HomeMy WebLinkAbout0033 SCHOOL STREET - Health 77-
33 School Street -�
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TOWN OF BARNSTABLC
LOCATION �� SEWAGE # -�7
VILLAGE rexal /-
ASSESSOR'S MAP & LOT
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INSTALLER'S NAME & PHONE NO. ke
SEPTIC TANK CAPACITY
LEACHING FACILITY:{type) /r��/C �g,�/,�size)_
NO. OF BEDROOMS-PRIVATE WELL OR PUBLIC WATE ,;
BUILDER OR OWNER
/SAmp
DATE PERMIT ISSUELI:�'��-��
DATE COLIPLIANCE ISSUED: '
VARIANCE GRANTED: Yes No
0
TOWN OF BARNSTABLE
LOCATION - 5-!� S L �® SEWAGE #
VILLAGE �,nUTJ'r ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) / (size)
NO. OF BEDROOMS PRIVATE WELL OR UBLIC WATER �(
BUILDER OR OWNER L.(����,,,� , R P
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratvan for Uispnial Works Tomitrurtion Famit
Application is hereby made for a Permit to Construct.( ) or Repair ( . ) an Individual Sewage Disposal
System at:
3..-- ............................... `
...................................
................_ t . -----
Iocati - Addr s L -or.Et o. /
�nez Address
------._��de ------------------------------------------ .......... r� � .... / ��''S
Installer Address
d Type of Building Size Lot.._ 1 feet
U
Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) ? Garbage Grinder ( )
P4 Other—T e of Building ............................ No. of persons__________________ ___ Showers — Cafeteria
W Other fixtures --------------------------------------------•-
a--- ---------------------------
W Design Flow........... /`.�....................gallons per person per day. Total daily flow..............
,
WSeptic Tank—Liquid capacity/5J-`gallon 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)K) Dosing tank ( . )
Percolation Test Results Performed by------------------------------------------------
•........................ Date----• •...•----------------------
Test Pit No. 1________________minutes per inch Depth of Test Pit_................... Depth to ground water--_______-_-_-__•.____-:
ri, Test Pit No. 2................minutes per inch Depth of Test Pit........o.......---- Depth to ground water........................
Pa' ............
c------ . .
ODescription of Soil----------- -------------------•------•----•--------------------=--------------•--------------.__....-----------•--------.---------
x
W ................................................--••---------•-•-------------------•--•...---•--•--------•-•-•----... -- /� .
U Nature of Repairs or Alterations=Answer when applicable--__,___ .S?- .........................................................
.........................-........................t...... --------------------------------------------------••••.--• .....---
1. ers.�c�--
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 as been 'sued the boar of health.
Signed -- .L �`�
-----
Daze
Application Approved By ------------------------------------------
Date
Application Disapproved for the following reasons: =-------------------------------------------------------------- -------- --------
' -----
......................................----------------------------------------------------------------------------............................................................................................ .....................................
Date
Permit No- -- ----------1- -✓ 1-y
Issued
�--------- -----`---------------Dare...................................... `
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x
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE '
Appfiraiiou for Big nsa1 Works Tons#rnrtiun T amit
Application is hereby made for a Permit to Construct ( ) or Repair t( ) an Individual Sewage Disposal
System at
cation Addr s or L,,ot�No. ,.��[cr
rf t { .................................. .•............. ..! ..�l.._!................................
W er Address
.................................' ....... ---•-------- ..... --!?/
-------
Installer Address �
V Type of Building �t Size`L-ot.../9 0� ---Sq. feet
Dwelling—No. of Bedrooms.......... .............................Expansion Attic ( ) Garbage Grinder ( )
' 4 Other—T e of Building ............................ No. of persons.....:--_--•-•-------------- Showers — Cafeteria
Q' Other fixtures ............................................. --••-•------
W Design Flow........... X�--•-----------------------gallons per person per day. Total daily flow..............•... ...........gallons.
WSeptic Tank—Liquid capacity-/-l-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%.,e) Dosing tank
Percolation Test Results Performed by-----------------------------------•-•--------------------------------- Date
Test Pit No. 1................minutes per inch Depth of Test Pit.........`......... Depth to ground water-___--__--___-__-_-.----
L� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
...................................................... ..........`.---•--...•-----••-•--.........................................................
O Description of Soil v` ------•-•..............•--•------'�"'�a-"�-------•------------
V
.................A ........................... ----•------•...... -------•---------------
.. .:._..
Nature of Repairs or Alterations—.Answer when a,
W livabl
'�."7
ye_--_---
--
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 has been issued the boar of health.
Signed j z l�D - - —. .... . .......... Dare
Application Approved B Date
-
Application Disapproved for the following reasons- ........................................... -------------------------------------------- ..................-------------
---------- - ------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------- ........................................
Dare
PermitNo- ....---------- ... .---------- - -- Issued . ---.............................................._.__•'- _ .. - f. _. ° �- Date
THE COMMONWEALTH OF MASSACHUSETI S
BOARD OF HEALTH
TOWN OF BARNSTABLE .
�Er#iftrate of Co ttylianve
THIS IS TO C RTIFY, That the Individual Sewage Disposal System constructed ( >/) or Repaired ( )
by------------- � ..........-- . ...... ........................................................................................................
In
at 5 ............. / 9 .......`�?--'-. "..... ��i` l "-'.......:
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. ............4'/......... dated .........................----...................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTII�ON SSA`T SF�TORY.
DATE.............................................................................................. .Inspector ................................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH �z:,
TOWN OF BARNSTABLE
No.....1..�.;� �l. FEE..�� -.......�..
Disposal or
�unstrudion rlerntit
Permissionis hereby granted..-•••••--•--- .... ...._..................................................•--•---........................................
to Construct ) o Repair'( ) an Individual Sewage Disposal System
atNo........................ .. ..... f�0.1 .............................Street
Street p�
as shown on the application for Disposal Works Construction Permit No.1--:&r 4l Dated..........................................
•--•........................... .......
...........
.._..-------........
..._
Board of Health
��
DATE.................... "•--•--• --•x ........... .........................
FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS