HomeMy WebLinkAbout0014 KENNEDY CIRCLE - Health (2) 54,Kennedy Circle
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TOWN OF BARNSTABLE
LOCATIO1 L/ ver,a(c/ SEWAGE #ft/' - ,7
VILLAGE ASSESSOR'S MAP & LOT r
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INSTALLER'S NAME & PHONE NO, job�rt�,CiQIGz
SEPTIC TANK CAPACITY d�a�
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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No.............� Fas...;/. .:..
APPROVED THE COMMONWEALTH OF MASSACHUSETTS
Bernstablo Conservation Department BOARD OF HEALTH
OF BARNSTABLE
clato
Appliratiolt for Diripniial Worlup Tomitrnrtion Permit
Application is hereby made for a Permit to Construct ( ) or Repair (---Y` an Individual Sewage Disposal
System at
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ie., n- \dd.... !( e/ or Lot No.
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w O `e M. res r�. ./' �/ dd cr � - ,
Installer Address
Type of Building Size Lot............... ........Sq. feet
V Dwelling— No. of Bedrooms.............................. .. Lx ansion Attic Garbage Grinder
►-+ g— P" ( ) g Vet!/
aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Q' Other fixtures ................... --------------------------
w Design Flow...........5_5 ---------------------gallons per person er dam. Total d4il,.Y flow......5J ..:........._.........gallons.
WSeptic Tank—Liquid capacity../OPO allons 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 ( —�r Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.................
t4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
9 --------•--------------------------------------•-••-•-••••...._..-------•---•---•--........---...-•-.....................................•----.........
---•--
ODescription of Soil.......................................................................................................... ............................................................
x
w
U Nature of Repairs or A ter ions—Answer applicable._.`.n`�t�- ��_.....1 b aC>....��- ��� �....
11
f�. ....P. -- ....Ida. ------••--•---•---••-•---••...................•----...---------------------------------•--•-----------............................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environment Code—The undersigned further agrees not to place the
system in operation until a Certificate of Com lianc s bee iss d�bath. nSigned ........... . - �' /—`"/�
.. ........................................................................ ........................................
Da e
Application Approved By .... /..'' �'
... .. ..... .................................... ................................................ ..... ...... gte:...............
..
Application Disapproved for the following reasons: .................. .............. .........................................................................
....................................................... . ........................................................................................................................................... ...................--.7..........----
Dare
Permit No. ...( . ...� ...................... Issued ... .' '............ � '::� /.
Daze
�r "..,..—.—,....,'�;r�._t.,....,,,,;yr y�•r:✓+..w.�.�,.. V ... ram. .,y .,.,,.�.�,.�,. � tr:r ., ,,, ,�� .�, a ,„ _ _ _
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
2_S yTOWN OF BARNSTABLE
Appliratinn for Ali ipwml lVurl;i Tomitrnrtiun Permit
Application is hereby made for a Permit to Construct ( ) or Repair (i)- an Individual Sewage Disposal
System at
I - - ---- ---- -•-- ....... ...........•
c. ��
Location Address or Lot No.
rner...•-•-- --•• 1-•'-----------'-•---'•-- -•---------•-----------•--•-•---------------Address.. i
w .............................................-C:-ICE=r}...-=---.... 1...... - . . U4.................. Y......lf57.••i..'} _..d 4%-`.'
a r Installer Address ` .r
U Type of Building � Size Lot............................S . feet
q
..� Dwelling—No. of Bedrooms----------______-------------------_--------Expansion Attic ( ) Garbage Grinder
aOther—Type of Building ___________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
a' Other fixtures .................................. _
W Design Flow..........._`T!5� _______________________gallons per person per day. Total daily flow.......'a-._�-7l__ .......................
9 Septic Tank—Liquid capacity../,6bogallons , Length----- Width_--__q...... Diameter................ Depth................
Disposal Trench—No. .................... Width.................... .rotal Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------.-_----.-.- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( —)' Dosing tank ( )
�" Percolation Test Results - Performed by__________________________________________________________________________ Date........................................
aTest Pit No. I...............minutes per inch Depth of Test Pit.................... Depth to ground water........................
(i, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
•-----•--••------------------•••--•••-•----•------•------•-•-•----•-•••-............ ._...._...°_....__.........._.......................
__-•••••.......
..
xDescription
of Soil-•-•--•-••-----•-•---••-••••--•-•-•-••--•••.....----'••................•----•--•--------.------------•-----••'_.______._----•...----_._-_---..._...._._.._.._••-•-•---••
V ___.._._..-••........---•------------------•---•••••-••----------------------------------•-••'------------•--------------------------------•----•------------•--------------•-••---•--•-•-••••••----•-
W _
V Nature of Repairs or Alterations—Answer when applicable.J.n`ae-c--k 1........
lox(( ! !t 1,f 1 1. "1
... ............�.__.__._...-•-=---•• i--•----.,--___._._...--•._..._..._.._...__.._..---•-•--•---.._.---••-............--- _..._.___..___....._. .... __.........................................
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 Com lianZhs been issued by the'board :f health.
Signed ............
1- 2 �/- ��
. .... ............. ..........`
Dare
Application Approved By ........ ......... ....
Application Disapproved for the following rearont: ........ .........V..................................................................................................
................. .................................................. . ........................................................................................................................... .. ..............................-
Date
Permit No. h....0....,"F... ........................ Issued ... `"-. �..� . �.......,
Dare
THE COMMONWEALTH OF MASSACHUSE17S
BOARD OF HEALTH
TOWN OF BARNSTABLE
��
I ertifirate of Complianve
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repairedby
(--
In rdlcr
. y .... ...... ... .
has been installed in accordance with the provisions of TITI.E 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. �,�...�.e— ... dated "'.. '
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT Bf CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE....... -f. `." , ...."...�� ..... Inspector ...__ -����L"v ........... %` = ....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
_u
j r TOWN OF BARNSTABLE
—41
Dispalitt1 a ark,i Tangtriglivit rainif
Permission is hereby granted -------I 6�... i�F2( r?......................................................................
to Construct ( ) or Repair ( Oran Individual Sewage Disposal System 1 cy"/
at No.-------••-------•--••---------•----/- --------•-��.e,/2/..--�cl C1...� /yr�`� /-......�-�.���.!�
Street
I;
as shown on the application for Disposal Works Construction Per
Ngq.�x Dated..- '`�-..
..............
....................... Board of Health
DATE...... -•---�
FORM 36508 HOBBS A WARREN.INC..PUBLISHERS