HomeMy WebLinkAbout0126 LEWIS POND ROAD - Health C,
TOWN OF BARNSTABLE
LOCATION V ! SEWAGE #
VILLAGE?�_ :ASSESSOR'S MAP & LOT go 00,9
INSTALLER'S NAME & PHONE NO,ZAZLiall
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SEPTIC TANK CAPACITY _,,4i�2Dp --_. e�Q•_,�
LEACHING FACILITY:(tppe) D gL .p'1/¢ (size) —�—�/
NO. OF BEDROOMS _PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER Ocz
DATE PERMIT ISSUED: oZ _
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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...............
THE COMMONWEALTH OF MASSACHUSETTS
BOAR PF HEALTH
3 , & o 10
_0..............0 F....V..r ..t7�17.5t .1 d.................................
Appliration for Uhipugal Warks (9jamuurtion Vanat
Application is hereby made for a Permit to Construct or Repair &__<an Individual Sewage Disposal
System at:
Rd.... .................................................................
on. kjdAss or Lot No.
....................................... ....................................................................................................
e.r............. .............................................
Installer Address
Type of Building Size Lot............................Sq. feet
U
Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder (
PL4 Other—Type of Building ............................ No. of persons---------------------------- Showers Cafeteria (
Otherfixtures .......................................................................................................................................................
Design Flow............................................gallons per person per day. Total daily flow......................--....................gallons.
Ix Septic Tank—Liquid'capacity--..........gallons Length................ Width.-..--.--------- Diameter----......--.... Depth................
Disposal Trench—No. .................... Width....---............. Total Length.......----..._..... Total leaching area..........---------sq. f t.
Seepage Pit No..................... Diameter.--......--......... Depth below inlet.................... Total leaching area..................sq. f t.
Z Other Distribution box Dosing tank
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I----------------minutesperinch Depth of Test Pit..............----.. Depth to ground water------------------_----
GT4 Test Pit No. 2................minutes per inch Depth of Test Pit..--.........---.... Depth to ground water-.--------------.------.
a ............................................................................................................................................................
0 Description of Soil------.................................................................................................................................................................
W
........................................................................................................................................................................................................
------------------------------------------------------------....................................................................;...... ----I------ -- -----------------------
U Nature of Repairs or Alterations—Answer when applicable.....g9§t2452_ ",............ -----------0..�fo Ce
......... ---------------------------Z......................................................................
The undersigned agrees to install the aforedescribed Individuial Sewage Disposal System in accordance with
the provisions of J.-�1E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been i ealth.
Signed.. .. .. .. .... . .. ... .................... . .................. .
............ ....
Date
Application Approved By............... -------------------------------- --------
Date
Application Disapproved for the following reasons:................................................................................................................
.........................................................................................................I...............................................................................................
Date
Permit No.Y?........ ------------------- Issued.......................................................
L Dste
lOwl-
n �
No.. ---• /��% FEs.;= ......��..._
THE COMMONWEALTH OF MASSACHUSETTS
-. BOAR OF HEALTH
ylEr..��......__....0F.. �'.. ......L 7_'.07?to. P.............................
Appliratiun for j3iipuiial Works Tonotrurtiun Prrmit
Application is hereby Trade for a Permit to Construct ( ) or Repair &,j'0'an Individual Sewage Disposal
System at: � � ,
--------•--------•--- .. C _ � .r.. ............................................................
lion-rAd ss or Lot No.
. '-
--•----•--------------•---•--•----... --........-----.•........-----------•... .. .....--------------.......---•--------•---
�d e s
... ................. .------. I' i f? ---------------------------.......--------
Installer Address
Type of Building Size Lot............................Sq. feet
V Dwelling—No. of Bedrooms.............................. .. .Expansion Attic ( ) Garbage Grinder ( )
�+
'4 Other—T e of Building No. of persons__..•_.__._..._..•...._._... Showers — Cafeteria
al Other fixtures ..................................
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
9 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................
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........................................
Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water.........................
(T4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
94 ----•-----------------------------------------------------------------------•---•-----•----..-----•-----------------
•-•------•-------------------------------
DDescription of Soil....................................................I....---•--------------------------------------•-----------------•---•----•-•----•-------------.......-•------•------
x *-------------------------------------------------•------------------------------------------------------•------------
W ---------------------------- ......................................................',-•--•-••-•-•--------•-••-••----_...----•--•-----•••--..�/......... --•-�...................... f
UNature of Re airs or Alterat•ons—Answer when applicable._____- _G'�'_..___.__ ;�_____-__---o...%r.'......r_U��S Crj
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of:i'L
p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been i e boar-d;o.4ealth.
Signed•.-= �•-:f /. /.......•-. /
• / .�
Date
Application Approved BY -----------------•--...-�.... ------
Date
Application Disapproved for the following reasons:.............................................................-•-................................................
-•-•------•---•--._...•---------------------•---•--•----------------------•--------.........-----------•---••••••----•-•••••-••••--•---••••-------•---••......--•••••-••---•-•--•-•----•--••-•••'.••'•-
Date
�- i Issued--•-'------•--------------------------•••-....-••-••---
�Permtt No.............• - ---------------
LSi.,
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
f�
w. ..............OF.. ..........................
Tntifiratr of Tomplianre
THIS ISj,1TQCERTIFV,jThat the Individual Sewage Disposal System constructed ( ) or Repaired ((.)L,.
bY-...... .._.5........... .......... ............/�--•--------- �: ------
/ Iy�talle
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No...... ........ dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..............•--•--••-•1 = -•=-el......................... Inspector.......................... .A�...........................................
THE COMMONWEALTH OF MASSACHUSETTS
�,, BOA OF HEALTH
/ /
NO.,,.t._...__ .. ...J FEE2�S2..............
�t��ru��l, rk� un��riun .rruti#
Permission is hereby granted. .��i 1...•. ••--•- . ---------•--•----••--------------••-.........-•--••.................... ....
to Construct ( ) or Repair (4,� ecti"Indivi Sew a e qj&P071 Syste�
atNo......... E� _(') cl .......................................
as shown on the application for Disposal Works Construction Permit No.J ___ Dated..........................................
------..••-•••... ... -.A------------------------------------------------------_
Board of Health
DATE.................... .....................
..........
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS