HomeMy WebLinkAbout0058 BUCKWOOD DRIVE - Health - 58 Buckvvood Drive
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LOCATIONS$ SEWAGE PERMIT NO.
VILLAGGE
I N S T A LLER'S NAME R ADDRESS
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0 UILDE R OR OWNER
DATE PERMIT ISSUEDle
DAT E COMPLIANCE ISSUED �f ��
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THE COMMONWEALTH OF MASSACHUSETTS
MAP n 21 BOAR®7OF HEALTH
PARCEL -M5 003 =T oF.:..... -
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�ot 3 pp artt ion for Uigpooal Works Tonilrnrtion Vamit y.
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at:
...................•........... ..--•-••-•----..............: r -'- -----------•--•------ ........................
Locatio -Address or Lot No
Eli ... 1 � 'vim.-•----•-----•---•-------... . 15;{---.....! �'� ..��' �
ow Address
Installer Address
Type of Building Size Lot__-4?.C?0.0'5�P...�!Sq. feet
U
,., Dwelling—No. of Bedrooms---- __ ______________________________Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building ........... No. of persons___________________________• Showers — Cafeteria
Otherfixtures -----------------------------------------------------•-•-------------------------•-------------•-----•--•---------•---•----•-•-------•--•-•-------•-
Design Flow.......... .......................gallons per person er day. Total dail flow.._...... 5;. .gallons.
WSeptic Tank—Liquid capacity&—.gallons Length_ Width----- _..I... Diameter________________ Depth_.�11_151--
x Disposal Trench—No. .................... Width................... Total Length................./ Total leaching area....................sq. ft.
_---- Diameter...._.. _..... Depth be ow inlet.......____. Total leaching area...
� Seepage Pit No______________ � p 1, g .sq. ft.
Z Other Distribution box ( G. DIsing tank ( )
'-' Percolation Test Results Performed by-_._ -C " _._ �.. '�. _ Date__.__ Z.
o ..-
,� Test Pit No. 1___ng:;�.2—minutes per inch Depth of Test Pit-_,1,�� .__ Depth to ground water-__
(� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
......
•--- -•----------------------------------------------------------•--------
O Description of Soil ..... �' C----•----. ..._..
U . '-- - � r>J_a� " 'r'�---'e''� '�---------- ------
W Nature of Repairs or Alterations—Answer'when- -- P PP
ti
Agreement: D
The undersigned agrees to install the.aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITLL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
' operation until a Certificate of Compliance h en issue by the b health.
0001
igned--. ---•- .....?--- ------- . --- - . ....�-------
D
Application Approved B -' ..... .Dafe
rl
Application Disapprove ..o the following reasons----------------•----•-•-------------------------------------------------------------------...........-----•...
...................•-•--•----------•-•--..._..•-•••-•--------------------••--•--•.....------------.......•--•---------•----------•-----•••-------••-----
x Date
PermitNo......................................................... Issued.................................I
x
No. p f ..... c,,. Fim ............ ...............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
� C✓�`J... 0F.....' 1 S r.........................
Apptiration for Disposal Works Tonstrnrtinn thrutit
Application is hereby made for a Permit to Construct (C•)'o Repair ( ) an Individual Sewage Disposal
System at:
................_--.............................................................................. ............................................`` -------------- ------ ------------
Location-Address or Lot No.
F= ......................... ,': �`'"C.••,,rG..-c'.
Owner Address
..... . . ....!__
....,v.
Installer Address
d Type of Building Size Lot__ -----------------------
Dwelling feet
Dwelling—No. of Bedrooms_________________�_�_'_______.____._.._.._Expansion Attic ( ) Garbage Grinder ( )
pal Other—.Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
a Other fixtures .................................................`=• . - 4
W Design Flow............ ?. ____________________gallons per person per day. Total daily flow.......... cr?_. ..........gallons.
WSeptic Tank—Liquid capacityrc JZ.0 gallons Length_.r_': ......... Width_.._.:r-11...... Diameter________________ Depth__' `�..--
x
Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No....... ............. Diameter.__. Depth below inlet........ _ .. Total leaching area... C!_'_sq. ft.
