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HomeMy WebLinkAbout0626 SCUDDER AVENUE - Health (DaZ(o 43CUGIdbyl )ue •, Z TOWN OF BARNSTABLE . LOCATION 54�v®oeJi� RY e— SEWAGE # VILLAGE l�j/, �O�e ASSESSOR'S MAP 6z LOT -7 1 INSTALLER'S NAME & PHONE NO. A & B CANCO775-62 SEPTIC TANK CAPACITYo7-,000 LEACHING FACILITY:(type)Zele (size) j agO NO. OF BEDROOMS .PRIVATE WELL.OR PUBLIC WATER BUILDER OR OWNER 91—(ey d DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: /® 1,3! VARIANCE GRANTED: Yes No ,-� __ _ �� c,._, f it l ��� .. � r !G� —,, f�o�.S� � � ��� � e� _ �a�� � ... .,, �• � �• pa r Q� onsts2 !e(�rizervatlon Department Fast ............. E COMMONWEALTH OF MASSACHUSETTS signed ate OARD OF HEALTH TOWN OF BARNSTABLE Appliration fur Diripwi it Work,5 C omitriirt"tun ramit Application is hereby made for a Permit to Construct ( ) or Repair (�an Individual Sewage Disposal System at: n�-Qe ................... ...-c U d4!�-�r-----_A=e........................ ......................................................=.......................................... Location-Address � Lot ' �anxYl------------------------------------------------- _b 1 a �< p i s O.ner A ress Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms.........7 _Expansion Attic Garbage Grinder NO aOther—Type of Building ��'f►r! .fL---------- No. of persons.......Q'..�_------------------ Showers (� — Cafeteria ( ) dOther fixtures tk------------------ ------------------------------------------------------ ----------------------••--------•--•-------•---..._......__.. W Design Flow............................................gallons per person per day. Total daily flow.............................................gallons. 0x Septic Tank—Liquid capacity............gallons Length________________ Width---------------- Diameter................ Depth................ Disposal Trench--No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No--------.-_--_-___- Diameter____________________ Depth below inlet.................... Total leaching area..................sq. it. 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........................ fTq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a --••--•--•--------------------•••---•---------•----•---------••--•---------•------------------.............................................................. 0 Description of Soil........................................................................................................................................................................ x -----•----------------------------------------------------------------------------------------------------------------- ------------------------------------------- --------•--- •-............... U N ture of Repairs or Alterations—Ans ver when applicable., n_anat�_-_.__fw-.......5���«...... o......./....... AOR 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 the board of health. Signed ------------ --- -- �. '. .` ._ . .................... . . .... Dare Application Approved By ......... .................. ��.. -------- --------- ---- ---�3.— ue Application Disapproved for the following reasons: ........................................ -- ............-- -..................-........-...................-- . ............. ............................................... .......................................................-....--............ .-- ...- ....-... ..- - .. ........................................ Dace PermitNo. ........�-3------5-0-7.................. Issued .........................................................-........-. Date - �f3 Aa ovate - No....................... Fas. _............... T E COMMONWEALTH OF MASSACH-USETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiou for .Ulrip ial Worlig Tomitrurtion Permit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: �I Location Address r Lot N•o. --_ � . . �16 a,� �........... e.l Q ................. ..... ..--- - Lan. iff. ------. Owner Address ,�t- ? �'/�,/'lCZ..----------•------------------------------------- .... e•.----�D!a;n_...... s_±:........ �: ---- . ....- . Installer Address Type of Building Size Lot.................:..........Sq. feet II Dwelling— No. of Bedrooms.__--_-_�----------------- -- -----Expansion Attic ( ) Garbage Grinder (No) -.3 Other—Type of Building a9tf ,;A._.......... No. of persons-------©------------------ Showers (�• ) Cafeteria ( ) Otherfixtures ... kif............................•--•----•--.....---------------•--.=------...........---••••-------••-----•.....--•-------......--.------ 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 ( ) Percolation Test Results Performed by...-...................................................................... Date........................................ Test Pit No. 1................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........................ a 0 Description of Soil.............................................................................................-------•-------••-•-••-------•------•-•----------•-•--------------------•- x V ....------•--••--•••----•-•--•--------------•-•--------••--------------------------•----.......----------------•---••-••---------------•------•---------•----._.......------------...........-----.----- W ••--------•----.•--•----•----------------•-••----••-----------.....••-•-•••••............--------------------------•-----•---••---...-••-•-••--•-•••--------------------------------•-- . ------- UNature of Repairs or Alterations—Ans ver when applicable.-./"___ L� z......fA-_ _.____. � � -_-._-_�......-1.......D PDX bra. LP..l o A �----•- .& e---••-- •---- --...••---••-•----•••-----•........----•---••••----------- ------ 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`...:..... - 'i - — - .... ... .. - ! Date Application Approved By ---------------- J.:� --- ......................------------------------------------ ....��...-�_3,7 . Date Application Disapproved for the following reasons: ................_......._......------......---------------------.-----.- ..................................................................... . .................................. ...... ........................... ..- ................... -- ........................................ Permit No. -------C�..�,.,�...--5_0.../ Issued Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired'( by.... -� 12:............. ............. -- .... .......................... ll �-+ � InscJlcr at .... d`... ......_------..C'_r A:f......_..... .... ........ 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. .---_—?-3!�Q..7._..._. dated ...---------.............----------......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............. t..n.'..I.. J...".. �-------------................ Inspector ---........ 1 � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH o.jkTOWN OF BARNSTABLE No... 3.-.7(57 FEE........................ 3�i��n�tt1 �>ax�� �A4t���1�UQIt �lexuti� Permission is hereby granted--------. 4 r�`•�.-•----�/1f7 C----••---------------------------------••----••------------•---•--•------••------.......... to Construct ( ) or Repair ( a Individual Sewage Disposal System atNo. Cp .l...... = �, i n s..-••-•-... !'`r------•--------------- ------------------------------------------------------------------................... ? Street Q 1 as shown on the application for Disposal Works Construction Permit No.%j-S07.. Dated....--C�.-.�.�.... . ........ --------------------------------------------------------------- Board of Health DATE------. .......................................... FORM 36508 HOBBS&WARREN.INC..PUBLISHERS