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HomeMy WebLinkAbout0145 CROCKERS NECK ROAD - Health Cb'�1M-� • � / Q��3 7 .y \ TOWN OF BARNSTABLE LOCATION I VSS COCII(cl- 4CC k /?W. SEWAGE # Ry- 1/7 VILLAGE CO TO/ T ASSESSOR'S MAP & LOT ? S- a3 III INSTALLER'S NAME & PHONE NO. S-IfOf <ell y SEPTIC TANK CAPACITY 0 LEACHING FACILITY:(type) a ' �i TS (sue) (n O D 6`71 NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATERS p BUILDER OR OWNER DATE PERMIT ISSUED: q—�-�- DATE .COMPLIANCE ISSUEDi__ VARIANCE GRANTED: Yes No �/ G 6� )SESSORS NIP NO: sn.RC£LP.. �t 7 Fmic THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ... ................................OF...-.-....--.-...-....-....--..--......--------------------..-._.....-.........._-........ Appliratiou for Dispati al Works Taustrnrtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair (t/S an Individual Sewage Disposal System at: �J v ..-• -•-- ••••--- Location-Address or Lot No. 2. y� _ O_ �f' Address /�i� a ................... 1__ !0 ....-- �-/ � ° .................................... --•-•---•--...--------- ._A�2�./r-_...!_4%.-----------••--- Installer Address PQ Type of Building Size Lot___-.J g ............Sq. feet Dwelling—No. of Bedrooms..........a.............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria. ( ) Q' Other fixtures .----•-•---•--•-••-------------- W Design Flow.......................11Y1?............gallons per person per day. Total daily flow---------=..................................gallons. W Septic Tank—Liquid capacity_15�4�__gallons Length....!1'_____._ Width._.-?_-�_. Diameter________________ Depth_-.S:__7._..-. Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area----------_.........sq. ft. Seepage Pit No......27-------_--_- Diameter.__._./_9.`-._._. Depth below inlet.. Total leaching area_Z�Cr_ n___sq. ft. Z Other Distribution box ( ) Dosing tank ( ) �{'r _ aPercolation Test Results Performed by.......................................................................... Date......................................... Test Pit No. l................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........ 1L?l'1.- tfe � �?. --------------------•-------------- ------------------------------- x W ----------------------------------------------------------------------------------------•--•._......---•-•-•---- ... - --------------/--------------------•---- •--------------------•--- VNature of Repairs or Alterations—Answer when applicable.-_-_--_.• _ , __�__----©lc?-___s: Ice g Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i T p of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issu d by he board o health. Signed---- -- ..' _•• lid ` `?/ Date ApplicationApproved By.................................................................................................. Date Application Disapproved for the following reasons-------------------------------------------------------••------------------------------------------._..._..-•---- •..........................••-•--••----•--•-•-•------.-...•••------------....•--.....---_._._.....--•-••_.. Date Permit No......... ___2_^_._�7� ............... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....... .................-----.........OF.......................................------------------------.................---------- Appliraa#ion for DiopooFal Works Tonotrnrtion rumit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: - ........CuTul F - 9 C Locati n-Ad ess or Lot o. Jeo Sf �4/-soatl 4 4 sr.... 1. oaf i.�,, r A _.._ n.. - - .. er ......................Address -- - ................ r iE...--- •c 4!?----------------------•--•-......._ ..-- o ld` ------------•......_......--••--..--.. Instalier Address d Type of Building Size Lot.... ......Sq. feet aDwelling—No. of Bedrooms.__.....a.............................Expansion Attic ( ) Garbage Grinder ( ) 4.1 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) QI Other fixtures ................................. . W Design Flow..................... ............gallons per person per day. Total daily flow............................................gallons. 0Y Septic Tank—Liquid*capacity.l. n°_gallons Length...1.1......... Width.S_'&- . Diameter__-_--__-____- Depth..17 7... Disposal Trench—NTo. ................ ... Width...... Total Length.................... Total leaching area---------_----------sq. ft. Seepage Pit No.....2.------------ Diameter.....A2.. ....... Depth below inlet......6..#-------- Total leaching area...S7 ..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...................... tX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ----------------------------•-----------..------ ---.... ...----------.......------------------------------------ •----------- ----•--------- O Description of Soil......rnt�_......Co.!4k._.__._.__. ` � x ----------------------------•--------•--------------------------------------------------------------•--•--••_.. U -----•---------•--------•---••--------•-•----------------------------------------••-----------------•---------------------------.....----------- W • -------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable____ -c ._tct_ 4'f.,( .�r.f,4.•, -------------------------------------------------------------------------------------------------------•--•--------------------------------•--•-----......---------------------------------•--•-------. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'T'T y g g p y `�of the State Sanitary Code—The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been iss ed by the board " iealth. cy Signed----- --- 7 Date ApplicationApproved By.................................................................................................. ---------•--------------............... Date Application Disapproved for the following reasons---------------••---.....---•--••----•--•---------------------•--•------------------------------------------•--- -----------------------------•----•-----------------••-•----•--------------------............------....-----•-----------•-------------------•---------------------------------•----------•--------...._. Date PermitNo. ........................................7 ..............Issued-....----......----------•-. ------ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............f ..L�: C.�.........OF.......f Tntifiratr of Tomplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( } by-------------------� ='' ... -- ----- Installer at < �' Y� ---------------------------------------------------------------------------------------•------ has been installed in accordance with the provisions of ii""r 5 of The State Sanitary Code as described in the application for Disposal Works Constriction Permit No..�'- -:.. - __:Z,.._....... dated-.---------------------------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �r� DATE......... _ g�----------------------------- Inspector.....!)t.e. - . ?.>.�---- -- . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _ f C%L.c-r �. NO .....................� FEE-7 ....^ %V opal Works Sono ra ion rranif Permission is hereby granted.....� = - - -----..................................................................................... '`&.. to Construct ( ) or Repair.�!) an Individual ewage Disposal System at No.. l........... I`�e:�;.......V-?�------------- Street , as shown on the application for Disposal Works Construction Permit NoJ5j 2:1-5.)_ Dated.......................................... Board of health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS G � FIJp ( 01 tr qj a _...� 43� _41 G 'tipC.l . ROAD cEZTIF=ICL7. 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