HomeMy WebLinkAbout0140 LONGVIEW DRIVE - Health / 0 Lona v ew bf •, Mix
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LOCL,TION ' w5EW&C,E PERMIT
VILLAGE 3 — —
IMST"I ER•5 1J(�,NIE ADDRESS
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BUILDER 5 Q &VAF— ADDRESS
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DATE PER"VT ISSUED '
D ATE COP/IPLI &&ICE ISSUED :
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G� TOWN OF BARNSTABLE
LOCATION ® L.® 4eve Lt SEWAGE
VILEi®E ASSESSOR'S; MAP & LOT
INSTALLER'S NAME & PHONE NO. A zc"y' c<;r�3
M,
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) ?Re C S r (size) %-OCk-.5 '
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNERS
DATE PERMIT ISSUED: 9 - 1 -
91,
DATE COMPLIANCE ISSUED: - ed T �3
VARIANCE GRANTED: Yes No �,
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TOWN OF BARNSTABLE
LOCATION Iyb �VIAUW Dc S&W*6E#--TiA
VILLAGE Otlam0c, ASSESSOR'S MAP&PARCEL p
IN64A&L-ER'S NAME&PHONE NO W.2
SEPTIC TANK CAPACITY
LEACHING FACILITY.(type) �� (size) 1
NO.OF BEDROOMS 3
OWNER JC041 r%-kr- /
PERMIT DATE: CQ44P14ANff DATE:,-
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetl sexist within
300 feet of leaching facility) Feet
FURNISHED BY
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No.--•� /..... , �—' F�$. �:....................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEALTH
.._.._....OF....... .. . .............
Application -for Big ugtti Works Towi#rurtion Vrrmft
Application is hereby made for a Permit to Construct ) or Rep 'r (" ) an Individual Sewage Disposal
System at; . �--��
---•••-•••••.. • •� . - . ... . ••-••--••--- --
"Ad , or Lot No:
Owner Address
W
Installer Address
QType of Building Size Lot----------------------------Sq. feet
V Dwelling—No. of Bedrooms------------------------------ -- --------Expansion Attic ( ) Garbage Grinder ( )U
per, 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. f t.
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_.--_--..---_----_.-._..
L14 Test Pit No. 2----------------minutes per inch Depth of Test it---------- ----- Depth to gro d water----- -
W ------------ --••- -- . .............
.........
............
•----..... ---
0 Description of Soil------------------------ •. •.`. ..-
x
V ------------------------------------- ---------•-•••-----•.....•--••--•---••---•••-----•---•-•••----------•--••--•---•••-•---••-•------------------•----•------••--...._..-•••-•--•------•-------------
W
U Nature of Repairs or Alterations—Answer when applicable--- __............ .. a
------------------------------------------------------------------------------------------- .- ------ -
Agreement: ,
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be sued by the b and of health.
,Application Approved B
' { Dates
Application Disapproved for the following reasons:--------------------------------•----------- --•---- -•-------..........................................
--•-•--••-•-•--•-•-•----••----•-----•----•---•---•------••----•---•-------------•---•-------------------•..---------------•-•----•....._••-••-........;.....----------------------••--......--------•--•-
k _ Date
Permit No............... Issued.....
Date
No.-- ,/ FEs.,f.....................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD QV HEALTH
L V 710c�_14...........
;�
.- .OF_.....
Application -for i_gpmal vrk� ( onstrurtion Vrrmit
Application is hereb made for a.Permit to Construct ) or Rep 'r (�) an Individual Sewage Disposal
System at;
•--...-•---•- --- •- --- ,
L a" Ad or SLot No.
`.. -----------•--------- ---------------------•--•------••-•----•-=. =•----.......----••---------•-----------•--•-•--•----
4 Owner eAddress
a -•--•--- - ----------- ---------- --••-••-••--•-•••---- ••-••--•-•---------•----------
Installer Address
Q Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic .( ) Garbage Grinder ( )
Other-Type of Building _________________________"__ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
a
Q' Other fixtures _.___._-,"_-_.
Q
W Design Flow---------------------------_________________gallons.per person per day. Total'daily flow--------------------------------------------gallons.
WSeptic Tank—Liquid capacity------------gallons Length-----------------Width---------------- Diameter---------------- Depth_"_-______"__---
xDisposal 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. 1................minutes per inch Depth of' Test Pit.................... Depth to ground water_...____________.____---
rX4 Test Pit No. 2----------------minutes per inch Depth of Test it.________. __._... Depth to gr d water__"_._._..."_.._______-
O
---
Description of Soil........................--------- -- ---�+�"'-=�`p►--- •-- --- -' --- ...............
.___.... -----------------•--------------
x
V = :: : .
----- -------------- ------------------------------------------------------------------------------- ---------------------------
U Nature 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 Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be sued by the b'ar of health.
tgnedr=' ----------- --• ---••--•-•---------------- ................................
Application Approved By---------- --- ----- - -- -- - 7!
Date
Application Disapproved for the following reasons:------------------------------------ :.....__..._______..._._...___________._._._______-_________•._...
..--•------••-------------•-•----••-•---------------------------•---.-....-------•-•••--------•---•------'-----------_---_._...------....-----------•-----__..----------------•----------•------
...
Date
Permit No......................................-----------------• Issued------- -� --. .. - ---
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEALTH
...Q........... .............OF......... � ..
Cnrrtifirate of 10,1lamplianr
THI S TO RTI ' h t the Individual Sewage Disposal System constructed ( ) or Repaired
by .. Installer r._
has been installed in accordance with the provisions of Artic e o ifeState Sanitary ode as described in thee"
application..for:.Disposal Works Construction Permit No.____ _ "`dated
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TF�E• ISSUANCE OF.THIS CERTIFICATE.,SHALL,,NOT-;BE.CONSTRUE® AS A GUARANTEE,THAT THE
SYSTEM WILL FUNCTION SATIS04CTORY
DATE f - "y Inspector -•--- .
THE COMMONWEALTH OF MASSACHUSETTS
BOARD, OF HEALTH
*OF....- i... ._...............................................
�.- No._C-l .f .._... FEE- ---
lisp iittl Pr T .itrnrtion Vrrmit
t
Permission is hereby rante _.. ,-- . ------ . --
-,r--- ---------------�. ----------
to Con t t )- or it ( Individual Sewagy ova
at No.. ........ ......`"'°............. ... ---- -- .................. ------ - --------
-
- � ��• �-- S reef �
as shown on the application for Disposal Works Construction P No.. :_ ____ 1ted...1_�:." " .......
-- --- =•- - ---- ------ - -----------••-
q Board of ealth
DATE--- L�........ t
FORM 1255•HOBB$ & WARREN. INC.. PUBLISHERS"""^---.,