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HomeMy WebLinkAbout0041 BATES STREET - Health ti�t�/ r� TOWN OF BARNSTABLE ` LOCATION - 73 LA.fj f3jg_4 Lot-,,,ct SEWAGE # VILLAGE ASSESSOR'S MAP & LOT a INSTALLER'S NAME & PHONE NO. &©atom i3uw)yi SEPTIC TANK CAPACITY 1000 Gt 4 L LEACHING FACILITYA ype) 't-(,off l')tfPgsw- (size) 3 NO. OF BEDROOMS Z PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER ..,Sf'I"o jk iS DATE PERMIT ISSUED: 1 Y — DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No � w �, � O_ 1') c S. '-) '`0 c'1 � v �— y No.-----1-----��1 ................s:`...... THE COMMONWEALTH OF MASSACHUSETTS _ BOAR® OF HEALTH ... ..o..,.r�.. o F......1�?..:r......................................................................... ApphrFation for DiBpos al Works Tnnitrur#ion ramit Application is hereby made for a Permit to Construct ( ) or Repair (V\) an Individual Sewage Disposal System at: 1 3 T= T.���4...........................�s .�11 ----------------------------------------------- ....... .............. ... .....----- ocatt n-A es or Lot No. --------.. 'Q�....�.1 . . •------------------------------------------------------------------------------------------------ ner Address .................... 6% � ....................................................... Installer Installer Address AJ C_ dType of Building Size Lot......a.7...............Sq. t= ' Dwelling—No. of Bedrooms.........2-.............................Expansion Attic ( ` Garbage Grinder (� aOther—Type of Building ............................ No. of persons.......................:.... Showers ( ) — Cafeteria ( ) Q' Other,fixtures --------------•-_---••-....... . W Design Flow..............5S.............._..__..gallons per person per day. Total daily flow-------._._Z U_.--_................gallons. WSeptic Tank—Liquid capacity.1000.gallons Length.!.!;... Width.. (..-1 Diameter---------- --- Depth..5.-.`3.. x Disposal Trench—No. .................... Width.....&........... Total Length......�?.�_....... Total leaching area....................sq. ft. Seepage Pit No--_---------------- Diameter.................... De th below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box Dosing pnk KC) _ ~" Percolation Test Results Performed by..... .. \..".c•............... Date... ............ ,aa Test Pit No. 1----- -------minutes.per inch Depth of Test Pit....--ll........... Depth to ground water-.Ko i=-5t�krcu '-L Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..--................---. a -••--------•-----•--••--••----•-- -- ............................................................-•--•---------...------------------.......---...--- O Description of Soil---------- ^- ` - -_ -�JI��?�-(,1.....t�5� C.LC_A(,.X Tite�-•50\"�7- 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 Complia ce has been i sued Woard of health. LSigned�!� 1� G _...-.-.mac. , ........ ....�-- -�- --�..-..... Date Application Approved By ..... �....�-. ... ./..........!..J�.��------------------------------------------- - ----//Date 1 _��� "� (jam- Date Application Disapproved for the following reasons: ....................................... --------...........---..............-------..........----.......................... .................................................. ......... ... .. .. ...................... . . ........---- ---- . ---.........-- ---------------------------------------- Permit No. �1............................ Issued ........ -------Date ` Date M I? () No..- .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH i �. •,_.C.o Appliration for Bispnstt1 Works Tonstrnr#iun rprmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .� • -....f.'.. =�i...!.`.::�° .'s `''': ..... .............. ....... ...?fit. •--•--•---•.............................. -•---------------------------.....---•---- ..... Location-A r s or Lot No. a-►A,.�t. +. ................................. .......------ —,I,'Iwner �/� Address .........�."• -le-'-----I.,............. .. .' 9 Installer Address "t A d Type of Building _ Size Lot......... f .............. feet Dwelling—No. of Bedrooms..........Z...............................Expansion Attic (t4 Garbage Grinder (,�t} Other—T e of Building No. of persons............................ Showers — Cafeteria a Other fixtures ----------------------------•-• --•• .---••- W Design Flow...............-�. ..........__._....._._gallons per person per day. Total daily flqw............................................... .....................gallons. 0; Septic Tank—Liquid capacity...,..: _:.gallons Length...._._ Width.A-..::.�.. Diameter----- Depth..5._:.`6. 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 (Yrc.), Dosing tank (?JOB Percolation Test Results Performed by.. Ut' t-. ...... - �'`. �° __. f' 1 Date =....... Test Pit No. 1______ _______minutes per inch Depth of Test Pit...... ........... Depth to ground water.._' +._ __�+�._?.'`3� Test Pit No. 2................minutes per inch Depth of Test Pit.......... ........ Depth to ground water........................ O Description of Soil----•---•9- l `tie 4��::..� � ,:..__=t��,...'� �' `-_ iE t n j-wej o:! i - - - -. .. x �-'-1l• VoA "54 f_rti-trt tar l � a d 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 i sued b the Board of health. Signed.: {r�c � � c� {.. ... Date Application Approved B ��� � �/ Dare Application Disapproved for the following reasonr- --------------------------------------------------------- ---------------------- ---------------------------------------------------- ................................... ---------------------.......-------------------------------...........................------------------......................... ........................................ Dare Permit No. 7/i.�_�// Issued D ( to Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -- ------------------------------------------ (9er#tfutt#P of Q10mytianre THIS IS O CEVIFY, T,4q the Individual Sewage Disposal System constructed ( ) or Repaired ( X, ) - i by-------------------- ljl Installer a . �� l .. ...................................... ................. has been installed in accordance with the provisions of TITLE o The &ate Environmental Code as described in the application for Disposal Works Construction Permit No. ............. ................... dated .....&...--.- "14-el...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT B CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION) S� TIISF CTORY. DATE................................. �!\ `U. q.. --... Inspector ... .. r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH l/ FEE... No. ...__. ............................................ Diapns�Works �rudinn rrmi# Permission is hereby granted-------------fl'�" p .... w -----......--•-•-----......._..........---------........--••--....... to Construct ( ) or Repair ( '�)•an Individual Seage Disposal ystem -.............................................................I :- -- .........................................`� ---•--------•-•-•---..._....__._._...... Street ... as shown on the application for Disposal Works Construction Permit No. .: ��_ Dated.._ .......... Board of Health DATE........................... .........._.. ................................ FORM 1255 HOES & WARREN. INC., PUBLISHERS