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HomeMy WebLinkAbout0064 DUMONT DRIVE - Health �0)m+ Dr.,, µgyms 307 / b%8 TOWN OF BARNSTABLE LOCATION O�tJT o�iC1�' SEWAGE VILLAGE /p 44�stf�S ASSESSOR'S MAP & LOT ,-;257 e3R4 INSTALLER'S NAME & PHONE NO. pTT1tO �IS SEPTIC TANK CAPACITY 664C_ LEACHING FACILITY:(type) >¢� E• 1��$ (size) NO. OF BEDROOMS c PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER .s�k? iC�T�! DATE PERMIT ISSUED: DATE COUPLIANCE ISSUED: VARIANCE GRANTED: Yes No r 3�� �o Za' 7 vp No.- FEB.. FEB... � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Applutt#inn for Disposal Works Tonstrurtiun Frrmit Application is hereby made for a Permit to Construct ( ) or Repair 04�j an Individual Sewage Disposal System at: .......------- �'-1 -" ..���............................. ....:....' -- ................... ...........-•-----................•--- , L��catiyy-Address or t o A dress . ....... ...... .......------------------ ........ Installer Address f Type of Building Size Lot...,�cr i. .-Sq. feet aDwelling—No. of Bedrooms..........-. ............................Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ..........RfiS....... No. of persons............................ Showers ( ) — Cafeteria ( ) p' Other fixtures --------------- •----------•----•-•---•-----•---•----•--._---- ................gallons per person per day. Total daily flow............ -"'mac _©._.................gallons. W Design Flow................. g P P P Y• Y 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 ( ) 0-4Percolation Test Results Performed by....................... ............. •....................... Date........................................ aTest 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.................... Depth to ground water........................ a ........................................................ .......................................................................... LS Description of Soil �'�. l - �� . .......... SSO/L, :..... .-•-------..............-•---�.'"•:.Z_ ........ ...... -- ---- ---- ---- ----• -------•-------•- ........._ U Nature of Repairs or Alterations—Answer when applicable. � ...`. � ....�Sl ... .1��-S ,p -- -- ......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITIZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss d b the board f h h. Stgned- y----�--- Application Approved B ate Application Disapproved for the following reasons-............................-•--.............................................................................. - ..-••----••-------••••----------------•-••-•-----..�..........------.....----•-----.._.......-•--•------._.............-----•---------------............. .........._.._ Date A' Permit No.. -..............�� ------------------ Issued....... '. .i w`•YM*Yl""�•'rli�i'pi-r`'-,"'"y""'Y�i'�*.z'1...'ni''Y°�"t'r''y,� *^+-r•«�•FN,rl,,;rN..s:p.vN�+ ,.,��.•,++I,.A,:.,,,�.t,_*St�K"YY.r!':-.n:.N�;:�.Hra...y�,r,.:r„�!}";.tc+ .-,- .- No. �1r 0 `�- ''•.THE,COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -- } ......................................... Appliration for 14sposal 18orko Tonstrurtion trrmit Application is hereby made for a Permit to Construct ( ) or Repair (l an Individual Sewage Disposal System at: _; � ..�e./.c1cs ......��_..____............Location-Address---....... .................. ......... ..•---::................-....._...Lot"No.- ---• or .... - Owner' �js$ Add Y• .... � _;:!:�?!,�T_ 4.C�.?�'l"_._.�'�'�57`...��C�:----=---•----- ��5;GG1�l���_,E', .�.��.5..�.vts.l�L.S . Installer Address Type of Building Size Lot....... .AVt.Sq. feet ..t Dwelling—No. of Bedrooms............ ........................Expansion Attic ( ) Garbage Grinder ( ) e of Building � .._..... No. of persons............................ Showers — a Other—T YP g .....---•-•------ -P ( ) Cafeteria ( ) QOther fixtures ................................---.• ---------..::----------......---------•- ........... W Design Flow................ 5 �_ ................... per person per day: Total daily flow............G?o....:..................._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. it. 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.............._._....._. f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ----- =....--•-••--••-••--••••--••••-••••••-••••..._.7........................ Description of Soil........... .. .......... a.9�.�/../ F �..5U�.SU/G ...... U ........... .•. --..... ..-•-•._....••..........•-•--•.••••• -----•••-•--•-•-•....-•••-•.......... ............... W U. Nature of Repairs or Alterations—Answer when applicable...... /_�-�..�1-l.�f... -- —/� / //1J4......_. GcJIJ------ r .4lL£t/S l�tJ� - - Agreement: _ ,s The undersigned agrees to install the aforedescribed'IIndiv�idual Sewage Disposal System in accordance=with Y the provisions of iITI.I: 5 of the State Sanitary Code— The undersigned further agrees not to placethe system in operation until a Certificate of Compliance has been issued b the board f health. Sign dn VDate = - -�---•� .n�--- Application Approved -- J--------- r ...r .... Date 1.�.. a Application Disapproved for the following reasons--------------------------------•----------•--------......-----••---•------•-----......-•-................... ..........................•-•---•.......•--••--••-•� Date -•-._......-••••••••••-............................ - ._._.................................................... ' -----.. t r� Permit No. ............. '�-••-•-----•--------------- Issued_._... �.v�.��....._.......... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............OF.. a..............................:..... r Trrtif iratr of faomphaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (3<) by........................................ J)a ?��dr' 7 ........... =--- :........................................................-•---------•-- at................0. ..__..... . installer ...•... •......•-••---••••••-•••-••••. has been installed in accordance with the provisions of TITLE 5 ff The State Sanitary Code as described in the application for Disposal Works Construction Permit No._i� "�r... _ 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 OF HEALTH C� � ............oF.... ��. ................. ..... FEE. ..: Disposal Works t/T�oonstrudiun f rru/t/ijt� VW r// ....h...iaAJ... r.......1.!..`�.�/r....................................... Permission is hereby granted............,..... .._... :�....�. to Construct ( ) or Repair ( an Individual Sewage Dis sal System . at No........................... �....�.�� �. �.�..../vim..........•-•-' ' .....�5. .......... I t w Street as shown on the application for..Disposal Works Construction Pe mit No� " ! . Dated....... �'"'_/ ""� � Board of Health j DATE..............f..... , ............................... r ! i,