HomeMy WebLinkAbout0060 EAST LANE - Health 60 East Lane
037-007 cvruir
TOW OF BARNSTABLE
= LOCATIO SEWAGE $
VILLAGE ASSESSO 'S MAP LOT 60
INSTALLER'S NAME PHONE NO. �v7�
SEPTIC TANK CAPACITY �®
LEACHING FACILITY:(type) A (size)
NO. OF BEDROOMS PRIVATE ELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED: 6
1,1,v?/,91
DATE COMPLIANCE ISSUED: 6 �6
VARIANCE GRANTED: Yes No y
rk
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....................
THE COMMONWEALTH OF MASSACHUSETTS
APPROVED BOAR® OF HEALTH
Barnstable Con>OM ian DepartmentTOW N OF BA R NSTA BLE
igne� traU r:-i!ipv! al Wnr1w (�omitrurtiatt Wrmt�
Date
Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal
System at: l/
... __... �� � -------••---•----•---. ---•- o (J 1. -•----.... - -... .....
Loa 'm-Address or Lot No.
-
... r.tF r, s
sncr
Installer Address
d Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms------------------------------ -- _Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( )
p' Other fixtures ----------------------------------
d -------------------- --------------------•------------------•............
.....
W Design Flow............................................gallons per person per day. Total daily flow.........................._...._.....•......gallons.
WSeptic Tank—Liquid capacity------------gallons Length---------------- Width................ Diameter................ Depth................
x 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 ( )
�_' Percolation Test Results Performed by......................•-•-----•--•••-------•---------------•-------------. Date........................................
a
Test Pit No. I----------------minutes per inch Depth of Test Pit.................... Depth to ground water.....................
fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
0+ -----------------------------------
•.................................
.....
••.......
.•---•-•••--------------------------
....-•-•........
.........
•-=--•-•-••.
ODescription of Soil........................................................................................................................................................................
V
W ---•- -----•------------------------------------------ ---------•--•----•••------...--•-----...................... --- ----....-
U Nature of epair Altera ons—Answer when �p ' b ..... ,F. _..._ ....S_. `' ................................
Bement:
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 u�th
dersi ned further agrees not to place the
system in operation until a Certificate of Compliance h ee oard of,h lth.
o� ���.
Signed ...... .. ....... ... . ................... .....................e.....
Dace
Application Approved By .............. .....-.�.C?..-...1..4... 3
-------.—..............—..............—............................ Dace
Application Disapproved for the following rearons: .................................. .................................... .... ... ........................................
....................................................... . ............................. ....................................... . ............................................................. ........................................
Dare
PermitNo. .......... ..3... ....54..b-------------------- Issued ....................................................................
Dare
_ Y
• u t.wT'..� � � � O o � s .p ,
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH /
TOWN OF BARNSTABLE
� .� �lirtt iuit for Diripwiui Works Tomitrnrtinn Permit
Application is hereby made for a Permit to Construct ( ) or Repair (�},/) an Individual Sewage Disposal
Systemat- . .................................... . /J ( ...............................................................
(� Lo .itt*b -Address or Lot No.
-----------------•••••.••••--.........._...• ..................................................................................................--•••-•.--------------•-------------•-•-•------••-------------...... ........
Address
�.................. �/.: ..-----` ll Q ....................................-�•S •
Installer Address
UType of Building Size Lot............................Sq. feet
t., Dwelling—No. of Bedrooms`.l-----------------------------------------Expansion Attic,,( )• Garbage Grinder' ( )
aOther—Type
of Building ._.`.................._:... No. of persons............................ Showers ( ) — Cafeteria ( )
d Other fixtures ---------------------- -----
W Design Flow............................................gallons pert person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity.-:.........gallons Length---------------- Width---------------- Diameter................ Depth................
x 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 ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
j Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
fi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
-------------------------------•--••--..............-----•-•-------.......-------------•--........--...............................................
ODescription of Soil.................................................................... ---•-------------------------------------.......---------------------------•--..........-••-.......
x
W ----•-••-•-••-----•--------------------••--••-••-•-------•---......_--••----•--------••-----......••----•------ -- ........
U Nature of epair or Altera 'ons—Answer when Qp ' abl _ .._._.J. .._. � ................................��
g � f
AlWement:
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-bee A'sued- y thwboard of health. � �
Signed ......../....... ---- . :.? ............ ---------*--------- Date
Application Approved By ............ .,�.a - .. �'1.:4- � ,. 3
Date
Application Disapproved for the following reasons: .......................................... . . .................................. .......... ........................_
.. ................ ............................................................... . . . . . .. ........................................
Da
-
Permit No. .......... ... .. .....:7(,�................... Issued
Dare
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
V Qrtifir to of V ompliancie
THIS IS TO RTIFY, at e Individual Sewage Disposal System constructed g p y ( ) or Repaired (I/-
All )
by . l i - - ..................................... ------- ........._...........
.. -------
---- _.... --........... . ...................
Insrdlcr ,
at ........: .ice....0..............._... .4 ........, `;/ /Y/:......_.......__.......... -...Q..... ./.......... .... ....... .....
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ..._... -------- �. ... dated _....................................__.....
!i THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.....----------- I.C>.... .../......IJ�
_......... ..... Inspector ................V... _.....----------------------------------------- -------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE 3 a `' d
No....23. • -65 FEE. ....................
Disposal/V, r p Ton rur#ion ,Permit
Permission is hereby granted %� �� y/ -!�..4 •--------------------------------------------•-•-•-•--------
v
to Construct ( ) or Repair n Individual Sewge Disposal stem at No......•Z----• �- _ - �` --� f - v... / ---------------------------- ----------
'AVA . "
�/ __ Gt'--7••- �-_--- - - -.�•--•--- stet_.,.
as shown on the application for Disposal Works Construction Permit No.11-.`%A_ Dated...........................................
--------•-----•• ...=��----------------------------•--•-•----• •--•-------••----
DATE............./12.-...�.�L. 3-................................ Board of Hcalth..
FORM 36508 HOBBS&WARREN.INC..PUBLISHERS