HomeMy WebLinkAbout0067 MELBOURNE ROAD - Health (off M4&1 bac Rt ,ad - , Ir�;s
TOWN OF 'BARNSTABLE
LOCATION 5,0 Adel koolym, e r7 Gl SEWAGE #
r
VILLAGE U m m / S ASSESSOR'S MAP & LOT g - �•�J
INSTALLER'S NAME & PHONE NO. �.ir
SEPTIC TANK CAPACITY I G.
tmY3�P� l �' �/'
LEACHING FACILITY:(type) (� (size) 00
NO. OF BEDROOMS PRIVATE WELL OR=PUBLICWATER +0 W
BUILDER OR OWNER A ),C a V-d o
DATE PERMIT ISSUED: 0 )'
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
�fo
_ -4
LY
r�� i -0 uirv, l
ASSESSORS MAP NO:
No.--52'.I Qs.. Fus....2,57.:.._
THE COMMONWEALTH OF MASSACHU-SETTS
BOARD OF HEALTH
t H
>...OF........ wt� .......................................
Appliration for Di, paiial Works Toustrnrtinn faraft
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
Location-Address or Lot No.
........._/n.E..�_ .�. ..................... ...........••---- ... -
Owner ------------------•-•••--------Address
a -� C..........-.L.AMP.)
Installer Address
UType of Building Size Lot./Z,,7`t®.......Sq. feet
t Dwelling—No. of Bedrooms---_........................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers — Cafeteria
a' Other fixtures _________________________________
W Design Flow.................................. _gallons per person per day. Total daily flow.._334no............................gallons.
P4 Septic Tank—Liquid capacity/SrsFtf__gallons Length._/O=G" Width._.-':.7`. Diameter_______ ______
W Disposal Trench—No. .................... Width.................... Total Length..................... Total leaching area--------------------sq. ft.
Seepage Pit No............/...... Diameter------__4_______. Depth below inlet... . ..... Total leaching area..��IL.....sq. ft.
Z Other Distribution box (r') Dosing tank ( ) /
Percolation Test Results Performed by.......... ........................ Date....3.-.t_—IJ..........
„aa Test Pit No. 14409LA__minutes per inch Depth of Test Pit_.-.1.9. `....... Depth to ground water________________________
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..__-_.-_._____--______
a ----------------------------------------------------------------------..........-......-.......-------------------------------------- ...--------•.........
Description of Soil �� 3 ` -__........................i {re ..�, �P!Y ....... /=/sv' ', !r/7-•-•-------------
x
W ------------------------------------- -------------------------------------------------------------------------------------------------•-------------------------------------------------------•---•----
UNature of Repairs or Alterations—Answer when applicable._______________________________________________________________________________________________
-----------------------------------------------------------•------------------------•---......-•--•-----------------------------------------------------------------...-------------------------•-------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of L i TIE p of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been� ; ed b th oa of health.
Signed-- -- ....................
-•----------Da_..............
' Dat_t e e
Applica*on Approved By..................................................................................................
Date
A lication Disapproved for the following reasons---------------••----....------------------------------••------------------------------------•--------•-----•--
------------------------------------•-------.....---...------.....------...-•-----------•-----------••-•-...---------------------•--------------------------------------------------- -----•----•---
Date
Permit No------- l. --------------•-•-•••. Issued.------•-•-•-•----- ..-
� Dattee
FEB.. ,,5—.— ....
THE COMMONWEALTH OF MASSACHUSETTS
(BOARD OF HEALTH
- Cr-ti....- .....OF......1 t.�a..A^r,�i !. .Lc..........................................
Appliraiinn for Elispuiitt1 Works Tomitrnrtinn Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
Sv
Location-Address or Lot No.
---•...................----•---•-••----•--•-------•--......---•------•...................._._..._ .............._...-------•------•-•--_.......•---•----••.....•-----......---..._...........•-••--.
Owner Address
W _ _
Installer Address
UType of Building Size Lot�r1_ZZi_�-----.--Sq. feet
�., Dwelling—No. of Bedrooms... .................................Expansion Attic ( ) Garbage Grinder ( )
a`4 Other—T e of Buildin
yp g ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures ------------------•------------•-•-•------------•-----.....----------------•-•----------.-•-••--••-•-••--•...-----•--•--•-----••--•-•.............-•--
W Design Flow................................��..gallons per person per day. Total daily flow.3_s 4_................_............gallons.
