HomeMy WebLinkAbout0066 INWOOD LANE - Health 66 In wQ o d eve
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No......-.....APPROVED Flcs..... ...."
S8M8t8W9C9n=NetjmDC'p&W,9n=THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH 1�
• OWN OF BARNSTABLE - a1 9
Appliration for Ali►ipwml Hlurkii C onfitrurtitun rrrmit
Application is hereby made for a Permit to Construct ( ) or Repair (�n Individual Sewage Disposal
System at:
..........7........-���dQ�......� ..................... ...•----•-•'••-'---••---._...........•----'••-----'•-'••------•----............._.................
Loc tim-:\ddress or Lot No.
-------•---•-------•---------------------------
Q o" er ////�//� �fAddress
W . ,/mot �CC� ��.....'.eC.1��:.1........l.l_d..___ 516.�...... :
Installer Address
Q Type of Building �/ Size Lot............................Sq. feet
U Dwelling— No. of Bedrooms-------- -----------------------------__Expansion Attic ( ) Garbage Grinder ( )
Pk Other—Type 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 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........................................
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
a ----•-•-----------------------------------------------------------------------...........•.......
..----------------------------------•-----------------------
0 Description of Soil.............................................--------•-'--•.........._.........-•--•---.--......---.........-•---••-••--......-'•---•••••-••-•--....................---
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W ...'--•--------------------'-.......
U Nature of Repairs or Alterations— nswer when applicable._..-�,5/.z-���____ F!.� �!!f................
a-re i Q a�s �5" �Xl ......OFF.'-•--��(,��4 _.......fo0.,Q..... '�l......L5.:epA�-4•.. /4,vk
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 e n iss. d by th, board of health.
Signed ........................ ............ ................Da.............:......
11�
Application Approved By . '� :.. ..................................................... ..........%.�...-..�....
---------
Dare
Application Disapproved for the following reasons: ......... ... ........................ ................................. ...............................
............................................................................................................... ... .................................................................. ........................................
q, _ Date
PermitNo. ......f..... ... G..S... ................ Issued ...................................................... ..........
Dare
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certifirate of TIImpliance
THIS IS TO CER IFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( v<
by .... ..........
c1�I7+f
at ........'7..............:.. !✓`�!/�� C/'.......,/ l/ '.....-... .�� 1�-� ..:. ......................... -
has been installed in accordance with the provisions of T1TI.E 5 of The State environmental Code as described in
the application for Disposal Works Construction Permit No. ......�?...�_--..Z,-.:�, -- ... dated _........_. ................_......._.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE........1.----..•—J.... ..�.�''........`....._ __--- Inspector .. . ---- � - -- _ _..........._..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
No. - �'..... FEE....13
Disposal arks Tunitrudion "erntit
Permission is hereby granted ''-- t4----------- 1 'J/l?--•---------•-•-------------•---.---_.-_-------.---_---_-----.---..-----------
to Construct ( ) or Repair (�r`a1n Individual Sew-a.e Dis osal System
°z!-4?.----.....----•----.� .... /.r9f?CJ!'. [�. -•............ ..................................
trcct as shown on the application for Disposal Works Construction Permit No. �_._l_.s/!�.. ..__ Dated.......................
Board of Hcaltlt
DATE.............. ` _ ----------------••------------
FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS
ate, yr. •.
TOWN OF BARNSTABLE �
LOCATION uayf� v SEWAGEUAL-
# - (
VILLA � �G
_ ASSESSOR'S MAP & LOT � d
INSTALLER'S NAME & PHONE NO. A & B CANC,'O 775-6264
SEPTIC TANK CAPACITY%'X/s f/,✓4A��
LEACHING FACILITY:(type)f �itf/=�L fi�it fi4izs (s ) 3 �,
NO. OF BEDROOMS ,PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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THE COMMONWEALTH OF MASSACHUSETTS
-S,BOARD OF HEALTH
TOWN OF BARNSTABLE (�- a1 9
Appliration for Diriiaoonl Work.. Towitrurt"tun Famit
Application is hereby made for a Permit to Construct ( ) or Repair (fin Individual Sewage Disposal
System at
.Z0 �0
,( /— Locltion-Address /+ or Lot No.
.......
O-ne, Address
Installer Address
Type of Building Size Lot............................Sq. feet
�., Dwelling—No. of Bedrooms-------."_7___/`____________ __________________Expansion Attic ( ) Garbage Grinder ( )
per4 Other—Type 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 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........................
(i Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
04 -------------------------------------------•---.............---•---•----.........................---..............................
_____........
••-•----------
0 Description of Soil.........................................................................................................................................................................
---------------'--------------------.......---------.......---------------------....------------------------------------....__.....------s-.........................................................
0 Nature of Repairs or Alterations—Answer when applicable._-.E/7,,1i*�/l_.../49--------aZ�tJF!ltIAlel✓s........._ ......
..._..l�!%.ul. ...._I f...._� __._..�! - ---....0,FF ' ..........
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 inissued by the board of health.
SiSigned
.................. ... t.... . - a��,...�.............. .................. e :......
g D.ate...........
ApplicationApproved By ............ J J - 4.......- '................................................. .......... - -..-..��
Daze
Application Disapproved for the following reasons: ......._..._.............. ' ''"- ............._.... ..................................._...................
................................................................................................_._......._..............--......_....._..................................................................... ........................................
PermitNo. ...... ... ....—..:..�......----�----------------- Issued ..---------------------------------------------.---------------
ii Dare