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HomeMy WebLinkAbout0032 GERALDINE ROAD - Health (2) F7 Gcr-afcb h J TOWN OF BARNSTABLE LOCATION .7 �,ZQ-�� t I�Ic� [Z�- SEWAGE # VILLAGE �r'i LQ ASSESSOR'S MAP & LOT plg -�g®S- INSTALLER'S NAME & PHONE NO.��� 4,�i-S , SEPTIC TANK CAPACITY (&60 C. L. . LEACHING FACILITY:(type) {°7 I (IT (sue) e,le to � NO. OF BEDROOMS PRIVATE WELL ATER BUILDER OR OWNER t ,1byw k(t+- DATE PERMIT ISSUED: - DATE COMPLIANCE ISSUED: �© VARIANCE GRANTED: Yes No e� Q 1 OL�0 'Q0 Fps�d THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTa A P TOWN OF BARNSTABLE StabIL' Corp R v g D rv�t1o� Appliratinn for Di-sposal Vorkigi Can Application is hereby made for a Permit to Construct ( ) or Repair an Individual--< s-&p�osal System at: U:>:t ..... ! -�--- 1_.98 ........-- ------ --------- .......��s --...................... - ----------- Location-Address n or Lot No. . 1_1 ................: 61? '........... --....-•CZ ,C�' -�� fir- .1 �.�........... Owner Address . ------....-••-•--------------- Installer Address Type of Building Size LotC��D�.......Sq. feet Dwelling—No. of Bedrooms.....................3...................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ------------------------------- d ........... ......... •------ W Design Flow......................��....--..gallons per person per day. Total daily flow._........................._gallons. WSeptic Tank—Liquid capacityZMdgallons Length.............•.. Width................ Diameter_--__-___-_--_ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-----------/..... Diameter...... .CJ_.___. Depth below inlet..... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_-___-_____-_--_•----__. f14 Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ a ............................................•................................................................................................................ O Description of Soil-----------------Q "a�...----6A�(.... - �'��D/�------�- `l��----•C ................. x W U Nature of Repairs or Alterations—Answ r when applicable__1/:45Z*4.C__JGDQ-• . 77.tC -- D. O.r - -f . --...... ........ram .. _.......� 1 ---------------------------------------•------------------------•--•--........--------•---. 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 be n issued b t board of health. Signed .... ... .... .. .l ............ ® �.. j Application Approved By ce - -...-. --.... . ... -- ---...�.............. t ------ � _ Application Disapproved for the following reason = --------------------- ---- -- ---- --------------------------- -----------------........................................ -------------------------------------------- ----- - ------------- -- . ------....----....------------------------ ......--------------------.........--./ -- ------------------- --Date Permit No. r ............... ......... ... ............. .... Issued .......-- 0. .. No...-�-•............._ Fps_....._� ._....._. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Disposal Marks Tonst0ion., . mit Application is hereby made for a Permit to Construct ( ) or Repair (x) an Individual Sewage Disposal System at: >d .......... .�4c�------------------------------�......-a"--��0�__"�_'' r24 C00%v�7" �4 �_..... ----- Location-Address or Lot No. ................_ -------....-•-- � - - ner Address a s�Uc'�dG��.. C r>n T �/5- l c sh'� iz0 ----- ---- Installer - - � Address U Type of Building Size Lot�4 a2Qf_Sq. feet Dwelling—No. of Bedrooms...................1_._.-------------------Expansion Attic ( ) Garbage Grinder ( ) a Other—Type e of Building� yp g ............................ No. of persons............................ Showers ( ) — Cafeteria d Other fixtures W Design Flow........................ -----------gallons per person per day. Total daily flow-------------��v5 -.----------••__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..__. 1---_-- Depth below inlet....Z-.......... Total leaching area----_-----•-----sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by........----------------------------------------------------------------- Date---------------------------•------------ a Test Pit No. 1................minutes per inch Depth of Test Pit-_____-__----..__.-- Depth to ground water_____-_--_.._.___--_-__. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water._______..----••-------- 1:4 -•••-•-•-•---•••-••-•--•--•----------••---•-•-•------------------------------•-----•---...----••---•......................................................... 0 Description of Soil---------------=--�.� ......./t� �--�_.-�S �sD/ _-------�--=-. `-`' ................. W (� ------------------------------------- -.--.------------------------.-----------------------•----------------------•----------------------------------..-------•-------------------------------- W UNature of Repairs or terations—Answer when 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 issued by the,board of health. �C.�it 1, Application Approved B �7�, . .._.. ..__._- n,�J} //�/X - --_- pp pP Y ----- d ��� ------.. mate i Application Disapproved for the following reasons---------------------------------------------_---------------------------_---------------------------- --------------- -------------- -- ------------------ ------ Permit No. --�--� I ��- ----------- -------- Issued .......{'/�__/ C/-/ - Date (-....�..... Dare �-...1 --- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE &rtifirate of Tomlatinure THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ........ ..... - 0/ ............ ------------------------------------------ = Installer at -----------------------......................... C-' s �/nJ 'mod C�oTU 1T' has been installed in accordance with the provisions of TITLE 5 -f he State Environmental Code as escribed in the application for Disposal Works Construction Permit No. -.. 1--�T -... ..-- ... dated ....../0.;, ----- THE ISSUANCE OF TFJIS CERTIFICATE SHALL NOT BE-CONSTR D AS A GUARANTEE THAT THE SYSTEM WILL FUN TION TISFACTORY. z DATE. ---f--------- ----------------- ------ Ins ector -------- % A7 P �f a� THE COMMONWEALTH OF MASSACHUSETTS v BOARD OF HEALTH --Z�/oTOWN OF BARNSTABLE No....i...l.............. FEE... O......... �i��u�tt1 urk� �un��riun rrnttt Permission is hereby granted.........................•.. ---0 .. Go777 ______-_C--� � ~-to Construct ( ) or Repair (x) an Individual Sewage Disposal System atNo.---•---•--------••--------------------•---I � ��4G d i e Street.................................................i/ / (� !/� / as shown on the application for Disposal Works Construction Permit No.=1_��K_/l)Dated... �> J f Board of Healtli„ ~ DATE.........../7).•_..-/-AIq ----------------------------------- ,l l FORM 36508 HOBBS Q WARREN.INC..PUBLISHERS