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HomeMy WebLinkAbout0111 WILD GOOSE WAY - Health 11'I Wild Go©se Way Centerville A = 167 043 i • i 1521/3 BRA 100/0 P2 i yY, TOWN OF BARNSTABLE �� ), Q + LOCATION SEWAGE # f Pal® VIL-LAG146 ASSESSORS MAP & LOT � INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY 14149&" UI1�/f LEACHING FACILITY:(type) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER 4h e.— BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: z�r VARIANCE GRANTED: Yes No \ti V t�' oa' NO.. ...T....�........- THE COMMONWEALTH OF MASSACHUSETTS !✓ —��' BOARD OF HEALTH .............1. ..........OF........... t-15..1. t �- .... .......... c l ` °-- -����:_ pliratiun for Uhipasal 19nrkB Tonstrnrtiun rrrmit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: .....+.... \� it _ � .............. ._..._ ------............_.....-.-....... ----......---------....--•--...---•---•--.... .....•.�................--..........- Location dss r Lot N ttO � o. z .....� �Y- 1 ._...-_.... 0 Owner ------------------------------•--•-•--•-----Address a .... r............. .. ....................................................... ........................... pq Installer Address VType of Building Size Lot......Z�..©c-''_'. Sq. feet .j Dwelling—No. of Bedrooms................ ......................Expansion Attic ( ) Garbage Grinder ( ) ' Other—Type e of Building ...._ No. of persons............................ Showers-W YP g -------•-------•--•---- P ( ) — Cafeteria ( ) 04 Other fixtures ........................................................................................................... W Design g ...............................ii ` �gga P person P Y Y `��.�/...................gallons. Desi Flow...........-• WSeptic Tank—Liquid ca acit ...Z.--.-_ lions Lengthr ...._1\�. W dt ...... .flDiameter..:............:i Depth................ x Disposal Trench—No. .................... Width.................... Total Length.......... Total leaching area.--!................sq. ft. 3 Seepage Pit No..........'.......... Diameter.......14_........ Depth below inlet.....L............ Total leaching area._.5P........sq/ft.G Z Other- Distribution box ( ) Dosing tank ( ) i Percolation Test Results 2 Performed by...... '..-- •Dl�!`�h............................................ Date.__......-�k 1 �.. .... ,.1 Test Pit No. 1................minutes per inch Depth of Test Pit.... 2�'........ Depth to ground water.........�..�... Test Pit No. 2.. .2r_..miutes per inch Depth of Test Pit.... 2�........ Depth to ground water........!N j'?e... 94 ......................................................... -•--•-•--•-•.. - `................. Q ® — c7t Lam........y�.I'L,�.-lr �� 1 � Descriptionof Soil. ....... ............................•---..............`� ----•--•--....?�:........-•-----••-•-•--••-...... -1 W } Z ? .. l�n a.�-�l..----••----•---•-----Z' .. . 2-0 .. i a`t-k `...K 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 MITI.: 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee ,Ess d by the board off lth. Signed..../ ..../ ................................ G�` a P to Application Approved BY•-------•....... ........ ....... .� % . . ... to Application Disapproved for the f ollmx irig.reasons:..............•--•----••---.........-•-------------.....-------••---•---...---....................-••......._.. •--•-••--•..................••--•--.•................----.....---••-------........-----...--•------•-••----..........--•---•••-••••-----•••------•••--.......---•---•--...---...................•••-•- ••Date ,� PermitNo.....-`-----....-•---•-----•-•----------------•-----. Issued_....•:....---..-..Da -•---- --�. ......... .y ........... 1 � / / THE COMMONWEALTH OF MASSACHUSETTS ib1 ` J BOARD OF HEALTH ........ Q ^. ..........OF_._..... s Tontrh�%.... Qitrj� . I 5 Appliration for 19iipoiittl Marks jlrrmit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at Location Address a_ r Lot No. .... �.�........ ......... - �i ............................r � . ........_ . _._ . Owner Address a � - .......................................... ..............•••--•••-•--•---••-•........-•-...._......_....•-•-.._.....••••.................--•- Installer Address �U Type of Building Size Lot....1'0.A?Aa..•Sq. feet r-. Dwelling—No. of Bedrooms................ .....................Expansion Attic ( ) Garbage Grinder ( ) aOther —Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures ------•... ......................... W Design Flow...............1.1.0....................gallons per person per day. Total daily flow............44 9.............._....gallons. WSeptic Tank—Liquid capacity.k !gallons Length........k..... Width......^..... Diameter__-_-_-! ._.. Depth................ x Disposal Trench—No. .................... Width.................... Total Length' .........z......... Total leaching area....................sq. ft. 3 Seepage Pit No............I......... Diameter...._._1.0......... Depth below inlet...... Total leaching area_55!.......sq/ft. Z Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed by...-••C'---- -K102............................................ Date------............ ..�A­./--.. - Test Pit No. I...'�­.:!'....minutes per inch Depth of Test Pit....Nlq Depth to ground water......... _].A,_. 44 Test Pit No. 2...A!._&..minutes per inch Depth of Test Pit----I _ Depth to ground water......... .._ . a ................................ .........••••-•................ O Description of Soil--•" ........R.:-. ........................: �!"1'-•q "••' ''�:._.. ---------------`-=-=y.�:!r� -0------- - ...------ --------- ----•---------..----•-------•-•-----.-----------•---•---- -----.- t • . �`'� L.r��,l�l '... ...� t. � st• to --- - --------- - - - ---------•---_--_---------__ ._........_.. ...... ........................................................... _11 U Nature of Repairs or Alterations—Answer when applicable.................................................. '.........................I.............. .......................................................... ----------------------------------------------•---•--•-•------• ........... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of AITU'- 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee Irissued by the board of 1�e31th. � Signed----✓. / ........ 7 ...----------------- . .........................._.... \Application Approved By....._•_. ,._,.,_�O� r Date Application Disapproved for the following reasons:................................................................................................................. ...........................................................-------•------...............-----------....----..........---•--.............................. ••----.... ............•-- .............. Date Permit No...... ._ �'" /...f�} .... r� ,! "Issued.......��......................�! :- ---...-••••-•--.. ✓ Dom` ......................................... .......... ..... THE COMMONWEALTH OF MASSACHUSETTS �..•�f BOARD OF HEALTH / I ..�..' a' ....;,........OF..� .!1 ? ..ram (rrtif uttte of Gantplittnrr THIS IS T C RTIF.Xj That the-Individual Sewage Disposal System constructed or Repaired �� I(Al) ( ) by........ - -........ r ...._. ...................... installer . --.----------------................_.............._--......-...._.....� .� at...�; .. ��'� � ��"- % !a�.. _. ! ..............•---•. . has been installed in accordance with the provisions of TI!LPE/5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No... ZP - dated, " .. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................. _._/ _:_./_.. ................................. Inspector------............. r d ------•-•----•--•-----------.---------..---.-- w•we..ser.. _ �..'004----------. _ _. _ ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF No......................... o �- FEE.A'/ 7f; ?'J 11isposal Works Tonstritrtiatt r rmit Permission is hereby granted..~ . a�`'�•�- r"� ' u to Construct ( k) or Repairs( ) an Individual Sewage Disposal System � at No........"� ............-�-.�-- G` ! , -•'�-- 7 ....I: ���---------•-- _.._ - ___- .... ..�.. Street as shown on the application for Disposal Works Construction Permit Nc Dated.......................................... PP P �•----�j- ......................... ,� ............................. a� o alto DATE............. .................................. l.G t r.1,y. 51a i r�iG.K� 44, AND �����►-►�GE�• tzar-fit-- n''"' �"ti�G' l i�1T1,1,F:�r•• �r _ � +i��r ��.;:Sf �:�- l�Afd�SF II _ ✓ 1 � -- S C ' Za S 1 I. pn.TUM MSL/6C-0+v -,&yE�.l �eoM r�� ,e. 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