Other Distribution box Dosing tank
'-' Percolation Test Results Performed by / ! _-_ _«�'..J... ��r:'____E."~�_.�__ Date_.__.` '.j_ _� ....
aTest Pit No. 1...!_.7-:minutes per inch Depth of Test Pit...r�f... Depth to ground water.....n::_-'
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a --------•-------------------------------------••-• -•---•---•-._...-•---•--.........---.........--•--•--....---•.._..---•--------••-•---•----•------......•.
O Description of Soil.......�------' �r (0=�' - ` ``J�t = - i< --------.-.........................................
UT l.......--?-----�-�' t.-� . . . •�- ,. ----__-�-..--_____..::�`'................r.............................................................-"� i
W ..................................................................................................... ••-------••--------------------•--------•--•--•--•••--•-•---••••-•--•----••-•-••---..._•----•-•--
UNature 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 TIT1E 5 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 board-of health.
igned__!-,":<..1•--..:!____:__--\.: 'ram .-_'�,--- ---- ��. .
D
ApplicationApproved By"`-- . .---•---------•---------------------------------------•-------•---•--- ------•------ f ...
Date
Application Disapprove o , the following reasons------------------------------------------------------------------------------------------------------------•---
--•--•••--•-•-••••-•----•-.....•--------•••------------------•---------------------------------------------••••••--•----•--•----••-•---•----•----••---•---•--------•••••-•--•--•-•-•------------------
Date
PermitNo......................................................... Issued-.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF.....................................................................................
wrrtifiratp of f�untpliFanrr
T��:_
S'IS TO-,--ERTIFY, That the Individu Sewage Disposal System constructed ( or Repaired ( )
b -•--- --------------------------•--•--•--.....------•--------.._.............-•----•---... _ ......._...._.__
y -- -
17
------------------------------------------------------------- ------- ----------------------at__..._ .-•- --•-••-•••- --•- •--•- •••- - ----�----------_Installer /"
has been installed in accordance with the provisions of TI �1` o The State Sanitary Co . as scyfbed in the
application for Disposal Works Construction Permit No... ..-.-.--•---.-•-• dated_. : __� ___
THE ISSUA CE F THIS CERTIFICATE SHALL NOT BE CONSTVW AS A GUARANTEE THAT THE
SYSTEM FiJ�ION' SATISFACTORY.
DATE.--- ..._�.......................................•-....__.._.. Inspector!..
A
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF.....................................................................................
No......................... FEE........................
Dispo' at IV ks Tnnsirnr##ion .rrmi#
Permission is hereby granted ^`- � ` (ispoQ---- ----• -----
to Construct ( o e it ( ) Individ Sewage System
1:
at No.............. a .3- ��� �
• "Street
as shown on the application for Disposal Works Construction Permi++/�` o.__.._____ ated..........................................
.......................... ........- .............................................................
DATE...... _,Z.7 ._.
-------------------------------------••-••------ Board of Health
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FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
TOWN OF BARNSTABLE
LOCATION,-'59 BUCkLIJ004 D - SEWAGE #
VILLAGE NgCI nn-1 Z ASSESSOR'S MAP & LOTo Z9Ld-f Z-0-3
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS
Bb'FfhE)ER-9R OWNERtl
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility (If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
F
20 f'f Min.
Go✓el-5
7 4 Cast' iron or `
�S w .So/-h. 40 PVc pipe /2'rna�L. Gone.
n7in. pi�"Ch % " „ / Go✓er- wA she C/
ff: PVC- pipe P �=
er 4 SCh. 20 Pe- S a/-,
c/e o.r7
f/o w l i n
7I inv. a -
L OGAT/ON Mf? P
bo?cin✓. /. •
Septic fa n K in a/. _
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SEW/9G TEM P/eOFIL � o�- - `a o p e,
/70t f0 $GeL/e • c
c�rounc/ water fable e/. - �p,o
bo�to.T► -fest ho/e
ql.l A./ OfiTA T� ST HOZ- 4F-- LOG
nn� ' /VUMBE /e OF BEO/e00M5 TEST 0,97E . Z 3 �g
v ® GPR23 GE DISPOSf�L UN/T : A !.t//TNESS�L7 BY :
. . 1 TOT/ L EST/Ml9TE0 FLOW 0Z- /97-/0,l1 ,e97TE : �� MIAJ. INGH
40
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