HomeMy WebLinkAbout0096 REGATTA DRIVE - Health 96 Regatta Dr
TOWN OF BARNS
LOCATION SEWAGE # 9 "�
VII_LAG
�SSESSORW'SAP&LOTy
INSTALLER'S NAME&PHONE NO. _
SEPTIC TANK CAPACITY 14M 429e. y
LEACHING FACILITY: (type) Ar /ed� Se , (size)
NO.OF BEDROOMS
BUILDER OR OWNER Y516EE 66116 b IA16 G� /
PERMIT DATE: .V- T —,f� COMPLIANCE DATE-:,?—;?�
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility /vt�fvjeo 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 fe of leaching facility) _ Feet
Furnished by eMv 1-0� J_ - J7/lOG '
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THE COMMONWEALTH OF MASSACHUSETTS
,BOAR® OF HEALTH
TOWN OF BARNSTABLE
ApplirFativaa for Diinpmi al Vurkii Tomitrurtion Urrmit
Applica ' n is h eby made for a Permit to Construct (V) or Repair ( ) an Individual Sewage Disposal
System . ..__..._�..�,$-�_..._..J--... ..... .............................................................
9�................------------- - ------- -------- 3�' Gam°
Loc oc A dress or Lot No.
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..../... -•... .... ................ ......•-----............................ ---•--..._..•----------•-•--._...................---•••.
Address
Installer Address
d Type of Building Size Lot...... .......Sq. feet
Dwelling— No. of Bedrooms-------
. __-----------Expansion Attic ( ) Garbage Grinder ( )
04 Other—Type of Building moo. of persons---------------------------- Showers ( ) — Cafeteria ( )
Q Other fixtures .
--- - --------------------------------- -----_ -----
W Design Flow..................... �_�__-_-_----__._gallons per p€r- e per day. Total daily flow_.-_...-------------------------------------gallons.
WSeptic Tank—Liquid capacity..lXVgallons 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 tan Q�
~' Percolation Test Results Performed by------------------------------------ -y-- ==/ ---------------. Date-----, 31
W
Test Pit No. 1._ ______minutes per inch Depth of Test Pit____________________ Depth to ground water..._ !/.U _.
�14 Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water........................
P4 ... ... ... ...................................................•--•-----------------------•--••-------.--------........••-•---•--•------
0 Description of Soil.....nA lLl -----------•--•------------------------------
U -----------------------------------------------•-------------------•-------•--------------------------------------------•------------------------------------------....................................
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 Co e h bee=ju y the rd of h th.Signed ......... ..... .. ----- ...... ........ - ------ ..... ........ Dace
Application.Approved By ........ -------------------- - -3 — e3--
Application Disapproved for the following reasons: ..................... .............................................. . ................
-----------
....:........... .............. ...... ................ ................................. ..... .................................. ........................................
�.6-..&c.Q L� Issued ...:. .-- J-------------- ............- are ..Da[e......Permit No. ----------
No..._�/S.:_ � .�1 Fizis ....L.Q.!:?.......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Apphration for Mi5pwial Worlai Tonitrnrfion Vatnit
Application. is hereby made for a Permit to Construct (V) or Repair ( ) an Individual Sewage Disposal
system at:j11C�,GI
9� .---- .--------- 3..-....---- .............
-Coca�'oitfi 1ddress or Lot No.
- -- /-
f'
r vne Address
wb
/De, �'yl
-•-•-- ---•---••-•--• --•-• .....................
�1. Installer Address
Q Type of Building Size Lot.._.a�r_ --�.._..Sq. feet
Dwelling—No. of Bedrooms------ __-3 _-__--_--Expansion Attic ( ) Garbage Grinder ( )
�.'._.........�_� -No. of ersons---------------------------- Showers — Cafeteria p-, Other—Type of Buildillg(M1U�T p ( ) ( )
04 Other fixtures _--•--•---------•-------- ----------6 - --------•--•---------- -------------- - ---------•--
g ..............gallons per per-st per day. Total daily flow-,...........................................J gallons.
i7
�i w Design Flow----------------------�1�
WSeptic Tank—Liquid capacity-_0 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 tanky(�� M1
Percolation Test Results Performed by--------..__j.......................`�__._._ .------_----_--___ Date-_-_-.1.131__.._.�..........
a Test Pit No. l..� .....minutes per inch Depth of Test Pit-------------------- Depth to ground waten.__,U!/v
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..........................
--------------------�
Descriptionof Soil------ ------ ----.�C�-•-----•--•-------------------------------•-------------------•--------------------...---------------------.......---.-----
x
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
y 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 CornIiarI a has been issued by the board of health.
Z�J 6
Signed 1--� � ...- .,_ . ......... ..
ace-------
Application.Approved By ........ °L` ..........
. . , Application Disapproved for the following reasons- ---------------------------------------------------------------------------------------------------------
-- ------------------------------------------------------------------------------------------------------------------------... .. ............................ ......... ....... .........
. Dace
Permit No. -------- ..j ''n-t"s------------ Issued ............. ..— 1-., - -.f.. ---.-. -_.--
Dace v
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TO��TTWN OF BARNSTABLE
IS 1 TO CER �FY, Thatrth Indivi•ual Sewage Disposal System constructed( �) or Repaired ( )
by ----- ---- ---------------- ---------------_-------/�J -. d- - ---......., ... ...--.... -----..------------------------------------------- -....--------------------------------------
`ins(ii-t
at ...- -... `'2. - 1� �'�'.�......---------.. --.,.......... C�.t.�wt�i.o-..... - - -- - -
has been installed in accordance with the provisions of TITLE 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- "%° �----- �_47........ _ Inspector
- -...-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
No......�(...�..:�.�?.fl t"l FEE......:''">.�:`:�.....
�. �i��roottl or�o �uno#r� io �rrutit
Permission i hereby ranted__a .................... _....._ .
t y g -�—'' ' -------•--
to Constr ct ( " or Repair ( ) a Individual Sewa e Disposal System
atNo...- F ` ' -� ---------------------------------------------•---------------------.....---......
St
eet
as shown on the application for Disposal Works Construction Permit No...,__ --- Dated_-___--_. .__-_� ... _.:. ��......
Q
B art of Health
DATE--------------------------------------------------------------------------------
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