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HomeMy WebLinkAbout0086 GROVE STREET - Health 86 Grove Street A= 019-027 C6tuit ---- - - - i i TOWN OF BARNN'STABLE LOCATION Qv� ! SEWAGE VILLAGE2,Q4011� ASSESSOR'S MAP & LOT© INSTALLER'S NAME & PHONE NQ;�C Wa e ' / � 7- o SEPTIC TANK CAPACITY 0 Fq " TA, LEACHING FACILITYA( pe) 0 0 ) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER A - DATE PERMIT ISSUED: / DATE COMPLIANCE ISSUED: C/ YZ VARIANCE GRANTED: Yes No r C'ct *10 v s e, _j 7� a ....®... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH a� o TOWN OF BARNSTABLE 1 Appliration for Dig uiitt1 Works Towitrurti n Vamit Application is hereby made for a Permit to Construe r Re air pp y t ( ) o ( ) an Individual Sewage Disposal System at: ......... -.--. ..... ........ --- -- ------ --------------------------------- --------------- -------------------------------............ Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedroom____________________________-------_-Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building .................p,, yp g ___..._.._. No. of persons____________________________ Showers ( ) — Cafeteria ( ) Q, Other fixtures ------------------------------------------------- -- 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. 3 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. 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........................ P4 .....................5t.._...---------- -----------------------------------------------------....._........................................................... ODescription of Soil------------------------------------•----......--------------------••-----•------------.-------•--•-------•-•-•--•-------------•------------ •------------_.. x U ............................................... ............. .......... ........... --............. -------------------------------------------------------------------------------------------------------- VW ....................................... - -- - ------ - ------- ---- ---•• ------ Natuyof Repairs or --tesatior�—Answer when applicable. � �------ -------------------- ,A....... 41, '------------ --------------------` - ------- ...................................... P Ag eemen 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 ee issued b�the. .rd of healt Q. Q Sig, .... -�y� > . . S _ -..._l. .... "..5. Da,e q Application Approved BY � .' .4 =g/-- -/� Application Disapproved for the following reasons: ...................... ............. ............. . ------------------------------------------------------------------ Dace Permit No. --------? ;1_n.................... Issued ........... .7- -:`.-/_=5�------------------- *' Dace No.. ....©.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE , 1 Allp iratilalt for Di,ir w3al Works C owitrurtiun ramit Application is hereby made fora Permit to Construct ( ) or Repair ( )`an Individual Sewage Disposal T System at f au� , ( Lto -Address or Lot No. ---------- ................•..--._.--------- Owner �7 }, _ Address Installer Address Type of Building Size Lot............................Sq. feet U ,_, Dwelling—No. of Bedroom------------------------_-----_--__.-_Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons.--.------__--_-__---_---_-- Showers — Cafeteria dOther fixtures ..----•-------•---------------- ------------------------------------ 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I----------------minutes per inch Depth of Test Pit-----------_........ Depth to ground water..................... rzq Test Pit No. 2................minutes per inch Depth of Test Pit--------_........... Depth to ground water........................ 04 •---••-•••------------------•--•--••----•----------•-----------•-•-••-•--------••-----•-•--••----•--........................................................ 0 Description of Soil........................................................................................................................................................................ x U -••••-••••-•---•--...---•••--•••••••-•---••------••------•-----••-•-•-•--•--••••-••----•-••--•---•--•--•--•-------------•--•------•---••-•-- ---•-•---••-•-----••-••------•--•--•-•-.........-•--•-•... x ......-----•------------- -------•...........--- K' - ------- '%--------- •=--•- V Natu;p,of Repairs orrAlteratioras—Answer when applicable.-. - ` --r ---=---.---- ................ .................. - 5 -------- ' 4_. f- ___ •• -- -----------•-.-----•-----------•--- AgreemenC I - 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 healthl Q Q Signed f. /'... Application.Approved By .......... � J Date Application Disapproved for the following reasons: ........."------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------- ........................................ Date Permit No. .......... ......._.......... Issued ............... ...'..7-` Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certifi ate of Tomptianre THIS JS,�TO 0ERTIFY,—T,,hAt the Individual Sewage Disposal System constructed ( ) or Repaired ... .. -- - -- - - iurr at has been-installed in accordance with the provisions of TITLE of The State Environmental Code as described in the application for Disposal Works Construction Permit No. -----..- ----------- dated __....... ...`�.-_.1._�..._.._. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE._----- '' �- �-�• r f ' I.__` - Inspector :.-- :. '` .:.......:"�. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH C� TOWN OF BARNSTABLE No....A. ?..: �. FEE.. �....... Disposals urkii Tgnotrution "amit Permission is hereby granted___._:;} f.tom '.. ? to Construct ( ) or Repair )an Individual Sewage Disposal System atNo.-------- �-------------"-�--'-=---- -. ...------------.... .. t _ CC,,�� as shown on the application for Disposal Works Construction Permit No._�s�r�_IM- Dated------- ................. .......... ��. Board of Health DATE................... �� r� ................................ FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS