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HomeMy WebLinkAbout0120 CHESTNUT STREET - Health r 30q, oy3 / TOWN OF BARNSTABLE LOCA1ON e r- SEWAGE / VILLAGE l-ly,4y-(4S 'y 10 9 ASSESSOR'S MAP 6z LOT INSTALLER'S NAME & PHONE NO. 075- SEPTIC TANK CAPACITY f.-'- -�C LEACHING FACILITY:(type) �'r111'3-T015 (size)( NO. OF BEDROOMS- PRIVATE WELL OR IC WAT-R� BUILDER OR OWNER %� ,,�, s�r��'� DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED; VARIANCE GRANTED: Yes No �/ l r --1 b �% C,, \Wf X V Q O a � � �—�--- b. 0 3D No.... .......... Fins THE COMMONWEALTH OF MASSACHUSETTS 9`7°0 BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Di-nViiiittl Work.5 Tatuitrnrtinn ramit . Application is hereby made for a Permit to Construct ( ) or Repair ( %67 an Individual Sewage Disposal System at: r�q Location-Address or Lot No. 5. .k'0N.(>................................................. ................... ...................................... Owner T� Addps.. N"- S L .......... 1� ..{. c w .......... Installer Address Type of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms____.`--------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fix ures ------------------------------- - - W Design Flow________ ___ ___________________________gallons per person er day. Total daily flow..__. -�?____..__...._.___.___._gallons. WSeptic Tank-L Liquid capacity_1_�Qgallons PLength__�________ Width-_,�_____-- Diameter________________ Depth................ x Disposal Trench—No.�-_S!�_f II XC Width___.9..._._______ 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........................ P+ •-----•-•--------------------------------•------•...----•-•.....-•-•----------•-•-----------.................---•------------------------.._.....•---........ ODescription of Soil........................................................................................................................................................................ x U ----•-•---.....--•------------------------•----•-------------------•---•---•------------------------------------------------------------•----------------------•-------------------............---••••-- W ------------------------------------------------------------------••---•---•--------------......••------•-------------------------------------•--•--••-•••-•-•------••---------•----------------....... U Nature of Rep irs or Alte{{'ations—Answer when applicable.- �h-_�1T.Ip-1�...1 Q1�__�� �?`t.b.C_.'�_IG�N�--... _N"�...................................................... 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 be issued b rd of health. Signe ------------ .......... ............. ... t..'D�d .,- -- --`=---............... Dace Application Approved By ------------- --- - - -- -'------`------------' -------- -- -- ..... ..--- ---- ----------------... ...............—Dace—"----'----- Application Disapproved for the following reasonr: ...... ........................................................... ........... .................................................... �: "- .-. ... Date Permit No. Issued ..(...... .. = No.... �. ` Fps...... .................... THE COMMONWEALTH OF MASSACHUSETTS �`7' , BOARD OF HEALTH .S*'et4 TOWN OF BARNSTABLE Appliratiou for Di-tymial Workii Tomitrnrtinn rrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: ................ /.a 0 c .................................................... ...------... r Location-Address or Lot No. ..may..��v_...... K rl Owner e ^ Add }s� a S ................. L� �V ►Lti c VL vL.Q M Installer Address Type of Building Size Lot..................... ....... feet Dwelling—No. of Bedrooms........r2--------------------------------Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—Type of Building ............. No. of ersons---.--.--------_------.----- Showers g ---•-•--------- P ( ) — Cafeteria ( ) P4Other fixtures --------------------------------------------------------------------------------------- ----------------------------•-----•-----•-------------------- W Design Flow.........�,..�-----------------------gallons per person er day. Total daily flow------ �.......................gallons. 1:4 Septic Tank J-Liquid capacity./00.(0galIons Length--- Width_— Diameter---------------- Depth................ Disposal Trench—No._s. 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...--................... (s, Test Pit No. 2................minutes per inch Depth of Test Pit--.----.-.-..-.----. Depth to ground water......---....--......... --------•--------------------------------------------------•--------------------••---•••-•-•................................................................. 0 Description of Soil........................................................................................................................................................................ W ....... ............................................................ --•-•-•---------•-••••------------- -------------------------•-•--------•--•••-------••••••---•-••-•-••-••-•............-----•... U Nature of Repairs or Altetrations—Answer when applicable._ZX;Y\n��_Va_�X---1.0-00--��e�:4_�-�...... ...............0....!%v`?`..-�Y�.v�c��w���_\.f� �P S �''�`��� ��t�'�'--- .............................................. 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 beepi issued b t rd of health. Signed . ......... .-.. ..G� — -----------r................... ........ Date Application.Approved By "`— ©..... - -..., ..�..._.. ........................ ................Dare.................. Application Disapproved for the following reafons: ---------------- �-----------------------------------/........... ..... .......... ....._------------------.....----------- -'---. ...-------. ....�£j--- —. .................._.............................................................-- -..I-----...... Da --------------- -^.. ----- re— Permit No. ---- „ � ........ ........ Issued ...........{/..�%'.... /Da--------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Trdifi ate of Tontlatianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ((Ie- ) by ............._......... ........... ..............Gi..A.( ..VQo---sz�'�Y ----------------------------- ------------------------------------------------------------------- _Instauer / at -----------------------------------------------------l. -U------�k'f-G-�v`----- ��T........ 1.'---- has been installed in accordance with the provisions of TITLE 4 f The a nvironmental Code as described in the application for Disposal Works Construction Permit No. ._... ...._........... t�j .. dated -------------..._......_------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT B 6 NSTRUEA AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE �'.... --------- Inspect1 %% ��-J�--r�T" THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7 TOWN OF BARNSTABLE '�� No.. ,.._.........:..... FEE..._-_.................. �i��n��t1 nrk� �un�tr�.rti�n �rrmit Permission is hereby granted.................C. .- - L � 5- - --------------- ------------------------------- ........ to Construct ( ) or Repair (/-) an Individ al Sewage Disposal System I at No.--•••-•-••••••••.....-•••••-•-•••............••••l� ••...G1.�LN.-r-N S ---------f��_G_.._��Yate C .Street as shown on the applicati'n for Disposal Works Construction `ermat No.- - : . _ d�................... ................_.. ------•---.- Board of Health DATE.............. v... FORM 36508 HOBBS Q WARREN.INC..PUBLISHERS