HomeMy WebLinkAbout0072 WATERSIDE DRIVE - Health i
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
TOWN OF BARNSTABLE
Appliration for Disposal Works Tnnstrurtinn Frrutit
Application is hereby made for a Permit to Construct ( <or Repair ( ) an Individual Sewage Disposal s
System at:
AR.....41?t ---�'--'--£----,------------------------------------------- .............................8------•-*----------------------------------------------"---------
Location-A d res or Lot Flo/
... .. ....S.....�''4Q /........../.... / s. '!� �.... ..........•..--.......,.....`!GJ t.! ZQ.(/ -� ------------------------------------
ddress
Owner W. /�J��C/�SA �G�
. -a ........................... gl b._.
Installer Address
UType of Building /4?CS . Size Lot...... 39_l�......Sq. feet
�-, Dwelling—No. of Bedrooms............. ..........................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons__--_____-_-•_______________ Showers — Cafeteria
0.' Other fixtures ......................................................
Septic Tank—Liquid-capacity1q ..gallons P .. per day.
Length Width daily ... Diamete.. gallons.
..._:__ Depth...
Disposal Trench—No..................... Width_...._l__._._....... Total Length.................... Total leaching area.................... ft.
Seepage Pit No--------------------- Diameter.__...._......... Depth below inlet.................... Total leaching area...4!�D...sq. ft.
Z Other Distribution box ( tT Dosing tank ( ) ,,\
Percolation Test Results Performed by...... Date_._. .................................
t-a L J .........
a Test Pit No. 1. minutes per inch Depth of Test Pit------. Depth to ground water....
(i Test Pit No. 2......Z......minutes per inch Depth of Test Pit--------I 2c'_.. Depth to ground water________________________
------•---- T
O Description of Soil---v _-2-"-..�..aG�-e.........
.. -----�---°•�------------•----------------•--------------------- -------•--•------------
txj ----------------------------------Z- -!----------M --S �!N p
W
UNature 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 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 issu b the board of health. Cry
Signed .--- --- p/ ---- 2 3 /ro
--------------
to
ApplicationApproved By ------- --- -- ----- ------- - ---------- -- -----..............................................................
Date
Application Disapproved for the following reasons: --- ----------------------------------------------------- ---------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------
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PermitNo. 0.-. -..I--7--- ----------------------------- Issued ;--.-................--------------------------------..
Date
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No.. �d....�!. Fz$.... d ...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Applirafinn for Diipnsal Warks Taustrnr#inn "truth
Application is hereby made for a Permit to Construct ( ✓)or Repair ( ) an Individual Sewage Disposal
System at:
Location-Address ���— Lot N4011
...................... � ..... = r �•.. •-••••......•... -... ..........................
,L Owner Address
•---....---•-----••-•----...-:•---....----•-••-•••-•••-•----------------•-
Installer Address
d Type of Building ��5 Size Lot__._._•39_a�:-.....Sq. feet
Dwelling—No. of Bedrooms....._..._._�---_--------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures .----•------------------------------------------------.....------------------------
W Design Flow.........I10_.___.x...3.................gallons per person per day. Total daily flow............ 33.9......................gallons.
WSeptic Tank—Liquid capacity.I P�?..gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..._...._.I---------- Diameter......... ----- Depth below inlet.................... Total leaching area..... ...sq. ft.
Z Other'Distribution box ( v-) Dosing tank ( )
aPercolation Test Results Performed by.....�A e=! _2._�.!�( .�__ _'_ -r .. Date...-.�:�:B .......................
Test Pit No. 1.....2__......minutes per inch Depth of Test Pit........ ....__ Depth to ground water...:_6,6A)E
f4 Test Pit No. 2......Z_:.....minutes per inch Depth of Test Pit........1-...'__. Depth to ground water........................
01 1 --------------- -------------------------------•----------•---.....------•-•--••-----------•---•_..........................................................
O Description of SoiL._U..------ ----- o�"--z�_ �S °^�
x ---••---••-- ----------------------------------•--•---------------------•---•------..._.......----
U ..............................................�--------..�-�f............GJ.--.....-----•------•---------------------•---•---------.........................................................
W
---------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------••--------------••.......
x
L_%
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 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 issue by the board of health. 27_ Cro
Signed ..... ------------ a 2 3./ d-
Application Approved BY %f (- „m...... ----- ----.I.�y rry2-t ----
/ Date
Application Disapproved for the following reasons: ..q-1
y -
..................... ........`...................._��._:..._ ✓1.�................ .........................._................ ................................................... ....
Dam
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Permit No. ......../�/....'--�.. '�
l� 74-- --------------------------- Issued -------------------------------- --------------- -- ----......
Dare
THE COMMONWEALTH OF MASSACHUSETTS 1
BOARD OF HEALTH I
TOWN OF BARNSTABLE
(1ertifirate d (19ampXt2 are
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( V1*_)_or Repaired ( )
by----------- ......Cu--------------------------------------------------------------.......-------------------------------------------------------------------------------------------------- --------
Installer
at ......--�- --......w a i..•..S.LI�. .. 'Z <..:..t4:r. .R �C
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. ..990...--J�t� .............. dated ---J.022.`y/-j4;�................
THE ISSUANCE OF THIS CERTIFICATE'SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. -�--`-�
DATE------------------1 f.`.. ...` (
--� .....................•L .J..
---------------------------------------------- Inspector .---.....------.... . .............---------...------------.............
t V
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
L/ / TOWN OF BARNSTABLE F$E...l � ��-•-
No.. .�..L7h
Disposal Worko Tnntrur#inn 'rrutit
Permission is hereby granted... .......6._(�F
to Construct ( -`) or Repair (/ ) an Individual Sewage Disposal System
at No.-----...... '.Z....w. -r-s z a e � c_. C n_,i s �.c.�/.. .
............. :•15-- --
Street LL// // _ �
as shown on the application for Disposal Works Construction Permit :_7-74d—o
gated.....! 1! 9 .................
oHealth
DATE--�,/-.. . ..��
FORM 3850E HOBBS 6 WARREN.INC.,PUBLISHERS
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Shy?tT/.t/.S'E.eEaN S�'4UL 1J�S/Q)—Q� USEp
TOWN OF BARNSTABLE
LOCATION � '� .S' �,�. SEWAGE #
VILLAGE ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY /D o d
LEACHING FACILITY:(type)P IT (size) /t)o�
NO. OF BEDROOMS _PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER 0
DATE PERMIT ISSUED: 1 a -�.3 16
DATE COMPLIANCE ISSUED: / ), F-c d
VARIANCE GRANTED: Yes No (/ .
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