HomeMy WebLinkAbout0132 ESTEY AVENUE - Health /3� e34et gcrm 's
TOWN OF BARNSTABLEr� �
LOCATION �� - �� ���SEWAGE # 5 J��
VILLAGE ASSESSOR'S MAP & LOTJOT 0
INSTALLER'S NAME & PHONE NO. _
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) lU/,� ��� (size) 3 �� � f
NO. OF BEDROOMS PRIVATE WELL O UBLIC
BUILDER OR OWNER �6 �� toe r=n n ri r= m
DATE PERMIT ISSUED: A C
DATE COMPLIANCE ISSUED: � 3
VARIANCE GRANTED: Yes No X
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
7 7
_0_:W_V, ....OF...,.- . `. .......................................
Applirutiaatt for Mipogal Worko Touptrurtion lirrutit
Application is hereby made for a Permit to Construct ( ) or Repair Individual Sewage Disposal
System at:
......... !- - ......... ..Y._.....IA e ...... ............ s =�-s .. ....-
. Location-Address or Lot No.
. .4�� ,r.,... ........s..ra_ s.
.... ._..... .....................................
W
Address
� r S..... c`?-3 6"7�..............
Installer Address
UType of Building Size Lot........:...................Sq. feet
�-, Dwelling—No. of Bedrooms.......................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( • ) — Cafeteria ( )
Otherfixture"s ------•------•--•------------•-----•---------•-•----•--••--•---------•-•---•-•---•---•--•--•--•-•---------------------•--•---•------...._...._..----
W Design Flow........ �-......................gallons per person per day. Total daily flow------ .�.z a_--•---...___.._._._..gallons.
W Septic Tank—Liquid capacityL gallons Length....a�...__. Width...... . Diameter________________ Depth................
r;
x Disposal Trench—No..../............... Width_..._.8._....... Total Length__.. - 5�._ Total leaching area_._.-_---_-.--------sq. ft.
4 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area...................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by------------------------------------------------------•---•-••-•---•----- Date.........................................
.
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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. l
P P P Q ------•--------
--- --------------------------------------------
--------------------------------
•-•---•-------••-----------------
•------------------------------------------
O Description of Soil------.� �t �^-....... °J-------5" ?'c.Y---------------------------------------------------- x
U ...................................................------••--•-•---- -----------------
Z •---••-----------------------------••--• ---- • • .....���Ss�eO x ........ pV�t �o'RG '----____I�G__._rc��
U Nature of Repairs or Alterations—Answer when applicable.....�-'j-'-G_.. 0' ----e r4.....0 cSS_rG z-.
.......jpZ.7........ --7=r1'-k ..tea -----------�- f �stv�z�
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of THIT-1:p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has the bo d of he
.. ... ... ..--......__
c�• _ .: ate
�PPlication Approved BY -..: -------------------------------------------------- vJ! �P
..............
Date
N eApplication is for the following reasons---------------------•---------------•------------------------•..................................................
''►
1._ Date
Permit,No ... . ... Issued......................................................
f Date
�'► 72 a-`t
0 '
No. ...I I Co`7 � F��B-�-a_-- --..---
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
--....OF
c, \ --------------------•-.---.----------
Appliration for Disposal Works Toustrnrtiun Prntit
Application is hereby made for a Permit to Construct ( ) or Repair Individual Sewage Disposal
System at:
-` y Y:.v`e ! `fir tzq-!�=`'c'`-5
--• ........................................................
� Location-Address .p or Lot No.1�'..l`G .......... ...............................................^........
Address
.....-
Installer Address
QType of Building Size Lot............................Sq. feet
v Dwelling—No. of Bedrooms.......................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons........_------------------- Showers ( ) — Cafeteria ( )
Q' Other fixtures ........................................... -•-------------•-----------------------------•-----•-••-- • ------------------------ -------
W Design Flow....... _5.......................gallons per person per day. Total daily flow____? _........ gal
1:4 Septic Tank—Liquid capacity�.r >__gallons Length... Width........... Diameter................ Depth................
Disposal Trench—\To..-/................ Width....!-c-.......... Total Length... .._ Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter-___-___-__--___.-__ Depth below inlet.................... Total leaching arm.............:...sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
'-� Percolation Test Results Performed by.......................................................................... Date........................................
`4� Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................
GT., Test Pit No. 2................minutes per inch Depth of Test Pit................._._ Depth to ground water........................
a -------------------------------
-..............................------------------------------------------------•---•---•----------------------------.-----
Descriptionof Soll--------------------�F �-- l�'.....----------•--..�.-----••------------------------------•-----....-----------------------------------------•-------•-----
W ---•------------------------.......................................
U�.....!��-- --•------•--••••.................... . -------
VSsCo �(20VNA �j O RG�} �111C�G�F
A.s-------�--1-T ----•-----• --------------------• ---------....
!-.?ice..------... to --------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of T iT:2 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance ha the bo d oAh .
Signe
.......31.------
Application Approved BY ' '= p- r .................................................. ------•. vl 'ZO---•••-
Date
Application Disapproved for the following reasons:..............................................................................................................
................--..•-----------------------•--....---------------------......_......-----••-------••--------•-•••••••-••••-•--••••--------•---••-••-•---••--••••--•••-•-•......-------•---•......-•---
��� Date
Permit No. - '"' 1�.� -- Issued..... ..-•---.... ---•--------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
^T.U...W...Y`. ...........OF -u. :Q...................................
(Iptifirttte of f fampli anrr
THIS IS TO CE That the Individual Sewage Disposal System constructed ( ) or Repaired i(�
by----------------- ��... �: ------------------------------------------•.----------.-.-----.--------------------•--•---------------------------------
---------
Installer
� . /
has been installed in accordance with the provisions of T i TIE: 7 of The State Sanitary Code as desc .1bed in the
_. --
application for Disposal Works Construction Permit No �p..._.t�..5``.1� _ dated_--.____,_. _�. ( .. � .....
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT YHE
SYSTEM WILL FUNCTI N SATISFACTORY.
DATE..........................��... � ........................... Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH ,
r n`--T1� .1.t!✓ ........O F.. �.�`-" .............................. C�-
1� ....'1. f FEE........................
�in��an 1 n ��aatn�rnr#uan �ernti#
_
Permission is hereby granted----------`- .------------•-�--••-`°=-�---- .. ----•-------•-'---------------------------------------------------------•-•-----
to Construct �.) or Repair (L_j an Individual Sewage Disposal System
atNo............ ........ ---------_ -------------------- ............................................
. _
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as shown on the application for Disposal Works ConstructionPerrnt N io._� -��--_ __lated.._..•.� L..1...!-.
l n Board of Health
DATE............ _ ..�. - ...........................
FOR�fy 1255 HOBBS & WARREN. II�1 PUBLISHERS
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