HomeMy WebLinkAbout0035 ALLAN ROAD - Health (2)r35 Rllo✓i RvO , (en+.
TOWN OF BARNSTABLE
LOCATIO 14LL4^J /eD SEWAGE #
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VILLAGE L'fa�JT�Ul W6 ASSESSOR'S MAP & LOT/ QO/-6�a
INSTALLER'S NAME & PHONE NO.,,9'0,97Z0&)W7 ed^js-1 ,ice
SEPTIC TANK CAPACITY
LEASHING FACILITY:(type) 'i7� � (size)
NO jOF BEDROOMS VATE WE R PUBLIC WATER
B ILDER OR OWNER
DATE PERMIT ISSUED:
7
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes =No
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L0CAt-WN S I W A C E PER'RIIT NO.
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VI LLAG E How+ '3S
ASSESSORS MAP N0:
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PARGEL
I N S T A LLER'S NAME & ADDRESS _
(70
e U I L D E R OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED UAL
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR®" OF HEALTH
TOWN OF BARNSTABLE
App iration f Or Dispwi ai Marks Tnnotrnrtiun ramit
Application is hereby made for a Permit to Construct ( ) or Repair X) an Individual Sewage Disposal
System at:
...... `.-_._ ..........................� ...,..............:......... �f�.t,Ji�tl/ll�
ocatio -A dress r Lot No.
�---•---•_..���.----------�91v. � I�iLL ................
Own Address
a � T4�D/1j-rg2�sT.._....���.
Installer Address 7
UType of Building Size Lot__... 1.4!5.W ..Sq. feet
�-, Dwelling No. of Bedrooms...............y___.______._______._.__Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons____________________________ Showers — Cafeteria
a
� Other fixtures -------------------------------•-•--------------------.---------•-•----------------------
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid ca.pacityZa.O.gallons Length................ Width---------------- Diameter................ Depth................
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........................................
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
�r4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 -------------•-------------------•-------------------•----•••--•----------------•------------__.._...---•---------------------------=------...-----__...-----
0 Description of Soil...............................................................................---------------------•-------------••--•-------------------------------.......••-------
"� '
W
.1---------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------
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- as een iss d b he board of health.
Signed ----- =-------- ------------- - ---- - -- ---- ---- ------ ------------------
Application Approved By --.-... �1� 14 Y/
Application Disapproved for the following reasons- --------------------- ----------------------------------------------------------------------------------------fe---------- -
-----
`u P.Dace
PermitNo. ....... `/ a R ------------------- Issued ..................................... --------- ----..-------
Dma
No.....f.,�_. G Fs$..... 0 J
THE COMMONWEALTH OF MASSACHUSETTS
_ . BOARD OF HEALTH
- TOWN OF BARNSTABLE
Appliration for Disposal Works Tonstrudinn jhrntit
Application is hereby made for a Permit to Construct ( ) or Repair X) an Individual Sewage Disposal
System at:
-- •- J�-�r-...... G!! vJ / r c�lJ/LLf....................................................••....
Location-Address or Lot No.
- -----
Address
lj... =OAJsT.------��� GiJJ�� , ?LLD...----
Installer Address
U Type of Building Size Lot.__J.�,;� -- ..Sq. feet
a Dwelling_No. of Bedrooms............... ...................... Attic ( ) Garbage Grinder ( )
aOther—Type of Building ------••---••-.--_•--___-•-- No. of persons............................ Showers ( ) — Cafeteria ( )
d Other fixtures .-----------•-----------------------------------•......---------
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity.//a.Ogallons Length................ Width................ Diameter................ Depth................IV
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........................................
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........................
9 -----------------------------------------
•---------------------------------------
------------
•-------
---------------------------------------------------------
O Description of Soil........................................................................................................................................................................
x
U .....--••••••-•-•--••------•••-••••-•-•------••....--••----•-•-••---•-----•-------•-•...•-----•-•--•-••----------•--•-•-•----••••--•-•-•------•...---••••-----------------------------••-•-----••----•••.
w
x ......••--••------------ --•----•-•------•-•-•••------•-----------•-----•-•••--•-•-•--------••--•-•---••-•-••......-----•-••••-•-••--••.-•---•-----•--••-•-• --------------------------------
U Nature of Repairs or Alterations—Answer when applicable____- -------
-6%1 _.._p!7J..__ .--..
-------------s.._5nY5.----•-------------------------------------------------------------......------------------------------------------------------------------------------.........------.
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 As een issu- by,• e board of health.h �
Signed ------ ---- ------------------------------- .....
Application Approved BYr,-: � w --------------------------------------- --------- -- �' ,�------
Date
Application Disapproved for the, Yowing reasons• -- - ----------------- -------------------------------------------------------------------- ------------------- ------.
- - --------------------------------------------------------------------- ---------------- ---------- ----
C�
------------- ---------------------------- ----------------------------------------
- - / Date
Permit No. -------- r 1 - Issued ---------------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Cfertifira#e of Torayltttnre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( �)
by �> �� �QL7�f.------- �6�lJs'TCJL?1DN..
Installer
at ---------- ------------------------------------------- �5 C� CJ/G...G� - -
has been installed in accordance with the provisions of TITLE 5 of . e State Environmental Code as described in
the application for Disposal Works Construction Permit No. ............. .... dated .. ...)......................---.__-.____--__
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE......C_ ........ _t/.._-.....1.� Inspector ... a— .". -
v
THE COMMONWEALTH OF, MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
No.........•--•--•• FEE........................J...
Disposal Works TonstrudianDprrutit
Permission is hereby granted.................!. ,—'01-7 7 __._.._fl OAJZ_TWCJG7701
........................ ..........•-•-•-....._-----•--
to Construct ( ) or Repair (n< an Individual Sewage Disposal System
at No............................................ 4' --•-- C` �l/Gt
Street
�•_as shown on the application for Disposal Works Construction Permit No..���:�/*4 Dated..........................................
` ............................. R._\_
�J _ ` 9 j Board of�Health
- DATE............... _--7-V ...............................
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FORM 36508 HOBBS h WARREN.INC..PUBLISHERS