HomeMy WebLinkAbout0030 REGATTA DRIVE - Health 3.0 Regatta Drive
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TOWN OF BARNSTABLE
LOCATION 77",04, JlL SEWAGE #
VILLAGE ASSESSOR'S MAP &0—�
INSTALLER'S NAME&PHONE NO. 2— —1,98
SEPTIC TANK CAPACITY _,/4?0 U
LEACHING FACILITY: (type) /T (size)
NO.OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: I 3D- IS COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leachi facility)
Feet
Furnished byn"
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Allp irFatton for Di-nVooFal Midw Tomitrurtiora Famit
Application is hereby made for a Permit to Construct (� or Repair ( ) an Individual Sewage Disposal
System at/�-� (�
............ ....._..... ........---...-- � ... '�.e VN.�
Ow rl/1 A �/] Address
W
..........:................ .• . ••- r.� L n
Installer Address
Type of Building Size Lot-_L;�b.l.-3.d_3.._..Sq. feet
Dwelling—No. of Bedrooms._...._.3..._....... ...._._--Expansion Attic ( ) Garbage Grinder ( )
-:�! C No. of ersons---------------------------- Showers — Cafeteria pa., Other—Type of Buildiiig�iW�-`-1...--- P ( ) ( )
a' Other fixtures ------------------------------- - -
d -- ----------------------------------------- ---------------------------------------------------•---------
W Design Flow............................�_1_��_.___--gallons per p`�o per day. Total daily flow...... ---------------___-__-_----gallons.
WSeptic Tank—Liquid capacityl.Q(�U-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 �J -'� / � J/ ' !/S
aPercolation Test Results ` Performed by----= --------- --------------••.....------------------------•-•-...._.. Date----------------••-•---------------•---
1 Test Pit No. I---_0._.-_-_--minutes per inch Depth of Test Pit-------------------- Depth to ground waterwoA/F:_..
fZ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-.--__---.----_------__.
_
O Description of Soil..... . .. ______________v✓?�...........................................................n -- --- ---- ---- -----------------------------•------------------------------------------
•---------------------
x
W
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
U Nature 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 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 health.
Signed ................... ............ �-------------------- ---Q..........
Dace
Application.Approved By -------- ... '�.... .. ..... .... ................ ............... . ...ip................ .... ..................... -------.-......Dace---'----------
Application Disapproved for the following yearons ..... ....................................
------------------------------- -- --- ....... . ............ ........................................................... i � Date
Permit No. ....:'. ..
---- ----... Issued
Dace
TOWN OF BARNSTABLE
LOCATION
SEWAGE
VILLAGE ASSESSOR'S MAP
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY D
LEACHING FACILITY: (type) ;2/T (size)
-NO. OF BEDROOMS
'BUILDER OR OWNER
FERMITDATE: COMPLIANCE DATE: 7 ——� 9 �
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
Within 300 feet of leachi faciiity) /9"- Feet
Furrtished by ys
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Diripwial Works Tonitrnrtion ramit
Application is hereby made for a Permit to Construct (,-/) or Repair ( ) an Individual Sewage Disposal
System at
.....:.�. ...' ------------r----------------- -
................../_.....---•--- ^% -_' ._'.o..,...... ..-..---- / --- -- .....................
L... ..
.... y� ✓✓
o No .L..
Own Address
w �'1�1 �;
----------------........... - - ;, ----------------------------•---------------.-----------------...-----------.....---------------
Installer Address
U Type of Building Size Lot__ 6.(_3.G.3 Sq. feet
., Dwelling—No. of Bedrooms______________------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Build'ii - ..T. No. of persons_______________________._.. Showers ( ) — Cafeteria ( )
dOther fixtures ------------------------------------- -- ---------•--•-----------------•---------- --------•--•-•----•--•••------•------•-•-----•--•-•..........
W Design Flow............................./1 0......gallons per pt per day. Total daily flow.__--2,o___--__-____-__-------_.___gallons.
WSeptic Tank—Liquid capacity0UU_.galIons 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 �L� ... ......-� -------------- Date..... .. 3.. _ �!�_�
Test Pit No. I....;.__.__.minutes per inch Depth of Test Pit.................... Depth to ground water��!�!�-0-4
.._
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
W -�
Description of Soil L!d� �-?t Gc!t�------------------------•------------------.
x
W
-------------------- --------------
U Nature 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 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 health.
r
Signed -------------- ............
Dace----------------- - ----------------
,
Application.Approved By .... ---._.:.......................'.. l i�`
l/ �, —
.............. ---- .................
Dare.........-------
Application Disapproved for the following yeasons.�..................................................
. Da e
....-
.............................. ...._....... ......_n------------- ---- -------- -------- ----------------------------------- . .. ..da.re
-
No. Issued ...........Permit . -.. .. .... _....... .`
f.
----_--_-. --— ._,®� .�......v�.�, ...a _,� .---s--e,e_e----o_.._,._.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALT H
TOWN OF BARNSTABLE
�LPI'tt�t.C22tE of ILIII<ti�tlt2XYiCE
T S IS TO CERTIF , That the Individual-ewa e Disposal System constructed ( �) or Repaired ( )
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b .. ---;(, - .... J. ..�.. r .-
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------------------
has been installed in accordance with the provisions of TITLE 5 f The State E.vfronmental Code as described in
the application for Disposal Works Construction Permit No. ... _� ---_�. ._ .. dated ..........._ ....................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUEA AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE....- ....€ ---- .......)...........................,- ...... Inspector ------------ ....:... _............ ......... .... .._............... ..
IZ7
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
No....!. .- FEE...
io oottl orko �unotrurtion VerTit
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Permissions hereby granted u su = �Z.__U(.._.. ?' �
to Construct ( ) or Repair ) an I 2iividual Sewage Disposal System
at No... - p
t , Street (' L�y/14 Oated
as shown on the application for Disposal Works Construction Permit No.;_______.•__-_____._ D/ated..............................._.._._.._...
---...-•---......---•----------------------..............................................................
Board of Health
DATE................................................................................
FORM 36508 HOBBS&WARREN.INC..PUBLISHERS
�!c 6>AZ3AGE'
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51DEW4LL _ AREA,`-- 166
BOTTOM ARZA =;-7a 5F
TOTAL va516N 54-5 m /
TOTAL. CAI Ly rLoW = 3-30 �ft �, cV �
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