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HomeMy WebLinkAbout0089 LONGVIEW DRIVE - Health S 9 �on�vi�w 'Dr., �ann�'T 1 �, _ e TOWN OF BARNSTABLE LOCATION „C6v�7rf�l ,�-[� . SEWAGE # VILLAGE ASSESSOR'S MAP Q LOT Zor- 09Z. INSTALLER'S NAME & PHONE'NO.. SEPTIC TANK CAPACITY l000 LEACHING FACILITY:(type) %coo (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �' r �n QD o� `r - c N n No. .. FR$.... . THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH aS�l v ......... ........_......................... Alip iration for DisVog al Works Tougtrurtion ' rrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System t Ll Locat n Address (� or Lot No. r�r. ...... �...,� 41_.�a.-Y............................. ..........-•................................... .............................................. wn Address �° 1 ------.... ..°................................ •--------------------------------- -------------•------------------------ Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms......... .....Expansion Attic ( ) Garbage Grinder ( ) ' aOther—Type of Building ............................ No. of persons............................ Showers ( ) Cafeteria ( ) a 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth'of Test Pit.................... Depth to ground water_._-_----__-____-___---. f-T Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....................... P4 -•••--------------•-•--•-•••---•-----•------------------------••....------------•--------•---------•......................................................... 0 Description of Soil..................................................---..............-------•--------------------------------------------------------------------••...._.._-----------... ,. x ---------------------------------------------------------------------------------------••-------------------------------------------- . ------------------------ -----------•-- .....-•-- U Nature of Repairs or Alterations—Answer when applicable.____-- 40------- ----DLL ........ --------•--------------------------------------------------------------------•..._......-----•------•-----•-------••-•--•--•-----•------•---------•----•-------------------•---•--•-••••-•--....-------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of LIT:1E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has-been issued by the and of- Sigsocll Date Application Approved By........... '`?....... -----------• --_3a- 8'g' Date Application Disapproved for the following reasons----------------•----•-•--------------------------------------------------------•-------------------------------- ------•-----------•-------....•-----------•----------•--•---....--••-------------------------•--•-------.--...-•---•-----••--........------•--------••---------•--•----••-•--•----••--••--•------------. ¢p Date Permit No.....f1.D-... ... Issued....................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................... ................OF..................... ....-..._..... Appliration for Uhip sal Workii Tomitrurtiun rrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal S stem at: ........................................ ...............................................�r Location-,Address or Lot No. ........'..? .:._.. `! ./.C1! '.. ........................... ............................................. .....•.................------................. W Own r Address Installer Address UType of Building Size Lot............................Sq. feet �--� Dwelling—No. of Bedrooms........ ..............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures -------------------------------------------••-•---...... W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water-----------._-_--______- 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.___-_.--__-____---_____ P4 .---•-------------------------------•------------.....-----•---•--------••------.....------........_._._....------•---•-•---------•-•-•-- ... •--------------- O Description of Soil........................................................................................................................................................................ x V ---•----•------•---•--•------------•------------------------•---------------•--------•.....•---•-•--------•-------------...-•-•-----------------•-------•-----------------•--•------••-•-•--•-•-----•-•- W ----------------------- --------------------•--•----------------------------------------••-------------•--•-------------------------•-- ----- ------- U Nature of Repairs or Alterations—Answer when applicable.____--/ �-�------r`_____. �C�............. ---------------� d Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of ITT'. p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has issued by th oard o'-he2 _ Stgne ........ ... Date It Application Approved BY !` `j ................................... Date Application Disapproved for the following reasons:................................................................................................................ -•--•-••-------------------------------------•--•--•-------...--•---------....•-----....•---•-----••------•-•-------------------•-----•---------•••-•-----•-•••---------------•---------------•••------- Date PermitNo. .---- --...._��-----•---••------------• Issued-------------------------............................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ��pam✓.............oF.......... N.J..l.. 7.6.....�.........------ Trrtffiratr of Toutphatt r THIS S O CFRTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by ---•---�---------------------------•----.-------------------•---•-------------•----------•-------••-•---------•-- / Insta er ....... lWce— ..................... .............................................................................. has been installed in accordance with the provisions of TIT'- 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.___.._� .Yo._....... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...................•.�:•a` = ...!�....................... Inspector.....-----..... ................................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -31n /��.� ...........OF....... ..�.................................................. © FEE........................ Uhipnsa1 Works Trnns#rt ion rrntft Permissionis hereby granted............................................................................................................................................. to Construct ( ) or Repair ( wran Individual Sewage Disposal System Street as shown on the application for Disposal Works Construction Permit No.. . Dated.......................................... ............................... ..t ................................................... DATE..................k...e---- r v v........................... Board of Health .-- ------------0-•-••- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS