HomeMy WebLinkAbout0340 OCEAN VIEW AVENUE - Health F,3 -D ® ce-OA 1 l auw,
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No. ........... � FEB........:�............_
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HBALXH n p
TOWN OF BARNSTABLE table c,,, R E o
1 vatjoa
Appliration for Dispag al Works Cann p��COmrni.., a
cl
Application is hereby made for a Permit to Construct ( ) or Repair ) an Individual Se is ®sal
System at: a e
-• -•-.-•-•r •--
Lo tio -Address or Lot N�
Owner dd ess
--
Installer Address
Type of Building Size LO CI---- feet
�-, Dwelling—No. of Bedrooms_____________v�-J............._._...Expansion Attic ( ) Garbage Grinder ( )
a`4 Other—T e of Building No. of persons............................ Showers
YP g ---------------•--•-----•--- P ( )--- Cafeteria ( )
Other'fixtures -------------------------------•---------------------------•••------------•-•-•--••------------------••-----------. --••-•
W Design Flow............... ................gallons per person per day. Total daily flow_._.......ti��Q...................gallons.
WSeptic Tank—Liquid capacity .gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No......../......... Width......V....... Tot al.Length .... Total leaching area--------------------sq. ft.
i
Seepage Pit No....... __._ Diameter.................... Depth below inlet....c3 .... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
F-7
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Gz, Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................
------------------------------------------------------------------•---•-------•...--------------------•------•------------------- ------------------
O Description of Soil_____________________ _'",1...._—�! !K__ � fad -------/ �� / ', J�
V ........--•••-.--••-•-•...-••••-----------••--•--------------•----------•----••...------...---•-••----•---------••••----------------••-•----------••-------------------•----------•............--------
W
UNature of Repairs or Alterations—An were when applicable....__. �' .__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 Compliance ZasVeenisse y the board of health.Signed ------—551 . ........ ..-- -- .. � %
-- ------ ------Application Approved By -- ------- -...... .......... . �----- if ...�`
Dace
Application Disapproved for the following reasons: ..
.............. ................. ............... .....----------------------.........------------------------------------------ ---....------......-----------------------------
Permit No. --.-.../.....j.......� ................ Issued ------..ZA, ..^'-- /Date
Date {
a 0 It
..
v THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH 1111
TOWN OF BARNSTABLE
Appliration for Dispoii al orkii To irurtiott1hrmit
Application is hereby made for a Permit to Construct ( ) or Repair (><) an Individual S wageisposalc�
System at
........................................................ ........... .......G..ilJl7" a� .:....--------------......•......--•-•-••.......
/f Location-Address r or Lot No.
Owner . �- nddress
C -7GJ...../cJ tl1 ,Q`/ �`<U /115............•...
Installer Address
U Type of Building Size feet
Dwelling—No. of Bedrooms..............J� ...................Expansion Attic ( ) Garbage Grinder ( )
a Other—Type of Building No. of persons............................ Showers
pa-I yP g --------------------•------- P ( ) Cafeteria ( )
dOther fixtures --------------------------------------------------.........------------------------------
W Design Flow..............::5;57�................gallons per person per day. Total daily flow..........-'57�-2:9...................gallons.
WSeptic Tank—Liquid'capacity,- '-.gallons Length................ Width............... Diameter................ Depth................
x Disposal Trench—No........Z......... Width...... ......... Total Length..5y_..... Total leaching area....................sq. ft.
Seepage Pit No.......: ----- Diameter.................... Depth below inlet...ice./.... 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.---....................
LZ4 Test Pit No. 2................minutes per inch Depth of Test Pit--.................. Depth to ground water........................
P4 --••-•-•-•••----------------••••--•••••-•---•-•--••----•-•-.........-•-•--•---••..._----•------•-•---•----...•----••-----•.....---••._....--------•-•----••-
D Description of Soil..................... Ll/. s2� JD/G--...... ?.................................................
x
W
-------------•-------------- --------
U Nature of Repairs or Alterations—Answer when applicable....-J'_� - _... i .• 11a(
----------------------•---•
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the previsions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliancy as been issued.by the board of health.
Signed....... .(.' ` ��`' ...............--- ---
----------------
/ Dare
Application Approved By -----------. C.V... ... .............. e�- ............``f.......
Date
,Application Disapproved for the following reasons- ----- -------------------------------/........................................................................................
-------------------------------------------- -------------------------------------------------------------------------------- --------------------------------------------------------------------- ................................
G�` Dare
Permit No. / r �................. Issued ..------� `.. ..�. .., .....
Dare
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
('Ier#tfira e of C110rayliance
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repairedby (x )
.......................±hQ<G QL03 ------L'l�l G.......------------------............------------------.........--------------.
Installer
at ------------------------------------------------------------ D 0/sw = 140 C=�"U1T.
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. q� �. dated -- d�'.-.Ap...'/._
PP P Z->
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.--.-- ------- Inspector .....: ...........��...-._'-.t�-�------.----_^:. ~
P
t �t�l.. , ,
DATE.. --------------------- -i • ; ------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
G}� TOWN OF BARNSTABLE ��
No.................,.......� FEE....
Disposal Workii Twilmdrurf vit rrrmft
Permission is hereby granted...................� ��..__._.-���ZLJC776AJ
..----.--- ••------•--•.................................................................
to Construct ( ) or Repair (><) an Individual Sewage Disposal System
atNo......................................•-. ......• - y/a.......0 ................................... f-------------- /......--------••---•---......--
Street
as shown on the application for Disposal Works Construction Permit o..................... Dated,.-_ .._.---------�
jT Board of Health
DATE-------/----G-/--�-------------••-----_-•-------------------•--•----•------• mot/
FORM 36508 HOBBS&WARREN,INC.,PUBLISHERS
TOWN OF BARNSTABLE
LOCATION eCf.. &4t1lAJ 46e- SEWAGE # 91-
VILLAGE Cam/ � ASSESSOR'S MAP & LOT 0,33-0
INSTALLER'S NAME & PHONE NO. 90/Z7DL47 V l'fJ�
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS PRIVATE WELL OR BLI WAT
BUILDER OR OWNER 4Z&
DATE PERMIT ISSUED: Q
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
�N
JV` Q
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