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HomeMy WebLinkAbout0086 PONTIAC STREET - Health 86 Pontiac Roa f1.yannis ie" e i 4 , i i i !. TOWN OF SAR STABLE E (� s1 �Jp LOCATION, �� l:I' 1f2-� SEWAGE # I o�, J J VILLAGE 1 1 q�y��Q s ASSESSOR'S MAP & LOTol'&9 " :7,1Qf f INSTALLER'S NAME & PHONE NO.L t,rt�t keAt" cb. q?7-03y9 1 SEPTIC TANK CAPACITY 000 LEACHING FACILITY:(type) �„ , �;.�- (size) NO. OF BEDROOMS _3 PRIVATE WELL'OR:._PUBLIC WATER BUILDER OR DATE PERMIT ISSUED:__q DATE COMPLIANCE ISSUED: j� VARIANCE GRANTED: Yes No •C� ' ' -� —9 J��,g ' �� •.. ��� ��i %� I r 1_ �� -c6^n Cd 5 �.,�_ �. `� �" �_ -- ,. q Q IB f v FEE THE COMMONWEALTH OF MASSACHUSETTS BOAR®. OF HEALTH � TOWN OF BARNSTABLE Applira#ion for Uhipsal Workli Tomar n t F Application is hereby made for a Permit to Construct ( ) or Repair- ( ) an Individual Sewage Disposal Systemat:....... ..... r.0.--...(..�. ...................................•-..... ...... ...� I.... ..................... rr^_ � o.------------•---- n-------------• v�.f...cL,-, p .. . LcationAddress ...... / ©.....O ner r . A - s w � ....... .......... 1 4 � ...-........ Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms..............-------......................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons..............._............ Showers ( ) — Cafeteria ( ) C4 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a 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........................ •-•-••-•--•----------- ----••-- •-•--------•------•-•----•---....------------......-••••----------------•••---•------•---•-----------•-••-•••---••••------ O Description of Soil........... :�_ V --- UW -----•-----•--- .--•-.-•--------------------•--.•-•-----••----------•.--•-•-.--•-- ---....----------.--------•------------••---•--•-- ..... Nature of Repairs or Alterations—Answer when applicable_..__.._ __S �___.___.•..w.��...... ....._...... 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 Comp �e has been issued by the board of health. �. AQSigned .. �1. ----.-.`. Dare Application Approved By ................. '4 Z Da --------------- re Application Disapproved for the following reasons- ---------------- ------------------------------------------------------------------------------ C ..^o.^ _ ----------------------------------- - - -- -------------------------------------------------------- ....................................... ................ ................................ : q ^� ... Dace ------- PermitNo. ................................................................. Issued ...........1.------d--......(..-- ... Date • f 1 A FEB THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE •. 4 Appliration for Bhipoiial Works To ii itrft Vann# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at• 4rn 1 .......... .......... .... ------ - - ' S� Lo Nc......-•••. .. � ......•-........t� o. Q. - ..L aon•Address or t r Ovat---•_... c- - ..................... . � wner � A 'flits a .�_..._.. .. O C, Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............ ......................... p ( :) 1 g ( ).___.Ex Expansion Attic Garbage Grinder Other—T e of Building No. of persons.......................... Showers r a YP g p (. ) — Cafeteria ( ) Q Other fixtures ................ ------------------------------------------------------------------------ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ W Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. x _ Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 1-y Percolation Test Results Performed by............................... a ................. Date........................................ a ---- 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........................ 9 ..---- ---•--------•-------------•....._.-•-•-----------.........----_.__------•-----•-•-•-----------._.....--•-------••••--._...._------..._•--•••-••------ O Description of Soil........... V ...................................................................... --•--......••-•__.__•---._.._.-------•----•---------•------------------------__....__....-----------•--•••-__.......__..._... W ._S _..__._.._= U Nature of Repairs or Alterations—Answer when applicable._________ _ _ ..-_....__.________w ...!_._._ .................... -••-...•---------••••••-------------------•-...._.._-------- 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 Compliance has been issued by the board of ealth. Signed .-�) .. .( h _ O g Date Application Approved By ................. � -..-- -----------.--------------...........---------.._------------------ ?t ------ Date Application Disapproved for the following reasons- -------------------------------- --------------- --------------------------------------------- C�......q 2 ---- ----- ---- ----------------- -- - -------------------- ------------------------- -- --------------------------------------------------------------------------I............. ....... ( ........ - qq ey Date PermitNo. .................................................................. Issued ...........1... .d..-..---(- -.... Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ; GPrtifi ate of Contylianve T IS IS TO CERTIFY, T at th Individ al Sewage Disposal System constructed ( ) or Repaired (� by 1_.. ' . \............ . ... . ............................................................................................ Installer _ at ...... . ----.-- . Q� - ...2 � has been installed in accordance with the provisions of TITLE 5 of The State E vironmental Code as described in the application for Disposal Works Construction Permit No. ........,c� .-... .. �1---.- dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..... .�---� -- --------------------------------------------------- Inspector ......................... A i ......------.................... ....------- THE, COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE . No......................... FEE. .............. ua� �er�tit Permission is hereby granted__.__.__ :`�.-\_. .\��^...........................�V.7 c� ----_• ......--- ............... --•.................................. ---••---- to Construct ( ) I�a air ( Individ,al Sewage Disposal S stem at No............................ ...ij OvJ-- ------..W.-- Street as shown on the application for Disposal Works Construction Permit No._AAV?._ Dated...... '�.C-2_...LZ�.......... � I --------------------------••------___--____--- V B DATE l .................. oard of Health ••---••..._...----•-......-•---• . FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS