HomeMy WebLinkAbout0027 ISALENE STREET - Health �= �0)2
TOWN OF BARNSTABLE
LOCATION J�e`C:�cr �,1� . SEWAGE
VILLAGFAM, ASSESSOR'S MAP 6z LOT.Al L-6:3b
INSTALLER'S NAME & PHONE NO.e,r(,pyv 4477-AS36"
SEPTIC TANK CAPACITY . 1,5®0
LEACHING FACILITY:(type) ("�oi`��•, b ) (size) -K g - 3
NO. OF BEDROOMS Lty,
IVATE WELL OR PUBLIC WATER
a
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED: A�
VARIANCE GRANTED: Yes No y''
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ASSESSORS MAP N0. n ;�o
pp PARCEL NO �..r . .,
No....72::1.0
THE COMMONWEALTH OF MASSACHUSETTS
B AR® OF EALTH
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.................. OF........... t �
...._.._._ . _. ..... ......... ........
ApplirFation for Dispas al Works Towitraurtluu Prrutit
Application is hereby-made for a Permit to C struct ( ) or Repair Individual Sewage Disposal
System at
---- -------------------•------.....�.c� k
Location es or t No.
` �� f
ce'-........._\ . ` _ e - .- `�3® ...........
m�..�i_ � �✓� s s
Installer Address 1
d Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms............................... Expansion Attic ( ) Garbage Grinder ( )
a
p, Other—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures ----------------------------•--• -
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
0� Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
Disposal Trench—No. .................... Width.................... 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 ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water________________•______.-
G4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
-------- - --
O Description of Soil.......... _ .. "�
V .....-----------------------•---------------------...--•.....------------.
W •------------------- - ...........................................................=.......................................[
U Nature of Re airs or Alterations—Answer w a licable._._____� "���___---_.!�"___.��-�..le-.—
.....................
A.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of i i:LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has boffik issued by the board of health.
Ci
Signed.._ ....eih.Q , _w ��C�-- " 3 f7 ®-7
��" "> ----------------------- --------------------------
Date
Application Approved By............., ... ?t... >.a,.. ---� ------------ _...L.q.-
Date
Application Disapproved for the following reasons-----------------------------•-------•-•-----------------------------------------------------------------•--•---
..............•--•--....------------------•-------------------••••----•--•••--------------------•---••••.---------------•-••----•-•--------------------------•-------•-----------------•----------------
Date
PermitNo.._._16.?•r--6.5 0------------------------ Issued-.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF
. EAL7"H
............ Q-.-.....-_....OF........ .�..�.......:.........
Application for Bhiposal Workii Tanstrurtiun Prrutit
Application is hereby made for a Permit to C struct ( ) or Repair 4, l an Individual Sewage Disposal
System at: \
Location- re s or
--------------
Qw e. Address
installer Address
d Type of Building Size Lot.................... .....Sq. feet
U Dwelling No. of Bedrooms............................................I—I g— Expansion Attic ( ) Garbage Grinder ( )
a Other—Type T e of Building No. of persons............................ Showers
0.1 YP g -•--•-•------------•-------• P ( ) — Cafeteria ( )
a' Other fixtures
W Design Flow............................................gallons per person per day. Total daily flow............................................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. ft.
z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
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.................... Depth to ground water........................
P4 . _
ODescription of Soil - ``1�"•--•--•-------------------•---•-•-----.....................................................................................
x
w --------------------------------------------------------------------------------------------------••-----------•-----.._. ..................................... ........S- ------
x
U Nature of Repairs or Alterations—Answer w licable..___.. -__^_____f. �_`'_ 1G�___a_�..................
X.
- - =
Agreement:
The undersigned agrees to install the afor edescribed Individual Sewage Disposal System in accordance with
the provisions of i'T='LE ;of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has issued by the board of health.
__ �� Q r3o-o-7
Signed- - •-......-----t� .......... --•--------•---•••-•----•---•- .....................a...._...
Date
Application Approved BY ................• -------••.��'''-..��'-.^_ ..7_..
Date
Application Disapproved for the following reasons-------------•-----------------------------------------------•---------------•-----------••......•........------
-•------------------------------------------•-----...-----------•-----.......-------------••----------------•---•-----•------•-•-----••-----•---•----------•-••-•••-------------......-----•••----------
Date
PermitNo...$ �------------------------- Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF EALTH
o.......`......OF..... `
Orrtifirate of Toutpliatta
T11�4S IS TO ERTIFY, That h Individu 1 Sewage Pisposal System constructed ( ) or Repaired
Y----- -
�j' In taller (�
has been installed in accordance with the provisions of T i—p1E j of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.... ------- dated------------------------------------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE
SYSTEM WILL FUNCTION SATISFACTORY./
DATE.................�0.
_ ........................... Inspector Inspector__...------•---...._ _.70..............................................
/A THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
/ U ............... s.c........OF....... :x � ,�CP�t
PTO. ..a.'.4er.�._. FEE. .........---•
Disposal Works Tunitrttrtion Vrrmit
Permission is hereby granted. ��.n.....�1�.�-�.�Q :"..= .. -----------------------------
to Construct ( ) or Repair >6 an Individual Sewage Disposal System
at No
_, Street -
as shown on the application for Disposal Works Construction Permit Noa?r.G_j>- Dated..........................................
................... -- •. •--•--•--•---••---------.._
4^DATE................. �--�--._..__........----........... Board of Health �..
�r
7k FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
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