HomeMy WebLinkAbout0153 DUNN'S POND ROAD - Health Dunn s A Rd W$
TOWN OF BARNSTABLE
LOCATION 1j 0j P vws' SEWAGE #
VILLAGE t=4cA-vvWl S, ASSESSOR'S MAP 6t LOT
INSTALLER'S NAME & PHONE NO. G Vf�►w0 Cdvi-�vT
SEPTIC TANK CAPACITY L07V
LEACHING FACILITY:(type))rt��,�/ ®`� 5, (size)a
NO. OF BEDROOMS PRIVATE WELL OR
BUILDER OR OWNER lE Vli �c1Z vex.-
DATE PERMIT ISSUED.
DATE 'COMPLIANCE ISSUED: �r
VARIANCE GRANTED: Yes No
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
'.�.W.rN.......OF....... 2 .... .
Appliratvan for Disposal Works Tonovdion Frrmi#
Application is hereby made for a Permit to Construct ( ) or Repair (1Xan Individual Sewage Disposal
System at:
Location-Address or Lot No.
............ .......1�:0.:. 1P............................................ .................... . ....__._....-..-_-__----_-__---- .....-
Owner
a ........... ..) .. ..................... ......... �� ........ .... I..,I �` 7�......
...
Installer Address
Type of Building Size Lot............................Sq. feet
aDwelling—No. of Bedrooms.......o.................................Expansion Attic ( ) Garbage Grinder ( )
a Other—Type of Building ............................ No. of persons.............:.............. Showers ( ) — Cafeteria ( )
a' Other fixtures .................. ---•-----------.--------------
*-------
._.._....
d
W Design Flow........Cf. ........................gallons per person per day. Total daily flow........tea'O......................gallons.
WSeptic Tank S-Liquid capacityLM--.gallons Length...:r........ Width.....{....... Diameter................ Depth................
x Disposal Trench—No. Width................ Total Length....OLQ......... Total leaching area....................sq. ft.
3 Seepage Pit No..................... Diameter.................... Depth below inlet...........:........ Total leaching area.................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by---•---- ............................................................... Date........................................
aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a .........................................................•-•---••.........................•............------......---........._................---..........
ODescription of Soil.....................................•-'....-•------....................---------•-----------......------------------..........--------------•--•-•-•-.....----•-...---
•-•-.....--•--------------------------------------------------------------------------------------•------•-•--••-----------------------'-------•--.....----•----......----............•--.._.•"-•.'•'•-
U Nature of Repairs or Alterations—Answer when applicable._..Z]Zu�_51:A&i......Uffn..
" ---.. �_...��.tlid/.�..------S...t-�_�.s�.....5��1�-.----'Jc--`-'--y-'�-�'•'�'-'�----------------------•--------------•---......------•-------------....
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TL I'U 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance haLb=n issued by th �11 .Signed- .. ---- . -• ••------- ..GL .�:
ate
Application Approved BY ......... ..... ........ _ -�, z ' '.......
Date
Application Disapproved for the following reasons:............................................................................................................__
....................•----•---•--......................-•---------•---••---------...----.......------'---•.......••'--........------------......----•-•-----------•----•---------•---•.._...............--
"'Y
�(( Issued.-.......f a.......... ate
Permit No. t�- '-._..._.__ ..........._�
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.......OF.....................4�b&
.........................................
Appliration for Disposal Works Tonstrwtion jkrutft
Application is hereby made for a Permit to Construct or Repair (Cyan Individual Sewage Disposal
System at:
C;: .VM ....P0 . .....p \k ..... ..................... J%jA.Y
-
Location-Address or Lot N---o-.--------------------------
.......................................... .....................&4A/V-4c
.......... .... -------------*----------—-—-
Owner
.........
.................... . ... ......> A....... .. ..
Installer Address
Type of-Building\N, , Size Lot.............................Sq. feet
Oms.......;L.................................Ex ansion Attic ( 5
Dwelling—No. of Bedrooms.__.. p Garbage Grinder
Other—Type of Building ............................ No. of persons............................. Showers Cafeteria
Otherfixtures ......................................................................................................................................................
WW Design Flow..._.___ ........................gallons per person pty dayi Total daily flow........Z'R::Q --------------------gallons.
Septic Tank-L Liquid*capacityLMLgallons Length...... ....... Width.....4........ Diameter________________ Depth__.___...._..__.
Disposal Trench—No. ..Fllvu)a Width_..._._.._______ Total Length....6.0......... Total leaching area....................sq. ft.
Seepage Pit No_____________________ Diameter._.._.__._._.__..._. Depth below inlet..._......._.._..__. Total leaching area.................sq. f t.
Z Other Distribution'box ( ) Dosing tank ( )
0.4 Percolation Test Results Performed by.......................................................................... Date..............................m..........
Test Pit No. I................minutesperinch Depth of Test Pit.____._____._..._.._ Depth to ground water.._________:____..._.__.
Test Pit No. 2................minutes per inch Depth of Test Pit_____._._..._.__.__. Depth to ground water........................
.............................................................................................................................................................
0 Description of Soil..................................................................................................I.......................................................................
U .................................................................v...............................................................................................................................w.......
.............................................................................................m..........................................................................................................
U Nature of R
epairs or Alterations—Answer when applicabl7r,-4A._<rAt_k......J.07YZI...
-W. Inkc- .......k��J A 0 V0— g�.o a 9. ........................
- ------- -- ......"............ ............. ...................................
Agreement: o
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of T I TAIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a,Cer;ificate,of Compliance has-been issued,by the-boa-r-dV'Qf 4led
Signed-. ., . V . ... . ..
Date
........�_.
....... .. .......
Application Approved By.._...__.......&&......... ... ........4_�� ----------2-_- ------
.......................................................
Pate
Application Disapproved for the following reasons:........................................... ................................................................
.................................................................................................................................................................................*..........."--------
Date
Permit No. ............................. Issued..........7.-z 1� <V......................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
,S�.......OF........a?. _.W ...T.14 .............................-
Tertifiratr of Toutpliam
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired
by.............................. .......�. . ...............................................................................................
Installer
at.......................... d:) K S A, .. ...................................................
.......... .............14.t.r... .. ........
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No... ............
dated- do ......................
I
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS-TRUED AS A dated_...__
NTEE THAT THE
SYSTEM WILL FUNCTION SATIS4CTORY.
DATE................................ ?I/UK Inspector.�...... .................._
.......f--7 ................. . ...... ...................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.....OF....... ............................
N FEE.-20............
Disposal Works Tonstrudion rawit
Permission is hereby granted......... -97
........................................................................
to Construct or Repair (( ) 2,n Individual Sewage Disposal System
0................... .................................................................
at No..........1,245.
Street
as shown on the application for Disposal Works Construction Permit 'CJV.-..A�.7, Dated......9, :70�4.:7f�W. .............
P".' 221;
----------------------------------------------------Board of Health
................... .........................