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HomeMy WebLinkAbout0119 ANNABLE POINT ROAD - Health r I q A ttm wit fd Celt rv;N8 2 h) - 03-1 k A, SMEAD KEEPING YOU ORGANIZED No. 12534 2-153LOR SUSTAJNABLE q MIN.RECYCLED jQ INITIATIVE CONTENTIOAV CergfieOFiberSourcing POST-CONSUMER wwwr.sfiprograrUrg SU1290 MADE IN USA GET ORGANIZED AT SMEAD.COM TOWN OF -BARNQS,ATABLE ! LOCATIO I W Gl �� ►�7 _ SEWAGE # — VY VILLAGE Ct�.t ram➢ °&. _ ASSESSOR'S MAP & LOT D L-= f INSTALLER'S NAME & PHONE NO Q."&Q ►J��C�S. `I��' V�� SEPTIC TANK CAPACITY 1000 e 11 LEACHING FACILITY:(type) p.._ � � (size) 1 Q©-0 NO. OF BEDROOMS PRIVATE WEI,L 09 PUBLIC/ WATER BUILDER OR OWNER `� ck uu� elr DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: �- VARIANCE GRANTED: Yes No (/ IL I 0 lC 9 fip(Wt, 14 �o► � - 'd, , My z n u t �r � f t t e.t LL , w, T � A , r er w c ♦ , a k. J a. xa •. a .v x+ � a s � .. F .. . t s• s a x r: E A ' 4 .k�� ail ., � o _ • r „ s f v. .r. +r =. w : n - i ltr , ,r r N a r p, 9 _ No...Zj=.. VVT14 - 3,10 - t" 0 THE COMMONWEALTH OF MASSACHUSETTS FEz (3........ APPROVED BOAR® "O F HEALTH "rnMblo CW=rvati"0 TOWN OF BARNSTABLE . ppliratiun for Disposal Works Tnmunrti n ntit V= Application is hereby made for paDPermit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sy tem .,at.ti+`Tk��J e.�/J •� V �Q Location-Add e s n I a Address Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) `k e of Building Pk Other—T yp g ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) 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 ( ) a 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........................ f� •----------------------------------------•-•----•---------......----......-----...:...._._........ 0 Description of Soil........_. ... ......_..-•-•---•-----_------------................................... -•---•--•-• --f....-... ------••••-••---•-•------••----••-••-••-•--••-•--•---•--•••-----------••--•-••-•-•--••••. W x -------------------------- ------------------------------------------------------------------------------------------------------------------------• ---•-•------...._..•-••-•-------•------•--•------. U Nature of Repairs or Alterations—Answer when appli e__ ___________<}— 4a C`,�.�) Agreement: 1�5 C`��5�'` , c9 O i �LThe undersigned agrees to install the aforedescri Individual Sewage Disposalystem 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 Co 1 nce h b issued\y.the bo�f alth. Signed ...... Q... .... . 1.. ........^-- ------ ApplicationApproved By .. ---------------------------- -- -------------- -- --------------------------------...................................... L Q.......�. — D ate Application Disapproved for the following reasons- ------ -------------- --------- -------------- -------------- ------- -----------------------------.. -....-------------- .......... ...... ............ .. ......... ................. ....... .... .................. .... ....... D PermitNo. ------------------------------------------------------------.. Issued ....... ........ ....... [©..........� ate.................................... No....? yyFxs >Q. v - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for Disposal Workii Ton,otrn.rt' n 1hrmit Application is hereby made for a Permit to Construct,( ) or Repair ( ) an Individual Sewage Disposal y� e at ww C �-e_ � 2� / i � i l t 1/jam - ............`....._...........N...... ....---•-.....---�------------ .. .............---- Location-Add e s t No ..\< - --..... '� �.�• Address a .._.--v"C--\••-.A...... . .........l...Re_..1�+_:.`4 .... ...... .----5....0••>`-----�-1••^�--'--�-�`-----..SA�....... Installer Address UType of Building Size Lot............................Sq. feet I—I Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aa Other—T e of Building ............... No. of persons............................ Showers YP g ------------- ------------------------P--- ( ) — 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 ( ) Percolation Test Results Performed by-----------------------------------------------------.................... Date........................................ a 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 ........--•---••-•••••-•-••-•-•-------•-•-•-•-•-•---•----•--------•-•-------------------•--•-•--------••••••------•-•-••••••••---------•.......--•-----...... 0 Description of Soil.......... ... - /---•----------------------------------•-----------••--�-------- --•--------..-�-�`--V-�---------•------------------------------••-----------------------•-•-------.._......-•-- W r U Nature of Repairs or Alterations—Answer whe appli G_.t----------- _____ ___ _ Agreement: ��� C �k S} 4 e� . C�O O SeCtem t k C The undersigned agrees to install the aforedescrib Individual Sewage Disposal 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 Co 1 nc�e h11 a��b en issued by the board of alth. Signed.... IJ�.� t.. .. -<�, i� ..q.. -�..�I ----------- ApplicationApproved By --------- ------------------------- ------------------------ ------------------ ---- -------------------------- ---------------- ---- g ..-.... . Date Application Disapproved for the following reasons- ------------------------------ --. --....----------------.. ....---'---------........-------------------------. ----------------- -----......-- --- ------ .-- ---------------...------- ------------.-------...... ---....--- ---- -------............------------- . ........------....------.. ....----------------------------------- Permit No- ------------------- --- -- ----------------------- --- Issued . .................© .Z Date Date" \ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Ttrtiftra#E of Tontylian e HI IS TO C RTIFY, That the Individual Sewage Dis osal System constructed ( ) or Repaired ( ) by..-----.. . -�c` -1.. - '--... - w-aN...................�(L� ------- ---....... at .......... ............... .. .-----------------.....................�- .......... o..:....... Ce,� .� -( 5 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. ..........�,�..a,---Y.Y-.K..-- dated ---------------------------------------_--.---- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM W FUNF_ION S TISFACTORY. O DATE..................... ------------------------- ...---r-----------...-----------.........------ Inspector ........... ...... ---------------------------------------. ---- -- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH / TOWN OF BARNSTABLE 2 No........................ d tC� L. t./ FEE. ?.................. �tu�ru1 Turku C�unu�r�,r�Uan �ernti� Permission is hereby granted.. ___. ' .... ..� . ...........�-'� `r ` L� to Construct ( ) or Repair (L, an In idual Sewage Dispo l System 1 at No...................... ...... (�� -----..--- r_ �D w .v Street Q� r� as shown on the application for Disposal Works Construction Permit No----&n Vtl�K. Dated-__ ..........Q ,......... O ( � -----------------•----------......-s ...................................................... r Board of Health ---- DATE....... .... -•-------••--•---------------••. -------•••--•----- v FORM 36508 HOBBS&WARREN.INC..PUBLISHERS