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HomeMy WebLinkAbout0056 WILTON DRIVE - Health 10 �P�rri�q Raj Rd CI!,Ar4C Vi rIt z 28- O38 S M E A KEEPING YOU ORGANIZED No. 12534 2-153LOR StJSTAIESSTRVNABIf MIN.RECYCLED l INITIATIVE CONTENT1012 Certified Fiber Sourcing POST-CONSUMER avwwsfipro2ra=g W412M MADE W USA GET ORGANaM AT SMMJM TOWN OF BARNSTABLE LOCATION ,j /�/16 e, 7x) _SEWAGE VILLAGE ASSESSOR'S MAP 6z LOT/::; INSTALLER'S NAME PHONE NO. A & B CANCO 775-6264 -SEPTIC TANK CAPACITY LEACHING FACILITY:(type)/ /41 (size) 6A`-6 NO.OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER ORQ20 DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No a" alaol a� No..- •APPRovED Fxs.............................. Dt Conm E COMMONWEALTH OF MASSACHUSETTS OA RD OF HEALTH 0 igrtod Dato WN OF BARNSTABLE Appliration for Diripoitil lVark,s Tom itrurtion Permit Application is hereby made for a Permit to Construct ( ) or Repair (-,, an Individual Sewage Disposal Systemf���ayyt .... .�Y._......�.l 1.1.._...o.�•..... ................... ...... =` ....................................................... Locatiot .Address or Lot No. .......�!l/ ...........................................................� ------------•------------J'..9 ..................................................... O cncr Address Installer Address UType of Building Size Lot............................Sq. feet �. Dwelling—No, of Bedrooms.__......... -------------------_-_______Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------. Showers ( ) — Cafeteria ( ) Q' 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. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------- ----------------•--•••-•---...--•-------••............----•-•---• Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ L14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 ----------------------------•----.......--•--•.............._.--•-•-•------•---•-----•••-•-•-------...................................................---•- 0 Description of Soil........................................................................................................................................................................ W V ......•-••••••...-•-••....•••••.......••.............•-•-•-•••••----••-•------••-••-•-•--•---•-•-----------••---••-•••-••---••-•-•-••••----•--•••--••-•--•--•-----•--------......•••..................... W x ......•----•----------------••-----•-••-•...... .....-••••••.........-------•--.....---•-----•-••••----•------•---------------•-----•-•-•---......-•-•-•••. ................... 0 N ture of Re airs or Alteratio —Answer when applicable. _ Q.a.._. �� ____. ?�tc.....70•._.-••- -••.••••••.•_-. 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 issued by the board health. Signed -- .. .. ..... 7� /....�... - ........., Application Approved By ...... Dace �j ..e - te.�'�..�..9/ Application Disapproved for the�0710 wing reafons- ----------------------------------------------------------------------------------------------. . ............................... ..................... ............... .................... . . ........._............... ....... - - --.......... ..................................... . ............... . . ........ PermitNo. ...... ... . ................ Issued ........................................................Date Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by .................X� Y—p.............� ee�6-------------------------------------- 1�."all-------------------------------------------------------------------................................................ It N -11­f-ti.,'Jk----....................................................................................... at ....... .............tj..1,17-nn .............1-��-t. ................. 6 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. -----71/--- 1-6--? .......... dated ---....... ................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ' 5 lnspe&of� .................... DATE....... .--7 -- -- --- ---- .....................-----------------....... . ----------- ------------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE FEE........................ Workii Tomitrurtion "ernfit Permission is hereby granted.............. ............... r ---------------------------------------------------------------------------------- to Construct or Repair (%,)an,Individual Sewage Disposal System atNo.......<--(.......... ........... ............ Z"/-&.......................................................................... Street as shown on the application for Disposal Works Construction Permit Dated------- ................................... ................................................................. DATE.......... ..................................... 'Board of Health FORM 36808 HOBBS&WARREN.INC..PUBLISHERS . . . . . ._. . . . . ______ __---__.__________ __ _ -__ ____________ __ _ _._____-_ ________ _ _. ' 1 R.-....C»a »w..Y' „y...`.. . .-.-. •-.. �-.J�t.-...,,r�v� ,.. ;,.�...a,.+���-..i6�.n..-�.rxlr•..-.-...-,^%i�......L`...........-...� .. y�:..r�-s.�.�..ty��,- �. ..^ r.. No. G/...1 . Fes$..... ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �r TOWN OF BARNSTABLE Applirativit for Di�5pmi tl Wi ark,i Tomitrurtinn rantit Application is hereby made for as Permit to Construct ( ) or Repair (_,., )-an Individual Sewage Disposal Systemp.✓�............."-�•<--------•-•----.. _...._ �• .............................................................................. ..........•• �'� . . �..................................................... Location- Address or Lot No. ......_._(4. �1.Z. kj P_ _... •••••--- ............••••.. .....tIrC�.............................................................. ----••'--------------------••-----•---------Address I[istalIer Address � Type of Building � -.. >f L� ansion Attic Size Lot.•(,�rba e..Grinder feet a.-� Dwelling gNo. of Bedrooms-----------•-............ of'persons.....................(...-.)Showers � � q( ) Other—Type of Building,, �.= jp ` 5 we s ( ) Cafeteria ( ) Q 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........................................ 04 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ---------------------------------------------------------- ••......... •-••-------------------- •-------•................... --•-•.... •-••••.................. • 0 Description of Soil-----------------------•--------------------------------------------------•-•---------------------------...----•--•-•---------------------------•••••••................. x w x •••-..............................•----•••-•-----••---••------......._.......---•--...•••-••-------•---••-•---••--------------•---•-•--•-•--------•••-•••-•••-......••••.........-•-•-•......•••--_..... U Nature of Repairs or Alterations—Answer when applicable._/--:-.L.�A-6— .._.�:A _.___., r�J !c:....../a........./............... ......... -------------------------------------------------•----... ----..... -------------- 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�isssu�ed by the board of health. Signed ................................... — -0------ Gr-> �d� — 3 Application Approved By ............... �..,s %<t.:. . .. .j l c� Dace Application Disapproved for the o lowing reasons: .................... . ...... ............................ -- ................_................................... ...................................................... ................... ........ ..... .........qq .... . ................. . . ... . ............................-- .......--------------- ........................................ Permit No. .... /. ............. ...... Issued ..................... Dam