HomeMy WebLinkAbout0020 DEERFIELD ROAD - Health I�19�4� a
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LOCATION EWAGE PERMIT NO.
AV
VILLAGE
INSTALLER'S NAME ADO ���gg
JQW A. AA TQ I$ACKHOE S E
Mass. 026.68
OR OWN ER
DATE PERMIT ISSUED --13T79'
DA E COMPLIANCE ISSUED
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TOWN OF BARNSTABLE
LOCATION �s � ��0 �. SEWAGE #�O-SIB
VILLAGE 6�5 01"-lc ASSESSOR'S MAP & LOT /a-07r
INSTALLER'S NAME & PHONE NO. sc� cDTTI GOAkY ���
SEPTIC TANK CAPACITY_ /066
LEACHING FACILITY:(type) �l1 C�J (size) 6x f4 _
NO. OF BEDROOMS PRIVATE WELL OR C4LBLIC:WATER
BUILDER OR OWNER /t,06�i�Z4�Jn L �
DATE PERMIT ISSUED:
DATE COLIPLIANCE ISSUED:
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VARIANCE GRANTED Yes �_No�
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
_-_..-.....- & ----.....OF....... � ....�;
Appliration for Diipnsal lVinkfi Tomitxnrtiun ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
...
-----•----------------------i `--'/-. ----•----••------------------------------.
LocatioD-Address or Lot No.
......`. ...... ................................. ..........•••---.......................... • ---•••......----••........•••--....•-•...--•---
r Address
•. -- d-- ------------------------------ --•-•-------------•------•-------- --------------------••-.--------..---••--.-
nstall r Address
Type of Building Size Lot........1(4,6LO.Sq. feet
U ........................Ex Expansion Attic Garbage Grinder
Dwelling—No. of Bedrooms........ p ( ) g (�)
Other—Type of Buildingo. of ersons....... .... Showers Cafeteria
Q' Other fixtures ----------------------------------
W Design Flow................ St'..............gallons per person per day. Total daily flow....... . . ....................gallons.
WSeptic Tank/-Liquid capacity..__ ]Ions Length................ Width................ Diameter---------------- Depth................
x Disposal Trench—No- -------------------- Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No...._�............ Diameter...... -__.___ Depth below ffilet....4........... Total leaching area._ ^ I.-sq. ft.
z Other Distribution box ( ) Dosing ank ( )
Percolation Test Results Performed by.--- °-----••---------- Date-- -7 ..........
Test Pit No. 1---
_---
2---...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........................
- �-.- -
V-,- -
Description of Soil--••--• .. - ---.---- i ----
x
U ----------------
•-----------------------------------------------------------
----......
---.-----------------------------
•----------------------------------------------------------------
•---------------
W ---------------------------------------------------------------------------------------•---------------------------- - ---------------------------------------------------------------------------------
UNature of Repairs or AlteratioPs— swer when applicable________________________________________________________________________________________________
4)y.�@F$ adoavc ............................•---•---..........._._....................... .
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITi LE 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 board of health.
igned------ - ------- .............................--•_............ ........-••-•---------•--------
/ Date
Application Approved By ---••----- . .....-- �'` =f' �t � `-----
Date
Application Disapproved for the following reasons---------------••----...-------------•-------------------------•--------------------------.-----_--.-.-. .._
--....---•----------------------------------•----------------------------.....---•---------••----------------------------••---------...-----•--•--
--------------------------------------------------
Date
PermitNo......................................................... Issued.... E y 9=-------------•------------- .t,
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............... ... .. ...................OF..................... ...............
Applir�a#inn for DispoiiFal orkii Tonstrnrtion ami#
Application is hereby made for a Permit to Construct or Repair ( ') an Individual Sewage Disposal y
System at:
. " ''..........................•-------•......•-•------•
Locatiol; -'Address or..
Lot No.
........
rJ �dT ay!!...... .. ._............
: Address
nstalT PQ Address
Q Type"'of Building Size Lot.........1_0#AD1*Sq. feet
V Dwelling—No.:-of Bedrooms.._.............. '...•.............Expansion Attic"( "*) Garbage Grinder
01 Other Type of` Building o. of persons------ .......... Showers ( ) — Cafeteria ( )
ti Other fixtuires
W besi�gn�g Flow................S`-a-'.` 4a lions per person per day. Total daily flow...... ►+ .............gallons.
f� Septic Tank/-Liquid capacity.. '.. lons", Length................ Width... .._______. Diameter--------- ,_:,Depth................
Disposal-Trench—No..................... Widt .... ._ .... Total Length .... Total leaching area..._. ..._. sq. ft.
4,
Seepage Pit No....../r------------ Diameter _.>�Depth below inlet ,. Total leaching area...:". ...... sq. ft.
Z Other Distribution box ( :,) -: Dosing at k
~' Percolation Test Result Performed b ..... /.._1f�c t-__ ................. Date..._::_, . ..'T._.
y .
........
a Test Pit'No. 1.. .� ►_._minutes per inch Depth of 'Test:Pit..................�_ Depth to ground water........................
f? Test Pit No. 2................minutes,.per inch Dept of Test Pit...................... Depth to ground water-------....................
�i .-. j'`�r'
D Description of Soil......... ....... ` --------- ... --.-•- " , 1�•-•-
"�
W --------
---•- ------------------------------•-- --•-
- ••-----------'------.----------------------------••-------•--••-•----------_- ---------------------------•--••------•--• ------------------------
UNature of Repairs or Alterati s—Ajiswer when applicable------_------------- -----------------------------------_---------,------------_-.
>x.
L.............................................................................. ...........................................
Agreement
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT11 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of yr`Compliance has been issued by the board of health.
Date
Application Approved B .......... -"
PP PP Y
Date
Application Disap �Wh ollowing reaons:.......................... .
......................•------------•----•---••---•---------....--•-----•--------------.......----------...--------•---.....------•----------------•--------------------------------------------=--------
Date
Permit No...............................••-------•••••---•---•-_. Issued'. ==__........
Date
THE COMMONWEALTH OF MASSACHUSETTS
r
BOARD 9f HEALTH
5 y.
4 ....:..O F........ .......'.... ..............
wrtifirtt#r of 19am—plianir' }
T S I TO.CE IFY, �.1h t the Individual Sewage Disposal System constructed (. '�"°"or Repaired ( )
by �' a----........••--.. .
7--the
0 ------
taller •
has been installed in accord itwf provisions of TI - F . 5 of The S ate :Sanitary Code as described in .the
",application for Disposal Work., Permit No: ' _..__ __ ". dated-. ,
PP P . l
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM,,WILL FUNCTION SATISFACTORY.
DATE........::. .- .:.__7 ........................... Inspector
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF EALTH
1
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:.7`�r�. .P1.... FEE.. .........
Maps nrkg nn � #otj rrmit 5
Permissi t hereby granted----- .� ;,
to Construct ~�) or pair ) �ndivldual S rag asposal y`stem
��5 - -...at No.---- _.8�..c:. ,+ 1et! �t - � 'P ,
S reet
as shown on the application for Disposal Works Construction Per o....._t...... _... ted . __ '•-�'�
PP'' P
e
- --•- ----•.... ..
Board of Health "
DATE---- ....../--•��-•••-:..--................................
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
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