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HomeMy WebLinkAbout0023 LAKE STREET - Health Llelke, 1�1�e_elt (i)4u�tlq TOWN OF BARNSTABLE Q� f LOCATION .. S � -\ SEWAGE # VILLAGECnA Q ASSESSOR'S MAP & LOT635 ' 3� INSTALLER'S NAME Si PHONE NdNrt` vj k� - e-I • L4 I SEPTIC TANK CAPACITY_ 060 S LEACHING FACILITY:(type) i (size) : I NO. OF BEDROOMS PRIVATE 11WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: q/ DATE COMPLIANCE ISSUED: / ® -o 9 / VARIANCE GRANTED: Yes No �, ,. r � � 0 V '• T[� O �� i T � O y a e ASSESSORS MAP N0: PARCEL NO: �33 /N0.2 �' d ,D THE COMMONWEALTH OF MASSACHUSETTS Q v E D BOAR® OF HEALTH Barr +r. TOWN OF BARNSTABLE Signed Appti [Atatu 3�i� u 1 �xk C� a� c uan rruti# Application is hereby made for a Permit to Construc ( ) or Repair an Individual Sewage Disposal System at: ............ . ....._ . .. - - - -------------_.. .. �1.. Locptiep 1A�res , 1 ,'T�L� or L�t7f •.. '. �aer \ Address . a����5 .. `M�. �� . c�S of ... .............................- --- -•-•-•• ................... �. Installer Address d Type of Building 2 Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.........._.v..._...........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ------------------------------------------------•--------•-•-••--•-•-••------------------------------•---•-••------••••••••......-•-••-••-••••.•_.... 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........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water----_-_-_____-__•------- �1, Test Pit No. 2................minutes per inch Depth of.Test Pit...:................ Depth to ground water........................ a ---•---•-•-•----- -- ---- O Description of Soil............ . U •••••-•••••••-•-•-----•••---•-••.-•--••-••-•••••••......---•._..... �� •--.....---•-•-----••------•--------------•----•-----------------------------------•-----.....--••----•••--•••--•-•-••. W ••••••-•--•---------------------•---------------•----------•---------••------....-•----............•----•-------- -------------------- U Nature of Re airs r Alterations—An wer hen appli ble._ __ _... ______________ _ _______ ......'._ ------------ s '�----------------- s �'-----... �z 5 + - o -=---- "c,'P 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 Co p ' nce has been issued by the board health. Signed ............................ . Date ApplicationApproved By ------------------------------------------ -------------------------------- --- ---- ---- -------------------------------------------- ---- © ..I g I..... Dare Application Disapproved for the following reasons: ....... ... . .............................................. ................................................................ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------- �} Date Permit No. / /'' Issued �. I. ........-'..9.. ... Dace J THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ApV irdtivu for Mipaoa1 Works Tnnitrnrtion thrmit Application is hereby made for a:Permit to Construc ( ) or�Repair an Individual Sewage Disposal System at: � L �3� �L-e �-�1�' ..............._......?.�...........: .. S Lac ANress or Lot�Io. Qez...............................................\ ` ` ^�C, In J Address t_ _ 1P VYl.... �.:. ...:. .---- . Installer Address Type of Building Size Lot............................Sq. feet U DwellingNo. of Bedrooms__________13____________ ._.__Ex Expansion Attic— --------- p ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ---------------------------------------------•-•-----............................................................................................... W Design Flew............................................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--•-••. a ` Date. 4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fs, Test Pit No. 2................minutes per inch Depth of.Test Pit---................. Depth to ground water........................ M .--•-------•-----=------•---•••----•••--•--•---•-•••••••-•-•---•----..._..--•----._..._•••----------......................................................... 0 Description of Soil___________ __ _ U ----------------------------------------------- ---------------------� -.-••-----.....•••••--•••--•-••••••----•-••••----•---••------•-----••------------••••-••••......---•---•...-----------•- W x ............................... 0 Nature of Repairs Qr Alterations—Answer wQhen applicable. ____.__ S_Vr _r.. . -, _.A.?_`. __________________ o C ...Ste c?u = ^..-5 -..-1----------------�.:. - -----K----- 5�) 'n'� = CJO _ U(l o Q 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 Corn? li nce has been issued by the board 6f health. Signed\ ........................ - -------------------- ........................................ Date ApplicationApproved By ----- - -------------------------- --- - - ----------------------- --- -- ------------- ------------------------------------- ---- ----- Date Application Disapproved for the following reasons- ----------------- ------- -- ----------------------------------------------------------------------------------------------------- ........................................................------------------------------------------------ - ---------------------- ------ -- -- ------------------------------------------------ .......................................- Permit No. ---- ./^...... D ------------------------ Issued .......!� -------- -1. ..Date----- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cerfifirafe of C antplinure by Try IS TO C RTIFY, That the Individual .ewage Disposal System constructed ( ) or Repaired ---------------------------------- ------------------ --- -------------- -----------=------------ ----------------------------------------------------- Installer at IN k � s. rrt� �fi ��. ----- ----------- ----------------------------- -.-----------------------------------------------------------................................................................... 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 --- ......p THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ................ Ins Inspector-N. --- DATE.............. --� �...--�--- --�-�-- ------- -- -- --- - P --...� �T-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No.. ..._....�j'�... . FEE.----__•••.............. Permission is hereby granted............J�K --- ----•------....-•-•••--••-•••---•----•-••--••-•--•-••••••••-•••._....•••-•••-••........................ to Construct ( ) or Repair ( ,an Individual Sewage Di posal System No...-...................... ,:��----- �--( IL - � c- at _ Street i as shown on the application for Disposal Works Construction Permit ,___N __ ?-.��Dated.__._ ..7_^..../_._._.... DATE. I__e� �I 7 Boar3 of Health FORM 36508 HOBBS&WARREN.INC..PUBLISHERS