HomeMy WebLinkAbout0022 MONOMOY CIRCLE - Health 1Vlo omoy Circle
Centerville \
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O%r ford, NO. 1521/3 ORA
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No. . .. ......... FRic.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD 0 Lj.5;- HEAL-1
Z"t..........0 F......... .. . ......................................I............------------
Appliration -for 43hipotial Worho Tonotrurtion Vrruift
Application is hereby made for a ermit to Construct or Repair an Individual Sewage Disposal
System-at:
Vr, I I &�Z�P"" -��
a ermit to 41.1t 0&.. ............
.............. .... .............................. ........ ........ ..... _ .................................................................................
C , . ddress -1600 - or Lot No.
.. ........... ................................ ...........�*
�7............ ......................................................
Owner Address
.... . ... ...... ..................... ............
Installer Address /
....
0 ........ --- -- ---Type o Building Size Lot.......A61_1"Sq. feet
Dwelling—No. of Bedrooms--.__.___._.....................Expansion Attic Garbage Grinder
PL, Other—Type of Building ---------------------------- No. of persons..-_____-_-__-______-___..._ Showers Cafeteria
P4Otl e xtuLa&______-_—------------------------------------------------------------------------------------- ----------------------------- .............
Design Flow JS Mons per person per day. Total daily flow_._.._. R------ ---------------gallons.
S "L'iq"t'lid'*'c"a"p`a"c'i't... ........ allons Length________________ Width._._..-...-._.. Diameter___._---- ...... Depth---------------
P4 Septic Tank �Oa
Disposal Trench—No .,......... Wid)ll- ------- Total Length_-_-_____-_______--- Total leaching area--------------------sq. ft.
Seepage Pit No--------- Z i;
------ Diameter..ev Depth below inlet____________________............... Total leachl a....20--1----sq. ft.
I _—7
Z Other Distribution box Dosing tank /Ck�- 2_,2 S �g are,
Percolation Test Results Performed by - 4 Date-----
-7�- -------------------------------------------------
Depth of Test Pit........._-__.__.__. Depth to ground water.--.-----.----.------.-.
Test Pit No. I................minutes per inch
0-4
;�tl.e�r ,t u.ca"
fX4 Test Pit No. 2------ ---------minutes per inch Depth of Test Pit........_..__._.____ Depth to ground water.........---_----_------
----------f....../---------:7-
------ -- ---
0 --- ---- --------- ----------------- --
.. ....... .
Description of S(�l ....... -- ---- ........
U ..............P-.12- _ .> ..................................................... ......................................I--------------------------------
---------------11---------------------------------------------------------------------------------------------------------------------------------------------- ---------------------
U Nature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------
--------------------------------------------- --------------------------------------------------------------------------------I--------------------------------------------------------------I---------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code de—The undersigned furoer agrees not to place the system in
operation until a Certificate of Compliance has beenisstled by the bo hea th.
000ro.
SinIF---- ----------------- --------------- -------------------------- ---_--------------------
Date
Application Approved By------- -------- -I ................... ------
Date
_0e
lea�7 9'�
Application Disapproved for the following reasons:...................................................... ---------------------------------------------_......
....................................................................... ............................................................................................................... ---------------_
Aate
PermitNo......................................................... Issued....... ...... - ----------...................
Date
-----------
SEWAGE PERMIT NO.
LO CST
VILLAGE
C �N T�12 t>i11 E >l�y o
IN.STA LLER'S NAME & ADDRESS
B U I'L D E R OR OWNER
�-
0ATE PERMIT ISSUED
DATE COMPLIANCE. _ ISSUED
,a
._ _ �
�,p��
�s'
No............ -- -------- F��.. �..................
4 THE COMMONWEALTH OF MASSACHUSETTS
~ BOARD OF HEAL
Appliration -for M_gpoottl Eorkii Ton,strnrtion Vrrnift
Application is hereby made fora ermit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
ocatid Address or Lot No.
"r Owner '...f J � Address
................................... ..e . .....6'°w#� � .....................................................
Installer Address
UType of Building Size Lot....... _ ' 'Sq. feet
Dwelling—No. of Bedrooms__-______-_:�-.�"`'`---------------------Expansion Attic ( ) Garbage Grinder (f�/C:)
pa-, Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
p_I `' :
Otheures ..--"'--___------
S .,1 �...
w Design Flow. ______...............gallons per person per day. Total daily flow........ ?........
____-..-..._-gallons.
�
Septic Tc.nlc—Liquid capacity/____-____ allons Length---------------- Width-------_........ Diameter................ Depth-
xDisposal Trench—No _.__''_____.__. Width._._. Total Length--------_---------- Total leaching area___-__-_____--______sq. ft.
3 Seepage Pit No_____________________ Diameter. Depth bel w inlet__ ._________.___ Total lea l,Og area--_''__---
--- ----I ft.
Z Other Distribution box ( ) Dosing n »') ' ! '" � ''�'�'` r
a
Percolation Test`Results Performed by-_. Y_________________________________________________ Date.-.- - -` -S'"'_ ------.
Test Pit No. 1----------------minutes per inch Depth of Test Pit--------------_..... Depth to ground water---_______-___-________
Test Pit No. 2......_.........minutes per inch Depth of "Test Pit-r___________________ Depth to ground water................._____-..
.../
Descrion dSbll / --- -- -------- - , d
x --------------- �------ ,
-------------------------------
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 Article \I of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the bogrd-of health.
Si 7A-
. • --- ------•-•-••-
Date
Application Approved BY ; `------•-•--------------- .. __. .. •-•-_.
'• �' Date
Application'Disapproved for the following reasons;.;---------------------------------- --------------------------------------------------------
- -- --------------------------------------------- ------------------ ----------------------------------
r Date
Permit No.--••---•---••--••
- w.�,,,.. Issued----------------------:.................... ......
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..............oF.... .. ....:..... .............
Q.,rrtif iratr of Offlkolnpiiattre
T WS, S T Y That the Individual Sewage Disposal System constructed �) or Repaired ( )
by
iii ! er nstZll
r7 }
at - -------• - :--- - `'"-- ' -------- w"...................................................................
has been installed in accordance with the provisions of Ar -I o The State Sanitary Coe as�e cribed 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 -----------------= ......................... Inspector,........................................:_; .........................••-••---
THE COMMONWEALTH OF MASSACHUSETTS
BOARD PF HEALTH
No......................... FEE.•��..•--_....
:,._ .��• �� , o �M:q
`Permissipis hereby granted- '
r to C ry °t ) or. air ( ) an Indiv atl S age spos Syst
ey'!
Street
as shown on the application for Disposal Works Construction mit o ____ Dated__/�✓�'"'_� __________________
DATE::_•- '� Board of
�...--.:"-7 "
ea +
FORM 1255 HOBBS & WARREN. INC.: PUBLISHERS
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1.10 GATZSAGE GRI�..t��1Z 2.0�
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TOWN
OF BARNSTABLE
LOCATION SEWAGE #
'VILLAGE(,,tw ieYv� I,t �3
ASSESSORS MAP 6� LOT ���
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS 3 PRIVATE W LL OR UBLIC WATER
BUILDER OR OWNER • V"DY CN V, Dy(Cf
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes hvU15 t 4& wi.(owell'
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