HomeMy WebLinkAbout0038 CURLEW WAY - Health � g Cwfcw wa�--
TOWN OF BARNSTABLE
/71
LOCATION �,�� SEWAGE # - i{
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VILLAG4�U- ASSESSOR'S MAP & LOT ®/D-D,)-
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INSTALLER'S NAME & PHONE NO. � rl 1 a��cv a
SEPTIC TANK CAPACITY 1 ®D 6
LEACHING FACILITY:(type) -� �� (size) 10 6-0
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER r r So c„"�C�-
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DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED
VARIANCE GRANTED: Yes No !�
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
®Gvlu .............OF...... . .:-..
ppliration for Uhipaiial Works Tonstrurtion Permit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
� Location- es :._
•-----��'-- ---------------.` ..v ..... ------.................. -------EZ---- �
x
ner y � i Address / f/
W 6
W ... � _
Gija1 ei r Address
Q ._Type of Building Size Lot. _� Sq. feet
U Dwelling—No. of Bedrooms............. .........................Expansion Attic ( ) Garbge Grinder ( )
p Other—Type of Building a yp g ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Pa Other.fixtures ___________________________
W Design Flow........ f.6------------ gallons per person per day. Total daily flow...._._.30_0._._.:,__.._____-___-_-_gallons.
ao ..__
WSeptic Tank—Liquid capac ty............gallons Length................ Width................ Diameter...-_-_-________ Depth_-_________-._.
x Disposal Trench—No. .. Width-------------------- Total Length....................... Total leaching area--------------------sq. ft.
Seepage Pit No..,/l1_QU_' '_Diameter____________________ Depth below inlet.................... Total leaching area------------------sq. ft.
z Other Distribution box ( ) Dosing tank
aPercolation Test Results Performed bY.......................................................................... Date----------------------------------------
a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_-_________-_-____--_--.
tTq Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water.-__-..____________-_-_.
xDescription of Soil-----------------. -------• Alit—el ......... -------------------------------
V .--------------
W
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
V 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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee issued by the boar f health.
--•••- . ...• .................................. --�---y-•--�- ------
'gned----- -�z -�
Application Approved BY x ... ...... .• ---- ------------- / / Vie' :
ate
Application Disapproved for the following reasons:................................................................................................................. .
-••-•----•-----------------------------------------------•---------------------------•--•---------------------••••••-----------------------------------------------------------------------------------
Date
PermitNo......................................................... Issued........................................................
Date
THE FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINALS)
I A ,
m / �C(�J LI
DATA
THE COMMONWEALTH OF MASSACHUSETTS
BOARD. OF 2HEALTH
�C -------------OF..... "¢x. �`r?�� ' ------ - -------
Applir0on for Disposal uths Tomitrurtiun tlrrutit
.Application is,hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
• _ 'System at
_... ..t�1...... .._...>✓ Y�.. v � J. •/,f1 1 :✓� n� c - '
• .: -- --
w-M * Location-Address or b6t No ,
- t,!
_ caner �. k fi ,r - -
7 � 4!"y •`7__----- -- Aam„ Y
stalie?r' Address
Q. -----------
Type of Building Size Lot__-. '._S , feet
YP g
-, Dwelling—No. of Bedrooms------------- _________________________Expansion Attic ( ) Garb ge Grinder ( )
a -Other—.Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
a .
Other fixtures -----------------•------=-------------------------•--.............................................. .r -
W Design Flow..._. g r"_.. q� :_gallons per person per day. Total daily flow____,__ . __.gallons.
9 Septic Tank—Liquid capaetfy��+� __gallons Length________________ Width_____-_- Diameter___-- -__--____ llepth._.:.._.._.__. -
Disposal Trench No .�_- _______ Width.................... Total Length.................... Total leaching area....------------- _sq.;ft
Seepage Pit No r;,% Diameter____________________ Depth below inlet.................... Total leaching area-----------------sq. ft..
Z Other Distribution box ( ) Dosing tank a : K
Percolation Test Results Performed b
` Y------- - --------------------- - ---.`------------------------------:: Date----•---------------------.-----------•
' Test,Pit No. 1................mmutes 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........................
•.................. -•----- -
O Description of Soil----------------- c� `• 1 /= 1.......__.. f ,!, �ii¢ >, r-•
x _ = . --------- - ......
y
U: . ''"'--•----•-------•-•-----•--•--- -------------------------•-------•-•-------•--•------------------
----------------------------------------- ..----------------------------..... .
U Nature of Repairs or Alterations—Answer when applicable____________________ _ _____________________________________________ __.. -__ .-_---- .
-----------=---------------=---------------------------------------------------------------- ------------------------------------------------------------------------------------=--------------
Agreement
The undersigned agrees to;,,install the aforedeseribed Individual Sewage Disposal System in,,accordance with
the provision&'of Article �I of''the State Sanitary Code—The undersigned further agrees'r of to place the'�system in .
operation until a.Certificate•of ConiXtice-has been issued by the board of health
c sit..,.
� g : • �
" y�w+°l4 a ; ..�',-rr, -:: � � 3� >f •e , to
Application.Approved 7
, �Date a.
,Application Disapproved,for the following reasons_____________
----------------------
--------------------------------------------------•------------------------•---------------------------------------=-----------------------------------•--_..
.. Date
PermitNo.,......................................................... Issued----------------------------------------------------------
Date.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEALTH
w.. OF. ... ......... .......
THISISk
4 CERTI5 , That th,..I vidual Sewage Disposal-System constructed { or Repaired ( )
�E Installer
at �
.
---- ----------------
has been installed in accordance with the prbvisions.of Article XI of T, e State Sanitary Code as descl bed m 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.
DATE. Inspector---------........ .............................................................. .
THE COMMONWEALTH .OF MASSACHUSETTS _
t BOARD OF HEALTH �` # � `
6
... ------------........ .,
,;� .............OF......�. -
No._.._:. FE>r
�41 Ton t ttr iu t rr�ttif
Permission is hereby granted.__.__ . ter"_ `t-- _ _ -
- ---
to Construe ( r Repair ( ) an Individual Sewage Disp - I Syste�fn ..
da.
h at No. E� ......
�,r° -•--
MAI
as shown on the application for Disposal Works Co trucfion Pe. t No _ ._._. __. Dated:_:
°i• Board of health
DATE---------------------------------------- ---------------- -•---•----•----------
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS