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HomeMy WebLinkAbout0030 SEARS AVENUE - Health kR*Ctz)j Dos - ol I TOWN OF BARNSTABLE . LOCATION j© w SEWAGE # 13— VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY /�AL �A X2 LEACHING FACILITY:(type) 1,dqe7 4 e 9p,'T .(size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER / BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: L Y VARIANCE GRANTED: Yes No r 10 3° r No.. .... Fps. .d�.. ...� THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH / ... o F......,�� -�� � ............................ Appliratinn for Uiiipwi al orkii Tonstrnrtiun ramit Application is hereby made for a Permit to Construct (X or Repair ( ) an Individual Sewage Disposal System at . U.._ ........................c .6. f ... -------------------------- L ati n:Address r Lot No. fQJ _.1` -/ .. ,3s ..._..... ram../�%:.(flu .�� w er J Address ...... .. < Installer Address UType of Building Size Lot.__._ __._f_5�5 q. feet Dwelling— �lo. of Bedrooms______________________________x'.___.___Expansion Attic ( Garbage Grinder ('�� aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures ................................. W Design Flow......................1$75__.---------gallons per person V daly. Total daily flow.....................3__34nL.......gallons. WSeptic Tank—Liquid'capacity.A .gallons Length... 4t.. Width.__` _ q Diameter________________ Depth..��___—..(—.. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-----------1------- Diameter........1_4)..... Depth below inlet.._............ Total leaching area..�>5;?..sq. ft. Z Other Distribution box (/jT Dosing-tank (� _ ~' Percolation Test Results Performed by---.__ -�C_���+'...... .... ....r .-_•_-.'.�U Utv' "'Date----- .�s �_: ._:.______.. Test Pit No. 1................minutes per inch Depth of Test Pit_ .........._ Depth to ground wafer........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ r•..... ........................... ........................... -- - --------------------------------------------------------- 0 Description of Soil------©-152 ------------ -- C�J� lG �'✓� /IJYM r x J W d. ---- - ------ B. -----•-•--------------------------------------------•--•---•---•----•--------•-•-----••-•-----•--•--•-- ..................................... : _.._. ------------------------------------------------------------------------- -------------------------------------------------------------------------------- UNature of Repairs or Alterations—Answer when.applicable................................................................................................ ..................................................-..................................................................................................................................................... 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 Compli .'ce h s been is d t and of hea Signed -------- --. ' ....... . .. ... ............. -------------- - -o-- DOApplication Approved By . ... .. .... ....... ......... . Date Application Disapproved for the following reasons. ........................ ................................. -- ......-------- --- .......................................... ................................................... �......................................................---------....................... ..........--. ----------------------------- "- f Date Permit No. ----------- --------------1 -------------- Issued ........ (,J� ---,(� ....... ate Y SAP No.. •.................. FEB............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH - f OF ..... .......................................... Appliratilatt for Dhipaii al Workii Tomitrurtinrt ramit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: j cati n-Address/� r Lot No. / j 0, ,- xeA Owner Address W Installer Address � dType of Building .� Size Lot.___.1....__,.�SvSq. feet U Dwelling-41 o. of Bedrooms........ ...... _...__....Expansion Attic (�.5 Garbage Grinder ( a '4 Other—T e of Building No. of persons______________--__--_---__ Showers — Cafeteria dOther fixtures -----------------------------------------------------------------•-----------------------------------------------------------•----.-.------.--------. W Design Flow...................... . ............gallons per person eV day. Total daily flow__._.........__.....__=�ij........gallons. WSeptic Tank—Liquid capacity.A gallons Length___ _. '__ Width.. -/u Diameter---------------- Depth.V_-.(_... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.........../------- Diameter........C.v..... Depth below inlet.._............. Total leaching area...�� r�..sq. ft. Z Other Distribution box V,4 Dosin tank ( ►�3 _ ~' Percolation Test Results Performed by.__ -: t'_. ....l Q::___..P-5LJ/1Y/1Lbate J. ....S.._.c��::5_:............ Test Pit No. I................minutes per inch Depth of Test Pit_j_._............ Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ { t f� -•---------------- Pt f � f! ��` /O Description of Soil ' " --•• --- E ......--•-----------------------�------------•---• f._ -----_- --��=-• xU •. --- - r..................................................................................................................................................... W ::-...:✓ -- ----- ------------------------------•---------------------------------------------------------------------•----------------------•---------•----............... UNature of Repairs or Alterations—Answer when applicable............................................................................................... --------------------------•---••..-•••-•-•--•----•----•------•-•-••---••••-••-••--......--•--.----------•---•---•••--•-•--•-•••--•---------------••••--•-----•---•-•••••-••-•---•-•-----------..._---•-- 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 by the board of health. Signed ..................',----------_---��gP------------------ -----1 ...-G �.- "='' ,.fir ` I�.�r'! /tom j r L c Application Approved By ,Yip .... . = �" �� a :.... _........ C Application Disapproved for the following reasons: --------------y ..............................---------------------�1 -.-r".-------------..._.............................................................................------....---....�y.l. .............. Dare 7 Permit No. t .............. Issued <� l 1. .. �_ ------------ Dare THE COMMONWEALTH OF MASSACHUSETTS -. BOAR OF HEALTH f. / ' ---- �-�:. ��......... of .��....-. .....-- ---.� r-------- -- -- --- - ------ GertifiCatP of GraylianrP THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by........................------------------------------------------------------------- -- .-- ..... ------------....... -- -------------------- . /K -- I s�aller at ..... r_l L '-.-.. . .. r--'.L has been installed in"accordance with the provisions of TITLE of They to vironmental Code as described in the application for Disposal Works Construction Permit No. Vi � `p................ dated ........--.........-----..-----................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT CONSTRUE AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. y. f — ------ .......................................... Inspector ---- ..- ......................... DATE........... ..........:!;; ..- l--..-... .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH n .— 1 rr�........OF... . .` :%� t' �::.- ........... ............................ No..........�2.....:.. FEE....f............ Dispniii al Works Tomitrudiatt rrutit Permissionis hereby granted............................................................................................................................................... tic) Construct ( or Repair ) an Individual S3Iwagp Disp sal System ->�l at No �?/ �' _�- 71 .1 -C'' C '. Street as shown on the application for Disposal Works Construction Permit No.�..'-:�...-----�--/lated.......................................... ---------------------------------•••••-------•-••--•••-- ---•--•----•-•------•-•••••------.......------ Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. 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