HomeMy WebLinkAbout0098 WILTON DRIVE - Health q? vjl L
eie SMEAR
M 10.QQ
2-153L
_ MApF IN I,IC.A
FAT 0 PGANQEQ AT SMFAn COO
TOWN OF BARNSTABLE
LOCATION %� /GT��� SEWAGE #
s
VILLAGE Mery ��� ASSESSOR'S MAP & LOT� F-dq
INSTALLER'S NAME & PHONE NO. 1
SEPTIC TANK CAPACITY /Soo GJa-
LEACHING FACILITY:(type) ` . • (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATERPr
BUILDER OR OWNaTw ALT
DATE PERMIT ISSUED: -_ . - 16 _ -:-
DATE COMPLIANCE
VARIANCE GRANTED: Yes No ��
p /N-OlMo-
%
No.-��- .. Ficz.3. .
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
TOWN OF BARNSTABLE
Allp iratiun for Uiapaoal Workii Tome rnrtiun ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
-ration..Add s or Lot No.
W Owner Address
•-•----------------•--•------•---
Installer ^----..
Address
Type of Building Size Lot.................... .....Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
� e of Building a Other—T yp g ____________________________ No. of persons--------.------------....... Showers ( ) — Cafeteria ( )
d 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 ( )
1.4 Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit---.......--........ Depth to ground water..-.-.------------------
f� Test Pit No. 2................minutes per inch Depth of.Test Pit....---............. Depth to ground water----.........--.........
0 ------------
-----;�----------------•••-------------•-•---•-------------•..--------------.....----•-----------•-----------------•--------------------•--
xDescription of Soil------------------ly ----�.,&Aff -wu..-------•----------------•-•--•---------•-•---•--•---•-------•-•-•---•--------------•-•----------•--
U ----•••••.................••••••-•••-•----........--------•-•-•-••.....--------•-•-•-•----•.......---••----•-•-•---•••••-•--•-•-•••-•-•---•-•---•---••-•••---•------•----•-•---•......--•-•--•--•----•--
W
x -•-•---•---•-----•------••...........................................................-..................................................-........•....................................................
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 furt er agrees not to place the
system in operation until a Certificate of Complianc been issued by 4thboard of althSigned ------------ ----- ? _y
Date
Application Approved By ............. �... �A��--..............---------------------------------------------.--- ......... .---�. ..--' �
Date
Application Disapproved for the following reasons- -- ------------------- ----------------- ---------- -------------------------------------------------------------------
---------------- --- ----------------- -------------- -------------------- ..................................
PermitNo. ..... -t�---'--..3�------ ----------------- Issued ........................................................
Date
No._7.sa2._:.3 3 c
THE COMMONWEALTH OF MASSACHUSETTS
— BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratiun for Diu-puuttl Works Tunutrnr#iun jJamit
Application is hereby made for a Permit to Construct ( ) or Repair ( } an'Individual Sewage Disposal
System at:
topn-Aj = or Lot No
----------------#a—�......� � ss 4 .
Owner .
—Address
a -----------------�__C_C------- »��--------------------------------------- ----------- .-.------------------------
Installer Address
Type of Building Size Lot---------------------------Sq. feet
V Dwelling—No. of Bedrooms_____________ Expansion Attic ( ) Garbage Grinder ( )
- —
p, Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) Cafeteria ( )
cw 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 ( )
aPercolation Test Results Performed by-------------------------------------------------------------------------- Date----------------------------------------
Test Pit/-No. I................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------------------------
a ----------------------------------------------------------------------------------------------------------—-----------------------------------
ODescription of Soil-------------------Y= -----------------------------------------------------------------------------------------------------
V -----------------------------------------------------------------------------------------------------------------------
= -- ___
UW -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
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 Compliances been issued by th
- board lth.
Signed ti -
- ----- �Y
Application Approved By -------------�j ------ [ -. ,-w^` --------------------------------------------------------------- ----------
Application Disapproved for the following reasons:
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------
PermitNo. --------f vZ 33--`------------------- Issued ------------------------------------------------------------------
THE COMMONWEALTH OF MASSZ442#a
BOARD OF HEALTH
TOWN OF BARNSTABLE
(9er#tftrate of (gompliance
THIS IS Q CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by ------------------------ ------ /Q ---------------------------------------------------------------------------------------------------------------------------------------------------------------------
t��te
at ----------------------------...... .G------G(1�11'J� o' /Deel-V al-------------------------------------------------------------------------------------------------------------------------------------
has been installed in accordance with the provisions of TITLE 5 oLMe State Environmental Code as described in
the application for Disposal Works Construction Permit No. -------- -33._ __ dated _________________________....__________.____
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE------------------------------------------------------------------------------------------------------- Inspector -------------------------------------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Rnsttl urkii Tun ft
Permission is herebygranted--------------- __ _ ____ ��
to Construct ( ) or Repair / an Individual Sewage Disposal System
atNo--------------------------F4-----------------------1-V.1-1,mz-z ---------------------------------------------------------------------------------
Street q
as shown on the application for Disposal Works Construction Permit No.1- :J3 y Dated---------------------------------------
r--------------------------------------------
0
DATE-------------- l '---------------------------------
Board of Health
FORM 36508 HOBBS Q WARREN.INC_.PUBLISHERS