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HomeMy WebLinkAbout0030 WILLOW RUN DRIVE - Health 3D ku.dn`pKVv 1g►( Ts—MEAD KEEPING YOU ORGANIZED No. 12534 2-153LOR SLISTAIMMLE FO ESM MIN.RECYCLED INITIATIVE CONTENT10% Certified Fiber Sourcing POST-CONSUMER im sfipropram.orp Sl+0i190 TOWN OF BARNSTABLE LbCATION v Rwj'vtl i � btv R, SEWAGE � 7� VILLAGE ASSESSOR'S MAP & LOT `d!© 070 INSTALLER'S NAME & PHONE NO�GZ�`Iw SEPTIC TANK CAPACITY ( a 0 C�' LEACHING FACILITY:(type) �� -� (size) NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER �� DATE PERMIT ISSUED: ® 19 93 DATE ,COMPLIANCE ISSUED• VARIANCE GRANTED: Yes No �� l i 1 a N A.. a-f� �70 76 LOCATION : - SEWO,C,E PERMIT UO. . - -- - ® - . IWST&LLER-*S- IJ&NAE JU BUILDER-5 tIIE _ . .A RESS- -- ---- __ _ .-- D[lkTE PER"IT _1-55UED = D-AT-E - CO.KAPLI &111-CE ISSUED ; _ L__ f®ov 0 I V #_ �J ([ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Dirivwial Wurk.6 Tvltlitrurt >o n Errant Application is hereby made for a Permit to Construct ( ) or Repair - ) an Individual Sewage Disposal System at. • �i - �� d �� -•.................• ----•----------- - ........ Location._\ddrass or Lot No �� --r „mo d °,v a � �� �< ._......on:.......... ................ ....------ -----••-----•-•-••------•-•----•---•-- ....................................... -- Owner .' l-r Installer Address Type of Building Size Lot............................Sq. feet aDwelling— No. of Bedrooms--------------J_---___---__--__--_--._..-_-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 ( ) Percolation Test Results Performed by.......................................................................... Date........... ............................ 1-4 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........................ Pd . . .. • ----------•---••------••---•---------•••-•-----•---•-•••--.......--•----------------•---•----•--•-•----..............---------•---- 0 Description of Soil..........:. .... �`_ V --•------•----------------------•--------------•--•------------•---------------•--------.............._....------•------------• ••.-•------------------•----------------------------------------•----------------........................................ U Nature of Repairs or Alterations—Answer when applicabl _..._..:.. -•_ .. -• ... _._.___.... ... �� ----J -.......... ------------------------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Enviro "e tal Code—The undersigned further agrees not to place the system in operation until a tificate of Compf ante has be i sued by t e board of health. .- ti � 3 Signed ......... ....- ....... .-.......I...........g...... Dare Application Approved By ... ®..... .... ......... .... . . ..&.._�../0...��1 .......... .. ................. .... ...............---............. Dace Application Disapproved for the following rea o r: . ... ........................ .... ...................................................................... .................... ....... ... (v. Lo Permit No. ........��.. .... ....��� Issued S. r-• — .! Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Contyliiin.ce THIS IS/TO,C,E,R�jTIF , That the Individual Sea{age Disposal System constructed ( ) or Repaired �V �`�'� b ` has been installed in accordance with the provisions of TITI, o�The S ate nvironmental Code as described in the application for Disposal Works Construction Permit No. �� ".... ... .. ... ..... dated ......_............____......._._...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT t C.ONSTRUEA AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. (� � �3......_...._.. _...... Inspector ..._... -........."� .... ._................ . ................. DATE __....._.... P -----_-.----_-.--_-,-_--- --- -----•-_,------------.,------- ------- ----,e-m--- --,i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � �' TOWN OF BARNSTABLE 7� No...... FEE t .............. n�tt1 >ar Taan# i>� amit Permission is hereby granted ---- U ` �"-------1-------v"-- .....=- =L`-5-----------------------------•----..........-. to Construct ( or Repair a Individual S•'exvage Disposal Sit, �`-�:.__.. J at No.....................1-0........1-t-� = `.... �� street 1 as shown on the application for Disposal Works Construction Permit No_____-•... �!� `ated---_�,���-�..�3.......... n � l !rl Boar of Health DATE---------. ...^ -----••-••---•-•- -•-•••--••••-----•--•-•----•----••• FORM 3e5oa HOBBS&WARREN.INC..PUBLISHERS MA �) No.. Fps.............................. . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7 TOWN OF BARNSTABLE Appliratiou for Diripoiul Works Tonitrnrtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair (� ) an Individual Sewage Disposal System at: ...................: n..... - w ... c�: G� l� ----------- - ............ Ln� c;ition-:\ddr L or Lot No. ........... . -•--...�:...----•-... .�....---•----•--••----•-••--•......--•..... ...........�0•-•.........-----.�?-�.......� .................� ............ Owner Address Installer Address UType of Building Size Lot............................Sq. feet ,.., Dwelling—No. of Bedrooms.............................._--_--__.._.._Expansion Attic ( ) Garbage Grinder ( ) 114 Other—Type of Building _-_-----_-_-•-_---.-.--___ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures -------------------------------------------------------- W Design Flow...................................�.�.�..�...,j..gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity!l----'.gallons Length................ Width---------------- Diameter................ Depth................ x Disposal Trench--No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. t Seepage Pit No..................... Diameter.................... Depth below inlet.....................Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ 1.4 ie Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f3, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a . O -- --- --- -- Descriptionof Soil.................. v� ... .._,_....................................................... U ----•••••••••..............................•-•-----•-••--••-•••----•• -••••-•=...................................................................................................................... W . 4 ........................................................................... .___._..........._____......._._....______....._.___......_.___......... ....._................................. U Nature of Repairs or Alterations—Answer when applicable)_..._......���..�__.. ��•�;�.___..._..1k•)&..�........... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environ ne tal Code—The undersigned further agrees not to place the system in operation until a C rtificate of Compl4ance(has be i sued by t�board of health. Signed .....-..v ...... �. ..:�.-�. ...... . K'............e.......g3. Dace Application Approved B !rea � �� ��:1'/�.. ..E�....-� ...�. . ... PP PP Y . . .. ---------- ,....`... ...... . . ......... �............................. Dace Application Disapproved for the follow o-r: .......... .......... . .........................................`....:........................-...-............... Permit No. 7�... �. Issued .- .l..a.....cl.- ................... Dare