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HomeMy WebLinkAbout0134 CROCKERS NECK ROAD - Health r `� 134 Crocker Neck W-:� ' -- - -- - - -- - - - --- - - - - -- - --- --- - ----- I COWfir,7 "`tir A-019,' OS3 1 TOWN OF BARNSTABLE LOCATION VILLAGE �'y F—v ASSESSOR'S MAP & LOT INSTALLER'S NAME PHONE NO. if t.� � � � SEPTIC TANK CAPACITY �(�Z� U S LEACHING FACILiTY:(type) (size) ; NO. OF BEDROOMS PRIVATE WELL OR P C WAT BUILDER OR OWNER © o DATE PERMIT ISSUED .. DATE COMPLIANCE ISSUED: .- 9 VARIANCE GRANTED: Yes No ;/ - l U _ FRz THE COMMONWEALTH OF MASSACHUSETTS A"ROVED BOARD OF HEALTH cons aw Conservation Departmen'.OW N OF B A R N STA B L E ' ��'1'�r�rtt��bti���n�nl �i nrk,� C�n�t��rnr#inn rrmi� , Application is hereby made for a Permit to Construct ( ) or Repair (C4-a**n* Individual Sewage Disposal .System at .........j�. '�4 k Location-Addres i or Lot No. �S mod_ _ 4el._� . (f_JD (_ 9 i rn Add ress ,/ Installer Address Type of Building Size Lot............................Sq. feet �. Dwelling— No. of Bedrooms._-_.__�-------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' u Other fixt ----------------- ---- --- - d es ---------------------- W Design Flow.... ............................ gallons per person pe day. Total daily flow........_._.__._._._...___.__..._..__._.__..gallons. WSeptic Tank Liquid capacity./ .. allons Length----- ___ Width. .___-__. Diameter-............... Depth................ x Disposal Trench—No. .................... Width.................... Total Length------- Total leaching area....................sq. ft. Seepage Pit No------�._-.......... Diameter---�C_')..-___.__ Depth below inlet.____.._.____ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------- ----------------------------------------------•-----•---•-_--_.._ Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fj Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0+ •.... --••-•-•...----•--•------------•------------•---•----••--••--•................•-•-----•••-----......................................................... 0 Description of Soil................................-............................................................... --------...----------------------------•---------••---•---•---...--•-•- x U W -------••••-•-- ---------------------------••-•••......----------- ------------------------------------------------------------------- _..--- U Nature of Re airs o Alterations—Answer when applica le.-�� .__ ..-S-T ___:_�.QPd_5��.��__` Q'N�.� U JD 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 Com li - been ' sued oa of health. 1 Signed .......V ` ........ ...................... - -- ----------- ...... ...-..---` ---. ..............- ..................._.. Dve ApplicationApproved By ............. .............................. ... .. .................. ............. ....... Application Disapproved for the following reasons: ...... ......................... ............... ..... ..................................... ... ....................................... ............ ......................................................... - ---- ...... .D.ate..................... ® (1 Permit No- ---------------- ..-:. -.... .......... Issued ..............-........... Date •'J'tir+�. ...�..-.4�-:..�.....w..:1V._y�.,v .. ry .�,...._._� • .. 4r ..� y.y.�• w ..+,k t..� �^' ..v tvt w-"-4!M v - _ .. r- • .- . _ ._ _ No...73- �' FE$. ���.......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 1�_'0_XpVftra1ivu for Diripwial Wi urk,5 C ontitrur#ion 11amit Application is hereby made for a Permit to Cotstruct ( ) or Repair ((—)-an' Individual Sewage Disposal System at:pp ...... ....Location..\ddrrss --._-----•---- ----or Lot No-----------------•-•------------*......... Oicner Address 1/`t l _-------- �1. d .......................................................c a -•-•••-••--•-------------•--•.`.....--••-•...---•-•-••••-••••••••-•-•. ......-- Installer Address Type of Building Size Lot............................Sq. feet �. Dwelling—No..of Bedrooms.___ ______________________________Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building --------------------_--___ No. of persons............................ Showers ( ) — Cafeteria ( ) at Other fixtures --------------------------------- ----- - -- W Design Flow.......7 .....................gallons per person pear-day. Total daily flow............................................gallons. W Septic Tank iquid capacity-/r ztgalIons Length.Total Lengthidth__.��_._..._ Total leaching area Depth.............. x Disposal Trench—No. .................... Width.................... g q. 3 Seepage Pit No------/............. Diameter-__ Depth below inlet....1�t............ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by................ ......................................................... Date........................................ a Test 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.........-............ 0 Description of Soil.........................................................................................................................-•-••••---•---•••--•••..........---••-•---•-•-• x c, ------ U Nature of Repairs or Alterations—Answer when applicable................. ..�T�.'�:.(_t- x 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.i's'sued\by-the-board of health. Signed ......--A. \. �S Dare Application Approved By ............. _.. �.<E-.., . ... ..................................._.. .......�-�� ..�.�'�a.. .............................. Application Disapproved for the following reasons: ..................................... .................... ..--- .....-- ..........................-----...... ........................................................................................................V........................... . . ..................... . . .............................. .................._............... --. �j Dare PermitNo. 3--- � ,...y........ Issued ................................................................... Daze ---- sti.,_._..——-- THE COMMONWEALTH OF MASSACHUSETTS 1 BOARD OF HEALTH TOWN OF BARNSTABLE C�Er#ifirate of Qlamplia nre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( by .........................-__A�AA..r� �.----�.� C.... ..... .. .. ............._...... ..................... ....... Ins�allcr at ............_................ �...... ..........�.... .. .w has been installed in accordance with the provisions of TITLE 5gqof 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. `� 3- L DATE.................. ......'...a �-....! �....._.._ Inspector --- .... _gib........ - THE COMMONWEALTH OF MASSACHUSETTS ��� BOARD OF HEALTH TOWN OF BARNSTABLE No.....-i.- ....:�� FEE �i��rn�tt1 urk� �uu�#r�r#Uan �rrmi# Permission is hereby granted---------------_----_-��_.�-�' -�!�tn�7 .���.-�-�:.............................................. to Construct ( ) or Re air (, -) an Individual Sewage Disposal System � atNo. - ................./..r..� _h. ./__._..h z'Win- ---------------------- r� 1�._......------.............. Street q {� ,/ as shown on the application for Disposal Works Construction Permit No.l ....O�_._ Dated........................................... -----------------------------•--••---•--•---------------------------•.•.•--•------•---•..••--•••-•--•.... Board of Health DATE................................................................................. CFOR3i,383Q"' 1 08 HOBBS'�A WARREN,;:tNC..PIIBL�SNER