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HomeMy WebLinkAbout0040 IRONWOOD ROAD - Health (3) j �� �� i5 ay 0 TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE_ Co4,,j ASSESSOR'S MAP & LOT 6S6 bb�--Q y INSTALLER'S NAME & PHONE NO. 3J: 065(6\1 771--1014 SEPTIC TANK CAPACITY I,pa �41id S LEACHING FACILITY:(type) ?4,4s (size) 606y414,s e&,G NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER --r DATE PERMIT ISSUED: 1 Z -S - q 9 DATE COMPLIANCE ISSUED: 00 VARIANCE GRANTED: Yes Not/ Il A$z i `7 i No.. - O L! FEs..... a ........_ THE COMMONWEALTH OF MASSACHUSETTS ¢ BOARD QF�HEALTH .....OF_............. ��Jul. ��. -..._... Appliration for Disposal Works Tonstxnrtinn Permit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at_.... .... �......_. .�.:.------ ••..... rz .y:... ... ........... .... ion ddress or Lot No. .................. �._. .... . .. ..... ..... ............... . --............................................ ' Owner '- Address W ...................... ....... .. ........ . .._.•----._........--.---....-- ....... L ..... ........._..... Installer Address ��//� Type of Building Size Lot. _7.?>r ...Sq. feet Dwelling—No. of Bedrooms------------------- ---------------------••Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons.................... ... Showers — C4 YP g P ( ) Cafeteria ( ) W Other fixtures ...............................:... - ----------------------------------------------- =-------------------- Design Flow........... � ........... gallons per p pet day. Total daily �ipw............. ?.' ?. _.........gallons. WSeptic Tank—Liquid capacit .gallons Length..(,.... Width: /'.o... Diameter................ Depth.S.- x Disposal Trench—No..................... Width.................... otal Length.................... Total leaching area.................-sq. ft. Seepage Pit No...... -- Diameter..... Depth below inlet. :.. . Total leaching area..: Z Other Distribution box (� Dosing tank ( /� f � �j ~" Percolation Test Results Performed by...._.....�',,.: ..(,�� .........a4................. Date......L.'_........._,. .._....L Test Pit No. 1.,�„__ inutes per inch Depth Test Pit... . _. .._. Depth,to ground water.._.. .._0;V, ... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -• -- ----.. . -- .-- O Description of Soil.. -- -..� ...............••-••-----------••••- .__... V ----------------- ------------------------------ ----..------•---------------------- •------- •--------------.--.---- .-.-....---....•--•--••--... ....... •-• ---- VW ••----••-••-•--------- --•--------••---•••--•-•-•••-..._.....--•--•--•••-------••-•----._...-•-••-•--•-•---------•-•-----•-•-•_•--•----•••--•••-•----......-•---•...............7...._....--•--......... 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 LITL U 5 of the State Sanitary Code- The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss ed by the board O . . --- _ _. health y Signed- .. �l��Jd(� .... . j Date d Application Approved By.......... � s�cr.. m=. ... ........ Date Application Disapproved for the following reasons:......................:..............•...___._....._.__....__.........•...._.__...........................--- ...................................... .............................................._...-•----•--•-•••----•................._................. . ...--•-•-.. Date — . =� .:Permit No.... ................ Issued------••--.-•-• --•----•----....................... r No.... ...... ._ FEs............. ........._ THE COMMONWEALTH OF MASSACHUSETTS fl 7 / OBOARD` OF HEALTH ..---... ... ..!'S ` ....OF..... ..., l � J-.............................................�" t r Appliratiou for M-4putittl Workii Tomitruidiaan thrutit Application is hereby made for a Permit to Construct O or Repair ( ) an Individual Sewage Disposal System at: � ................__.... / ... :..% 4 �........... / '�:/� 1. �a�,iion-A as b� t/V[�uit�Y��or Lot No. ......................... ................_.... .,..- ..._.... ......_... ...••-•--••••-••-•---•.........._.......................... W Owner Address .. - �P. ....._ ... ... ........... ..._.. ..... Installer Address Type of Building ? - Size Lot....... .... ..:.:... ...Sq. feet ► Dwelling—No. of Bedrooms................. .....................Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—T e of Building ..._...... No. of persons.......................... Showers YP g ------------------ P -- � ) — Cafeteria ( ) Q Other fixtures -----••... �' ----------------•-•----------....•---•--------••--- .--- W Design Flow........:...........1...r/ :gallons per pegson•p�-day. Total daily flow.......... ? l .............gallons. WSeptic Tank—Liquid capacity/_�._�.�"gallons Length.Q.-�._.•. Width.. 6... Diameter................ Depth�.. -...` x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No.-----.�.....-..... Diameter....... Z fi:... Depth below inlet---. !�. Z.__ . Total leaching area... �s sq. ft. z Other Distribution box (X) . Dosing tank ( ) c a Percolation Test Results Performed by-_-......_ _. . ... ..?................................ Date..._..................o................. Test Pit No. L.Z...r�.minutes per inch Depth of Test Pit... ..._ Depth to ground water.... `.... f4 Test Pit No. 2................minutes per inch Depth'of Test Pit.................... Depth to ground water........................ PG :_ -•--•------------------------•------.-•---•-- �- - ----------------•-------------------.... ------...---------..........._......-•••••-•...... O Description of Soil...r____...��_....."�....d.a x x ••••-•-•••-•-••-••-----•••-••--........-••-•---...-----•-••-•-••-•--•--••------•-------•••-•--•----•-•-••-•••--•-•---•.............•......•-•••-••-••••-••-•-••••••-•-•---..........••.._._....-•--_.... U 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 TITIf 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board o health. Signed.._..Q)............... ..(...................fi ( ................7�..."..p..a ............ ..... O / Date Application Approved By......... --........!s:�a.- ...... ....................•--••- ---•--. ------.- -.�.-.....-�'L. Date Application Disapproved for the following reasons:-----•--•-----•...............••----------------------••......-•••-••-••••.---......_......••.........•••..._.. ---•------•..................•-••-----....--••--••--•--•-•--....-•---•----........-----.........---.............---.........----•-•-------•-----------------•---.....-•-------.........•-•............_ Permit No.....� .................•-- Issued-----•---------.....-_.-•----•---...-.....Date a , ._...... Date -------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH / ..::.........OF.................P ......................... (9rrtifiratle of Toutphattrr THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by........................`�- . 5=----------n. C F ......-----•--------•-----•-------.•......----•---•---•--•------...----•----•-----....-----------••-•-----..................-- " Installer { at...........1 -............ ....1�t'---------------------------•-----•--....--•---..........................--•-•---- has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No....... '-.-7 ._?_.... dated.__............................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. � _lam/ DATE............. ,�i ._....... Inspector......................................� .--------........................--- v ti .-.---•- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 2 t' �� No.....15............. FEE....--.................- �i��u�ttl urk� �un�lrttrtiun rrutit - Permission is hereby granted.------......�5.-Win....- h --•-----------------•-----------------------••--•-•--•----•-........... to Construct O' or Repair ( ) an Individual Sewage Disposal System atNo..••--••..•••• / 7.....Z2 'r , .vet .....UK,------ .............................................................. Street � , as shown on the application for Disposal Works Construction Permit No..,.._ .__ .t_____. Dated......—.................................. e.— Board of liealt6 DATE...--•--------•--•---------•................�:................................. AT '91 low AN o- ip v NIr ; i a m�• ° •' � - 0 O 3,PIPS? 'QITG4, I/4 /FT UhILE�� OTC+=2WlSE 1-lOT>✓D, a, OVS►6rk1 LAUnV- U &LLPerGasr u�t-r5 w ►�o -�` -44. / � 5. PIS Joi►.1TS ��d•t_t.. pSE MoOE. �.1dTE2'71CrNT I t' 111 s� i ` - '�pPs Cp. 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