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HomeMy WebLinkAbout0170 WHITEHALL WAY - Health i'7o ohlih4li W+j 9l�IN'!!s TOWN OF BARNSTABLE LOCATION Z p f 17 &�Jfka tl WOV SEWAGE VILLAGE ASSESSOR'S MAP & LOT 27.2 OVr INSTALLER'S NAME & PHONE NO. 4 'f SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO. OF BEDROOMS 3 PRIVATE WELL OR i�LIC WATE BUILDER OR OWNERR2. DATE PERMIT ISSUED: � q DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No t��' �/r�fjp� �--`. tS' S`- ASSESSORS MAP NO: PARCEL NO.- 6 O..< No.rsa l � Fiz.B .:✓...... THE COMMONWEALTH OF MASSACHUSETTS �- BOARD F HE T ............OF.. ... . .. -...F??�. - ------------- --- ApplirFatiou for M-4pug al Works Tomitrurtiott Frrutit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at _ S: .. .:. ...�. / .............� _ 1... Location- ess � or Lot No. P . 6'0- `' .. c 4----------------------- ,.. 1.� ?c - Owner �-•-.-•.-Address.-- Cs ----------- --.. ............................. --...... �l ---------.........------•--.......------ Installer Address Type of Building Size Lot.l �_��__.Sq. feet Dwelling—No. of Bedrooms........ ...............................Expansion Attic W.1 Garbage Grinder ,(�� aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures .................................. W Design Flow.............. r................gallons per person per day. Total daily flow____-__.1_3.-a.........____.......gallons . 9 Septic Tank—Liquid capacit 1 000 gallons Length................ Width--_--_.......... Diameter-_._____-___--._ Depth................ Disposal Trench—No. .................... Width......____......__.. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No____________ _______ Diameter................___. Depth below inlet.................... Total leaching area..._.____._.......s . ft. Z Other Distribution box ( ) Dosing tank ( ) . a Percolation Test Results Performed by. f� ..}... .1 _�' !�P� >%+Date____ - .._-_---1 .... Test Pit No. l�LZ2 .e.�..minutes per inch Dep1Y( of Test Pi f_.. Depth-lo ground water- Test Pit No. 11ha4d`_minutes per inch Depth of Test Pit__ ....... Depth to ground water d'................ R' -- O ;�-� ' Description of Soil.... -�......On✓n.. -•- Q --------------- - - - ------------------------------------ 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 IT--LE ; of the State Sanitary Code—The undersigned further agrees not to pla/thhetem in operation until a Certificate of Compliance has be issued by the bo of health. Signed•. • -••-•----•--. .•--•-.••--- --.Application Approved BY ... ---- -------------------------------••--.................-- -----� �-- Date Application Disapproved for the following reasons-------=- ------------------------ .......................................-...................... _ Date Permit No............ �...--•-.... ' Issued.......................-.......................... Date FE]`m_7�............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _--.---.--_---_---- Applira#ion for Uh4pasal Works Tonstrur#iota Vamit Application is hereby made for a Permit to Construct (& or Repair ({ ) an Individual Sewage Disposal System_at• - - f //" _��° Location- ress_ or Lot No r .Q.hr...T: ._. :._� k .d!.............. ..� � { 2 _.Ate... 4+ ...`. a -- - „ owrer Address F InstaLer Address Type of Building Size Lot/ ..Sq. feet .____..__:_ 4 . a Dwelling—No. of Bedrooms.......S.................................Expansion Attic,( ] Garbage GnnderoV `q Other—Type T e of Building ............... No. of ersons._............._......__ Showers — Cafeteria G� YP g ------------- P --- ( ) ( ) Other fixtures --------------• --------------• - w Design Flow.......... . ...................gallons per person per day. Total daily flow.......__. _......................gallons. x Septic Tank—Liquid capaciW __gallons Length___--_--•--•._.. Width................ Diameter................ Depth................ 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 ( ' a Percolation Test Results Performed by " � _._ _e�r "�' '.f ! -t----- Date__ a Test Pit No. P__ }r_.minutes per inch De i of Test I e... Depth to ground water Test Pit No jjp.al ._minutes per inch Depth of Test Pit Depth to ground wate _..• -.- oDescription of Soil..!2. -ate" . '` 5 x - jr f w VNature 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 Ti 5 of the State Sanitary Code— The undersigned further agrees not to place the s stem in operation until a Certificate of Compliance has b issued by the bo- d of health Signed ' " -_ f _._._...ad .... __ __.ate._.. f ...._. Y Date/ Application Approved By _ - _ ..................................... ........ 4t Date Application Disapproved for the following reasons--------------------.................................................. ••--------•---•--••--••---•••---•------•-- -•------•-----------•-----------------------------------•--------------------------------------......-•--------------------•-----••------••••--••-•-•-•-----------------••-----••---•--•-------...•••••. Date PermitNo. .-----.-..-�.............. Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS ,;,....... BOARD OF HEALTH. ..............OF. .. .. (..:�:........................... Trdifiratr of Ta'Mp tattrr. THIS IS TO aWTIFY, Tl at the Individual Sewage Disposal System constructed ( or Repaired ( } b .�_>a js°" =1 fig"' - %/ }---------------- -------------------------•---------- ---_----------- --..------•--- Y stall r has been instailed in accordance with the provisions of Ti T ti j of Thel State Sanitary Cod as sccribed•in the application for Disposal Works Construction Permit:No ;,_<�.._.1_d_Z�. dated------- t�®_��................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL1.FUNCTION SATISFACTORY. .-1 DATE................. '.' -.-- -••------•----------•--------- Inspector.................. ...................................... THE COMMONWEALTH OF MASSACHUSETTS © ' BOARD OF HEA TH FEE....- _ ... ..... Disposal or �otaotr ion "permit -s`. ... .Permission is ereby granted: ' ... _�. to Construct (�r Rep it ) an Pdiyidual S fm;age Disposal System �t 1\TO..°x2 5...__..'•_.._"""_ ____4n._:.f,.5a7._f._ _.. .�°.'. _. _._. .. :xi ............................._...................._--__._-••--------------- Street ��` as shown on the application for Disposal Works Construction Pe �No�t?._ �4'.�__,_D e�.__L � Z_........... ...••.,, ..............................5 .:�A. .-..� ............._._..........•... n ,� � I `, - Board of Health FORM 1255 HOBBS & WARREN.`INC., PUBLISHERS i r 'S qr� DAViD P' �A {I�? ro 30� F'i2oiJT:S7"BY�Itk MI a civlL No.31115 stag�/AAD . sa `W, i.ti` - ASSVrNED Lo'� Roc { H Air MT . -41 W (TE N-ArI.-L W► I 50' W1D� 'PRrV�4-t W / q I0,4 LOT 3 I / LOT ,3 SGr'n F� \ / tI1 M N O 60 Lo-r 37 1 2S 0 0Al ' tr T Z 7 ,� n oc : oT ?� TL� � �jT- LEGEND PAUL a EXISTING SPOT ELEVATION OxO LEVY EXIM'10.0 CONTOUR 0 --- - No. 106 YA y ' CERTIFIEU PLOT FLAN FINISHED SPOT ELEVATION \� i FtIdI�HEO CONTOUR %^-' NOTE: The lucation of un existin ui de ` r F,� . wells, or other utilities shown on th plan is approx- IN imate only as determined from records and/or. verbal ANNIS information. The contractor is responsible for the • a�� ` T81► �p"} /) � verification of the existing lOCatiOns in the fic ld 'SCA'lE�'�� - ©I DATE LEVY & ELDREDGE ASSOCIATES, INC. : CLIENT.����ei�t _ I. CERTIFY THAT THE PROPOSED' __j ENGINEERS-LANDSCAPE ARCHITECTS^ _ JOB.NO. LQ Y(� SUI;LDING`''SHOWN ON . THIS PLAN PLANNERS-LAND SURVEYORS . A �;/y CON FORMS..., TO THE 20 N I 6 L AWS DR..BY k . 1w i 712 MAIN STREET CN. BY$ 2 PW H YA N N I S, M A S 3. SHEET.! 0f A AT E LAND SURVEY R 1 'Sol, .q � 2J _._. ___. 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