HomeMy WebLinkAbout0159 LITTLE RIVER ROAD - Health � y --003
TOWN OF BARNSTABLE
a
LOCATION 4 LiJ7d r►ri SEWAGE #
VILLAG ASSESSOR'S MAP & LOT
=1(�
INSTALLER'S NAME & PHONE NO. SjERA LA Su'fg-
SEPTIC TANK CAPACITY
P
yam �._ c
LEACHING FACILITY:(type) �-- � Gs� G� size)
NO. OF BEDROOMS__PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSU Dc
VARIANCE GRANTED: Yes No
y�us€
GQI� eQAwL
Spew`
98
e
J
UJ �.
ASSESSORS MAP NO: 4
No.. .L�....1�.�.?..`.� PP.hCEL NO: "'� � yaQi�. Ur
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
,Apure#ion for Diopoiial Vorkfi Tons#rnrtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
Zoe 'fin-A d ss or Lot No.
.....lI - -•-¢.. ..... . . --•--•••-•---`--•---- ..........•-•----------------•-----------•--..._..•—•--------------------•'------••••--....----..
Ow�n�_�t Address
Installe Address
Type of B ding Size Lot----------------------------Sq. feet
Dwelling—No. of Bedrooms......... .................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of BuildingNo. of persons............................ Showers � — Cafeteria
Otherfixtures --------------- -•-----------------------------------.•---------------------------•--------------------- /. . - ................................
Design Flow..........._��.......................gallons per person per day. Total daily flow........... ......................
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------------------------------------------------•-------•----•--------- Date-------.................................
14 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-___--_____--______--__
a
0 Description of Soil----------------------------------------------------------------•----=-•=----...----------------------.._........----------------•--•---•-----•----------........_•..---
x
c, •--•---------------------------••-----•---------------------------•------•---------...........---------------------=-----------------•------•---------••-------------------------•----------••-----•--
W -----------------------------•----•--------------------- ......-----------------------•---------------•------------------------------------ ..........................................
U Nature of Repairs or Alterations—Answer when applicable..........15,W-___ ¢ ____A'—.�...................:..
,�� . . --
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 s en issued/by f e oard- f nth.
Signed
Application Approved BY t — - ,/- e ..--,��
Application Disapproved for the ollowing reasons-- -------------------------------------------------- ------------------------------------------------------------------------------ --
--------------------------------------------------------- --------- --------------------------------------------------............_....-------- ----------- ---------------------------------- ----------------------------------------
C� t_ Date
PermitNo. f�� J G *- ............ Issued ------------------------------------------------------------------
i
- � i` .,�.7`-1 - ` -•_' j 1.�. ../��►1 ter._ - ►. _ _ _..
Y3 FES ................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Applira#inn for Diipntitt1 Works (fnns#rnr#irin thrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
.............1_ _I_- ..................................................................................................
Loca ?n.A ss or Lot No.
.... -
�... � . =------------------- -------- .........--- --
W own O Address
_-Zing
--- - - -------..--- ....... -•------------- ---------------------------------------------------------------
Itlle
U - Address
d Type of B 'ding Size Lot............................Sq. feet
U Dwelling—No. �&oms.__..•...___.__-•-_-____--_._ _Expansion Attic ( ) Garbage Grinder ( )
WP4 Other—T e of Building No. of ersons....._.. -_
YP g ---------------------------- P ; �------------- Showers (�) — Cafeteria ( )
aOther fixtures ---:'------------------------------------------------ ---------------.--• -----------------------------------------.......
W Design Flow.............15-5 ........."'..........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. 1_:'_....._-____minutes per inch Depth of Test Pit____________________ Depth to ground water.___.._.................
fzt Test Pit No. 2..............minutes per inch Depth of Test Pit.................... Depth to ground water........................
Descriptionof Soil------------------------------------------------------------------------•.................................................................-----------------------------
x
t.,
W
U Nature of Repairs or Alterations—Answer when applicable____-_-_--Ifp0---- ---..._---___-_-___.
------------------------------------------------------------------•---------------........--------- rur— `"`�" ` %�-t 1�c2&?. _�,
Agreement:, •1
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 s b en issued by t oardof 40th. L
Signed "...... .........."......... .. . . . . 7.. /1U/G�........
Date
Application Approved BY " ' c ,�-� ------------------------------------------------------------- --"- g e? 9U
Application Disapproved for the ollowing reasons: ----'--"--_--------------------- ...........---'-'----'---'----...........-'-'---".-- '--...-- -- -----......."''' -'-'"..
- ----...--------------------------------------------------------------------------------------------
- Da[e
PermitNo. .a ----------------- Issued ..............Date---------------------------------------
Date
THE COMMONWEALTH OF MASSACHUSETTS
'BOARD OF HEALTH
TOWN OF BARNSTABLE
C'Prtifira#e of (�omplirxn e
THIS IS TO CERTIFY, That th Individual Sewage Disposal System constructed ( ) or Repaired )
by... �.
at ------------ -- ---•'-.--..Z_1,-------------1P`..y..a"----'-.. stall..................
.. ... ."""'.""'ti--------------.-. ----'----------'----------.-.............................
has been installed in accordance with the provisions of TITLE 5 he Sate Environmental Code as described in
the application for Disposal Works Construction Permit No. -.....I...�J... ���.`�Z............ dated --------.-- .1.................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED A A GUAR N�TEE THAT THE
SYSTEM WILL FUN 9TION SATISFACTORY.
;j
DATE------------ ' I ... _ Inspector ....r ".._
`± . �L-- " '------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
FEE...� '00.......
�i��nntt1 nrkn �nn�#r ' n �ernti#
Y g �} �i. .Permission is hereb ranted------------�'e�t- `.. --- ..
to Construct ( ) or Repair ( j an Individual . >age D'_posal System
at
` a� Street as shown on the application for Disposal Works Construction Permit N �q/_l_ Dated..........................................
....................... ----- 1___)-------------------------------•--------•---------------
Board of Health
DATE............... ........ /--------------------
���� FORM 36508 HOBBS&WARREN,INC.,PUBLISHERS