HomeMy WebLinkAbout0007 CURLEW WAY - Health t�JRI�E W WA Y ;�
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TOWN.OF BARNSTABLE
LOCATION f 31 SEWAGE # r %' —ij
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VILLAGE rdr Er�.t.:.= ASSESSOR'S MAP & LOT
INSTALLER'S .NAME &z PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(t7pe) (laze)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC' WATER
BUILDER OR OWNER
DATE PERMIT ISSUED.
DATE COMPLIANCE ISSUED-
VARIANCE GRANTED: Yes No
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13 � TOWN OF BARNSTABLE �
LOCATION �. (' a.,,,Q �,. , SEWAGE # , 7
VILLAGE (� ASSESSOR'S MAP & LOT D A0
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY n o n
LEACHING FACILITY:(type) ,'f" (size) !-/ ®m o i
U
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER 1, Y
cc77 0
DATE PERMIT ISSUED: 2- - -7 — A�
DATE COLIPLIANCE ISSUED: S
VARIANCE GRANTED: Yes No v-'�
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
....7T .w-N-...........OF....... ...................
Appliration for Uhipasal Works Toustrnrtinn ramit
Application is hereby made for a Permit to Construct () ) or Repair ( ) an Individual Sewage Disposal
System at: _
................_..-----�'-�.�t!:E . U.�.................... ................••----•---•-.... . !- ------..------...................------
Location-Address or Lot No.
a Owner Address
........................ ----^........ .................... a .U. �.. .•M...... ....................
Installer Address
UType of Building Size Lot.._ :l� _ P----Sq. feet
Dwelling—No. of Bedrooms..........._5...........................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers — Cafeteria
Q' Other fixtures ............................
W Design Flow.....................`�.._6_............gallons per person pjer day. Total daily flow................. gal
1:4 Septic Tank—Liquid capacity.LO.ftgallons Length _:�._._ Width..-.:!10.'/Diameter..t=.... Depth...�� ➢�
Disposal Trench—No..................... Width.._..._e�....._.. Total Length......_.r........ao Total leaching area....................sq. ft.
Seepage Pit No.........I----------- Diameter./_��__..-. _.... Depth below inlet._-1'...... Total leaching area._&.78_...sAtmit.
Z Other Distribution box ( ) Dosing/tank ( ) n
'-' Percolation Test Results Performed by....f... .. !V l :.l.. _, ,--�_ s...... Date.._..._-
.r
,aa Test Pit No. 1................minutes per inch Depth of Test Pit... Depth to ground water---1VAAj.6.__.
(s, Test Pit No. 2.......Z�n.minutes per inch Depth of Test Pit....._ _. ._._. Depth to
----------- ............. -•--...-----••..... _ �1�!e ._........
Descri Description of Soil �._-.� ..__ ?: . ®.Q / ...�' -- . -------•--------------
P ....... - .----
LTER
® E,-------•-------- -j
U Nature of Repairs or Alterations—Answer when applicable__________________________________ ... ....._4.._..........._.
spa? --------------- ---------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Dl Al �te�Iii��' 'ordance with
the provisions of TITIZ 5 of the State Sanitary Code The undersigne further " VjV!d� tla!:system in
operation until a Certificate of Compliance has bee issued by the bo rd ealth.
Signed.....
---- -------------------•----------------------------------
Date
Application Approved By............
Date
Application Disapproved for the following reasons:---•--------•------------•-•--••----•--------------------------•----------•-••-------------------------••----•--
...............................................................................
•-- ---------------------------•--------.---------
•---------------•------------------------------------------------------
Date
Permit No......... ' 7...................... Issued Issued........................................................
No.... D-:. .�. Fps... ......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.� .N.........-OF.......; .. `T'_ _. ., ...................
,�l�r��trtt�ilau .f 1�r �i��u��a1 urk� C�u�t��rur�inu rruti#
Application is hereby made fora Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal
System at: ,
-U R La i:' ...... .................. �..,. o T 16
................_.. ._......--•- ----•---•-.....----•------•----••-•-•---------•----••........................••-
Location-Address or Lot No.
7.5..... ----•_._..
Owner Address
--- .:tee.. .._l _.. ..
Installer Address
Type of Building Size Lot... .... 3 -t)_-.-Sq. feet
Dwelling—No. of Bedrooms............ ............................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building ........ No. of persons............................ Showers — Cafeteria
a Other fixtures ---------------------------••••. . -
W Design Flow....................6:_5'...............gallons per.person pr day. Total daily flow................. ............gallons.
WSeptic Tank—Liquid capacity. !;4 gallons Length._ _.' _:_. Width 4:.:"J6..Diameter..r- Depth...:�.�._..�:"
x Disposal Trench—No._-__----_--------- Width f.._...._".._._..._ Total Length........r......._f;Total leaching area.._...,.•__......sq. ft.
Seepage Pit No.........I...,_..... Diameter.�.. ..... .. . Depth below inlet)-_'.: -.....Total leaching area..G.78... .
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by. ; _`�_6:.+�J�"� �: ` �► :..104.._..... Date.......- t��
Test Pit No. 1........�____minutes per inch Depth of Test-Tit r �'._+___ Depth to ground water
Test Pit No. 2........ —.._minutes per inch Depth of Test Pit ..... Depth to groundwater ...
i 0 A)6'
O Description of Soil..._t _._'f.8. .._.®_10,0501..... �9".L f- :..._..
? ..• .p (?j.__O.q!!- fra.�.VBa"+.... � d ................• ...... G
V t�' /
W ----••------------------------ --------••--••------...-••--------•••••-••...........------•---•-•-•-...•--------•--...•--•---•---•......-•---•......`.- - ••`�fAL----
Z.
U Nature of Repairs or Alterations—Answer when applicable----------------------------•----.---.--_-. - .._ E.
Q- Sltif6T�d,X .Ml.--.. ..
..............----................................................................................................................................>' --•-• .......... $5128.......... .....
Agreement: �® �q
The undersigned agrees to install the aforedescribed Individual Sewage Dispos
the provisions of TITL% 5 of the State Sanitary Code—The undersigned further a f in
operation until a Certificate of Compliance has been issued by the board of health.
Signed...................................................................................... ---------------------•----------
ate
Application Approved BY 0\-.,.."'. ��. D
.�--or- _._.......
Date
Application Disapproved for the following reasons:----•----------------------••--•----------------------••---•----------------------------------------------------
--------------•---........------•...----•----•-----------•---------------------•----..........---------...-••------------•---•---------------•-•----•--•-•-•----•••.........---•------------------.------
Date
PermitNo.........5 9- `-- 2----•-•------•----•--- Issued-.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF..:.......�*A��B.AX............................
...........................
Trr$ifiratr of Tn mpliaurr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by....................................................................................................................................................................................................
Installer
at.........................................................................................................................--------•••---•--•-•----••--•---.........---------------
-----------------
has been installed in accordance with the provisions of TITIE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No------------F.8-__1V.Z_....... dated_.............................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE,
SYSTEM WILL FUNCTION SATISFACTORY.
DATE...............................................................•-----------.---• Inspector.....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
CC BOARD OF HEALTH
...OF... 6 .I&kF ? .4n c. .
No.--.. :...7... FEE.Zj.............
Uiupuual Works Tuuutrwtiau rrutit
Permissionis hereby granted.......W.-C. ...----6 ----------------•-------•---......................----------•-.............---------
to Construct (><) or Repair ( ) an Individual Sewage Disposal System
at No...........J.;.rz. ...l
- 'e4w
------
----------I• -...........C-�4...L..............................................-.................
Street
as shown on the application for Disposal Works Construction Permit No.. e._:_..�12 Dated..........................................
------...-•----•--------•--------•----------------------------•--•-........---------------••---•---...-•-
Board of Health
DATE..................................... .........................................
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS
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