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HomeMy WebLinkAbout0298 MITCHELL'S WAY - Health (11,U el s I nis _ q G TOWN OF BARNSTABLE LOCATION ® hA L LC �F W OL SEWAGE # ' VILLAGE ASSESSOR'S MAP & LOTS INSTALLER'S NAME & PHONE- NO��1r( � SEPTIC TANK CAPACITY ()® LEACHING FACILITY:(type) SC (size) i® r NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER p,,, a1 O , DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED ` VARIANCE GRANTED: Yes ..No 4 _ r. .y �. -� - -� � � r � �o � � �� '� No.....------•--_-Y.,r- ��`�� ©� Fl;:aw............... 8arn818bleConseriadwDepaRmeM COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Signed Date TOWN OF BARNSTABLE Appliratiun fur Diripwial Worlw Tumitrur#in , rrmit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal systern�t�..,� N, -•-•---•-----....x................................................ Lo ttrot :\ddr _..................... ------..... ........ 0 Address �14........ �. < Installer Address Type of Building Size Lot............................Sq. feet t-� Dwelling— No. of Bedrooms-----------------------------------------_-Expansion Attic ( ) Garbage Grinder ( ) Pk Other—Type of Building ---------------------------- No. of persons._-.-..--._----_-----..-..._ Showers ( ) — 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------------------------------------.... a Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gd Descriptionof Soil ..,.�` ----•--------------------------------------------- ............................................. x w ...•--------"---- ----------------------------------------'.....'--........-'-•------------------•----- ---- - ---- U Nat re of Repairs o Alterations—Answe when applica le__. __. ...... .. .....�._..._`-�� ;_.�.. .. �. �' Agreement: 00 , L, , The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions-'of TITLE 5 of the State Enviro ental Code —The undersigned further agrees not to place the system in operation until a Certificate of Corn ian has been issued by the boa d of health. �� O -9 ...Signed .... 1!--�.........). . ........ Application Approved By ........... � `�`'''`'mayP� `'p-------.....-............................................................. Dace Application Disapproved for the following reasons: ..... .... .......................... ....... V....�7 `� Dace Permit No. ......7--L-/- -33-/......... . .................. Issued .----1. P.. -------------------- Dare R�-�- 33 No................-....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diripooul Ni ork,i Tomitriirtion ramit Application is hereby made for a Permit to Construct ( ) or Repair �andividual Sewage Disposal System( . c ..........................................•-•-------- ••-••---............. S Lo sho \ •s ¢r I�t 1,1d AIp .................` _........................ .....L. •-----------•--- ----- ------- -:t.�:..��r �----................................ . © Address 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 ( ) pr 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. 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........................ fi Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ a . ----------------------•----•-----------......----...........--------••-------•------..........--------.._..---•- 0 Description of Soil------------------ .......................... ...--.................................................................. W V ------------------------- ---•----------------------------------------------Et� `.................................................................................................. --------------------------- ---------------------------------------------------------------------------------------'.. ...------------••--------------------------------- U Nat re of Repairs or Alterations—Answe when applica le___...._... .. .��-�: _.....CX,..}_ ```�. ,,.. .. ..:e.SS..D..vv.l.`� .-c - i �� `' `�.5. .w� ......... I...... .. Agreement: OQb 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, i"an has been issued by the board of health. Signed --- --�" '---------Y `^-�..�,.......... . ................ �� - Dace Application Approved By ............hU .- �. .` -,,-�-�-x^^-y .. . . ...................... ..�jr........... w......�Y Application Disapproved for the following reasons: ..... ..... ...... .... . . ...............................:. .. ........ ............... ......... .. .................... . . .............................................................. .-----/............................ Dace Permit No. ----�.�;./...-.._:��..j..... Issued .----6�----^..�Z J^n1... ............ Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r TOWN OF BARNSTABLE C er#ifirate of Contplian e TINS IS TO CERTIFY, That the Individ- I Sewage 1`posal System constructed ( ) or Repaired by ..... ....�........� __.........�n _--. --..-------�_....---...----- ......._.............-----------.---- ....------------------...._------- Inunllcr has been installed in accordance with the provisions of ITI.E 5 of The State Environmental 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 THE SYSTEM WILL FUNCTION SATISFACTORY. DATE_...._07`.._` - ..:>�- .............. Inspec /� . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH P�,rc�`� ' ©STr7 c� TOWN OF BARNSTABLE 0 No.../.��...�:3./ FEE ©!V �ua��r1i�rn� ��rmit Permission is hereby granted.....- --.....-C!.�(`-� t _..-_---...._.` - ..`!.`.�� 5' to Construct ( ) or Repair an Ind'vi�lual(Sewage Disposal System at No...................... q 9„ �•�,, 4.._c. t 5----.•... ?.. i.l zi-�.•r..C--... 1.�.:..._. z� r > s «t q as shown on the application for Disposal Works Construction' Permit No.-l-�^��..��-+---- Dated--_--110-.�.ab..'�j...�...... Board of Hcalth DATE. 6 ' C ........................................ FORM 36506 HOBBS 6 WARREN.INC..PUBLISHERS