WSeptic Tank—Liquid capacity 5"o%s..gallons Length./5�_�'. Width..: _5_'._ Diameter____--:...... Depth's=
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No-----------/-------- Diameter..../4_......... Depth below inlet_::-:2.......... Total leaching area?... ..._...sq. ft.
Z Other Distribution box Dosing tank
aPercolation Test Results Performed by......._% :4? ........................... Date.. _ ._ ?
a Test Pit No. 14!i- .. ____minutes per inch Depth of Test Pit.-. - Depth to ground water........................
f%4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
--------------------------------•--- -------------------•---.....------------.........---..------........................................................p _ r
Description of Soil. == --'s..../------........--••-.._-,r .... %!:� --------•--........
U •••----••••-•-----••--••-•----•-•---•••-------------••••--------------••-••-•--••-•------•---•-----•••------•---•••..........------------......-
W
UNature of Repairs or Alterations—Answer when applicable--------------------------------------------------------------_................................
---------------------------•-•••••••------•-•---....•---•••-•---------•----..........---------------•-••-----------------------•-----••••---••--•-•--••-•--•----•-•-----•-•--•-........------..
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TjE j of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee issu d th and of health.
Signed.
�
Date
Application Approved By.................................................................................................. ........................................
Date
Application Disapproved for the following reasons:-------•---------------•--------------------------------------------------------------------- ------......._...
----------------------
-----------------------------
-------•----------------------••--------•---Date--------------
PermitNo..•.F--- 5......................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARDn OF HEALTH
... ..............OF......l.:e�,> *x.ae ............................................
Trrfifirab of Tamplianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed jx) or Repaired ( }
by------------_-- .... .,. - ' ................................. -----------------------------------------.......------------......----------:_.........-------•----...
� �Q Installer
has been installed in accordance with the provisions of TITIE j of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.__?.7.......) 8� 3_._-_._�- 7- �"7
-----•--------•----. dated-------- _ -- -
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YFIE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..................... o _3. ............................ Inspector.....................---..... 2.........................................
'1
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF.......� ilk'J7...................................... 7 t
�i��r���� p nrk� ��an�#rirrn rrnti� •
Permission is hereby granted......�fg . /..............
--.--...--•--- ....................
---..........
_................
to Construct 64 or nRepair ( ) an Individual Sewage D •-•
isposal System
atNO--------lf5__4-M... 1��'�G?rrlse,:^Y!4.e..----.---.................................................................. ...... . ......---
Street ! �3
as shown on the application for Disposal Works Construction Permit No ZT[-L . Dated---------- ao Q
-------.---- 1� -
Board of Health
DATE------ .................................
FORM i25S HOBBS & WARREN. INC.. PUBLISHERS
- ;
:
1
J.
tu
n
500
22. l� I �3�•
,-qtt Cape �nrp naeu
Pa bog goad 1
'
100 � �1/2 titone
30 1 �-J -13 i 2 392 r�►p c�.: } !
3/ a-te l I-l0-86 30.0 /Z4,�1 10' Z�
RF-y 7 L
C13-i3M
odbouwe. : `?oail 1
! 40 1 wine
/3ao d i,Le Nocce
'1
;
- 1
,
f:Low Lika
.C.. it
We I
9 +,�;•,1 /fit
2 .tone
Z.3.d
i. -T I
:
;. L4 {
-,.. _
_
!9o2 1•;.i� Nede uto4.
�S,e tot SO as %Jjwo)n on a ptrui 'tec:6,tc 1.,min �..
`Eatn�. bte teg;Atiq boob 250 pacee 143.
'£tevat om. shown ah.c on mon;an a44wxed dai
_._,.. ___.._
:..., ......_ __ _ -
_
t�.ate: Aaent• a2wttal�e 'Oaf o' ,rfea�.tFi r r
�?ed.t act # -l66
n n ; -
'rJtit.'. �. .�acob t
w c,t .
No at e-mourrted ! I
Cep .tAraz 2' *4n. 1.)
I ;
� �f_ _
4ttb4o - MM
1 �
i
L-