HomeMy WebLinkAbout0095 SCHOOL STREET - Health Gi5�c-��- s-{Y-,�-�-
C�3S-b� g'
TOWN OF BARNSTABLE
LOCATION ' ' u''� SEWAGE # � L
VILLAGE cf /7— ASSESSOR'S MAP & LOT a•� y�
INSTALLER'S NAME & PHONE NO. .�`�JC 0",?;V
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type)__' %1' (size)
NO. OF BEDROOMS PRIVATE WELL O . :PU&:B:LIC:W:ATER
BUILDER OR OWNER
DATE PERMIT ISSUED: �� "�
DATE COMPLIANCE ISSUED: FL1- eI
,,VARIANCE GRANTED: Yes No
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No... F>s.... e ?....... .
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® 'E HEALTH
---------
0 F... 4.lz ApplirFation for Dhipooal Workii Tonitrnr#ion ramit
Application is hereby made for a Permit to Construct ( ) or Repair 4) an Individual Sewage Disposal
System at:
aL
Location.Address or Lot No.
l�..................•-••------......_.............-•-•-•.......--•-- ...............................................21 - .......
owner Address
••-
Installer Address
U Type of Building Size Lot...&J,f. --_Sq. feet
Dwelling—No. of Bedrooms......................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No, of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures .----•------------------•------. -•-
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.
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........................
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
x -------------------------------------------•-..........--------- •....------•-------•-•-••----.--•-----•-•• -----------.._.... ---
O Description of Soil......< nr6A.....,4� _ff..As6 .............. --------
U
x
W
................................................................................. ............................................................................................................
U Nature of Repairs or ltera ns—Answer when applicable.______-,�4��_._- _..' ......_... _� "
� - _-._.._. �a -----------•-------------------------•----------------------------------•.....•--.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of i?TU 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been is th bo -d.o ealt .
Signed ..
g - =
Date
Application Approved By.............
P
Date
Application Disapproved for the following reasons---------------------------------------------------•-----------------------------------------.................
••--------------------•------•----•------------------------------------•--•--•----------------•-------------------------------------------------------•------------------------------•---------•--------
p, Date
Permit No.••-••-__�-_.!_•n.._�`_2).•0-••-- Issued.......................................................
Date
No.. �:.f... FEB....Ar..-..C).....
THE COMMONWEALTH OF MASSACHUSETTS
_ BOARD F HEALTH
` •• OF..... ..% i9...... .. .............................................
Aliptiratiun for Bwvoiial Works Tuntrnrtiun ratnit
Application is hereby made for a Permit to Construct ( ) or Repair A) an Individual Sewage Disposal
System at:
....-,�._....... .. .. . ........� Z..... ........................................... -----•------......•---•-..........-----••.
. Location-Address or Lot No.
...................... 1----------------------------------•--•--•----- /a J '' �C. :--------C�
Installer Address
U Type of Building Size Lot--- feet
Dwelling—No. of Bedrooms.....................3...................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers — Cafeteria
p-I Other fixtures ......-••••-••.....•-••••.......-- - - •• - - .--- - -
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.
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-----------.____---_---.
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Q+' •---••---•--•---------•-•••••••••....................... •-••---••--........_.....................-•••••--••-•.............--•••--•••----------------......
O Description of Soil------ TG` ------ ..... ......
x
-------------------------------
W ••••--•-•••-.......•---••--•------••--•••-•-•••---••••-•-•---------•-•--••-••---•-- •-•--•-•----••-----•-•••••-•-•------•---------•-----••--•--.............................................
0 Nature of Repairs,orAlterations—Answer when applicable.... ��-j®.____` .f 11 ;:`____ !. ...... .......................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITLI E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been iss a th bo d o jieaallt
�k7
Signed.........f = = _••-•-• = •••• . -----•..... .. �,'
_ ate
Application Approved BY `"= =...... ••--......--•••••.-- ---------•-•••.... �r
Date
Application Disapproved for the-following reasons-----------------------------------------------------------------------------------------------------------------
------------------------------------------------•--...--------------------•------•------------------.......------------------------------------------------------------------------------------------•---
33 ,, Date
Permit No.......... =.....�-_.l..r�� ......... Issued--------------------•----•---•--------••- -•-•--
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD QF HEALTH
� �
OF............................................. 4...................................
ClErrtifiratr of TounpliFatta
THIS IS TO CERTIFY, That the Individual Sege Disposal System constructed ( ) or Repaired (•'�
by------------------------------- ~ �' t_c� ---------�nu/.. .,o'V ..,---------------------------------------------------..
,�_...
I taller
has been installed in accordance with the provisions of TILTY ;` of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.___.___fz�._f:_-__��. >�,.__ da.ted-...............................................
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
�I
DATE...................... ..'... .1..:. ............................ Inspector............ i.-A-_2....................................................
THE COMMONWEA TH OF MASSACHUSETTS
BQA�R� " HEALTH
. O F........... ...� �r� .......................................................... ...........
No--- ------------=.> ._ FEE.--- ................
Ripon al Workii Ton union Trani#
Permission is hereby granted............... Q t -6 e 0_�.__'_'._._._...._C'D��. /'jQ
-------•............................................
to Construct ( ) o Repair ( ) an Individual Seir&, Disposal System
-at No......................... --------------------------------------------------------------••-•....----•-••---..--
Street rl..X
as shown on the application for Disposal Works Construction Permit No.11___. \\ \Dated..........................................
•------•---------•-••----•--•-•--- f
Board of r3—_r
�} .C............................ Health
DATE......................�-`---......-•--------•
-�
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS