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HomeMy WebLinkAbout0128 RUDDER ROAD - Health (2) /a8 Audders &lop � b(qj / n� I TOWN OF BARNSTABLE LOCATION 1,M , J44-Ir IAJ SEWAGE # � VILLAGE ASSESSOR'S MAP 6z LOT INSTALLER'S NAME & PHONE NO. A & B C M 775-6264 SEPTIC TANK CAPACITY 10on LEACHING FACILITYAtVpe) L P /z,-nr) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER �`�}' DATE PERMIT ISSUED: /� e DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No . r FEE. c. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................................ Appliration for Dispotial Workii Toustrurtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair (vI an Individual Sewage Disposal System at: --...�. .�._ L) b:t>'E........R .:p......A VAN. ...........................•--••--..........__..._.......---•------•-------•..................---- Location-Address or Lot No. .._..... .1 _..... g. .S.t.S _....-•-•.................•---•-----..... ............................................. Owner �A`d,dress _..._ `!. ................................................. '�®V`t� i ..S .� 1Ad.: \.I F �19 }� Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms....oa............... .---.Expansion Attic ( ) Garbage Grinder ( ) aOther—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. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (T Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P .... -------------------------------------- ...... .-.------------------------------------------------ --- •------------------- ........ .------------------------- 0 Description of Soil....................................................................................................................................................................... x U ....................... ------------------------------------------------------------------•-••-------------------------------------------------------------------------------...------.....-------------- W -----------------------------•---•-----------------------------------------------------...----------------------------•---------------------------------------------------...---.....--- ..... - UNature of Repairs or Alterations—Answer when applicable...��...w�..... ......R!��S__.?Q. T...®��®_..� �.. .�A.. ....................................................................................................................................--=----------........................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITHE 5 of the State SanitaQeen � —The u rsigned further agrees not to place the system in operation until a Certificate of Compliance has by the o rd of health. Signed--- --- ---- ................... ............................... .---� Date Application Approved By--------- to fiJ /.Q..- 9Q... Date Application Disapproved for the following reasons:................................................................................................................ -•-----•--•..................•---•----------------•-------------•--------....---------------------------•---........------..........-------------------------------------------------------------------- Date Permit No.--- L71 ._...« Issued.................................-----... ....... Date No.. !.� •-��� � F�s�Y` _............._ r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Applira#ion for Dispniial Works Totudrur#inn rruti# Application is hereby made for a Permit to Construct ( ) or Repair ( 1i) an Individual Sewage Disposal System at: >I�. `©�L P ..............................•-------•-----•-----•------.....--•--------................--••----• l Location-Address or-Lot No. ..—? ! S ----•......_...... .............. Owner Address tti '..�.. �c:.:._.. i.. ..I........ ..... ...: ................ a Installer Address N Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms....-,;.....................................Expansion Attic ( ) Garbage Grinder ( ) Other—'Type of Building No. of persons............................ Showers — Cafeteria P� yP g P ( ) 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. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water..................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P; •---......-•....................................................................................................................................••------•---- ODescription of Soil........................................................................................................................................................................ V ------ ••---------------- -......... •------- •........ ----------------------- --------------- --•--------------------------- •-------------------- •----------- .-----------•-•--------------------------------- W ----••---•-------------------------•---------------------•--------------•---------•----••---------------••-- ---------------------------------------------•-•--------•-•-----------------------------.-- U Nature-of Repairs or Alterations—Answer when applicable._Wit.,!-_,-.....!a_�-._%....--- __ _r�_.".........-/ r-.--..? •.•;-. I =" '• -...................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI,;.;. 5 of the State Sanitary 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..`:• .......'..:.......................... Date qU Application Approved By............. Date Application Disapproved for the following reasons---------------••--------........------...-------------••------•--------------...------...----------------------- .............................................•---------------.....---•------•---.....--•--.........-•--...----------......-------------------------•--------•--•----------------------------•---...--•--- J / ......-^----------Date Permit No..... Cj� 7... �-------------- IssuecL---- -- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF. Trr#ifiratr of Toutphaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ................ 'C= -----•------------------...------------------------------...........------..................------------. Installer at..........��-_fit_....._ 3.: ,"z,C _---•-•. . ..:........................................................................................................................ has been installed in accordance with the provisions of TITIF 5 of The State Sanitary 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 FUNFTION SATISF CTORY. DATE......................... . "- ? ---------- Inspector---.--.... ... .. .................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1 ...O ............................... FEE....,��6... ^.... Disposal Worhg Toni#r ion rruti# Permission is hereby granted........ ='=` ----C-! `,f .( --------------------------••--•-------------------........................--•--•---- to Construct ( ) or Repair (I.--) an Individual Sewage Disposal System at No. 's.v1 ........_ -� 1 "= Street as shown on the application for Disposal Works Construction Permit Nol�. . Dated.......................................... -••---------•------------•-.-- ......................... rd of Health DATE.............��? -l�' <L�.................................... w/ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS