1-30-89 ��p�,"�"�' ,�-+411, ; No wa-tea mwunteed r)e c 2 ►sun. pelt to dam& a - -ed-i�n�,+rnc � c,�au e.� c✓cau e.� u j �tN OF 92.G 4Z.¢ ED;A D' N\ HN �yG rrpct'i,,u.�;ti rudi,,,ust � � M r s dal2d eland v KEA( c NIG o �MILNE ; y,o , 4 � o.32490 �O,r �IISTEt 9FFISTER�� 37. 4 ' - _4,1_L 1 . . .., iJ