HomeMy WebLinkAbout0131 GARRISON LANE - Health I Lat-,
OWN OF BARNSTABLE o P //�/fv
LOCATION Al0t..1'a1 /Gcrr�so� �uti� SEWAGE # 93"-'161
VILLAGE �,�l8''Yl// /!:o ll4'D03'DD3 j!'/- ��3
.. ASSESSOR'S MAP & LOT .w7-so-z
INSTALLER'S NAME & PHONE NO. JoI-h /7, AG 112F 5-95—
SEPTIC TANK CAPACITY 15-0 p . -
LEACHING FACILITY:(type) 1= /OUJ L/ems (size) 6'/la'
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER jO�+h
DATE PERMIT ISSUED: 91:3
DATE COMPLIANCE ISSUED:.
VARIANCE GRANTED: Yes No r/
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Application is hereby made for a Permit to Construct (K) or Repair an Individual Sewage Disposal
0, Address
U Installer Address
Dwelling—No. of Bedr
Z Other Distribution box (Yq> Dosing k
Percolation Test Results Performed by---- .......
Test Pit No. I.../_Z�.....minutes per inch Depth of Test Pit-----I?.......... Depth to ground water.-&M!5�ACOU&t_t UU-A)
-----'''--------'------'----------'----'----------------'--'--'''-------'--------'—
A&creozcuc
| The undersigned agrees to iootuU the ufor«6excribed Individual Disposal System io accordance with
� the provisions� of TITLE 5o6 the State Environmental [ode—The undersigned further agrees not m place the
system in operation until a Certificate of Complia hhas been issued by the board of health.
`
_� «�~�.
� Application Approved B
Date
Application Disapproved for the following reasons: ...............................................................................................................----------------......
------' ----__-----__— —__--___'
No../�.. ..: '-A R / Fly ...�•rr ............
THE COMMONWEALTH OF MASSACHUSETTS
_� BOAR®`->OF HEALTH
.tsar.A.Ak-----------------OF s:c
Appliration for 11ispii al Works Tontitrnrtinn Prrmit
Application is hereby made for a Permit to Construct (K) or Repair ( ) an Individual Sewage Disposal
Sys;gym at: f.. `
iE
-•- - _
1 Location,:,,-Address •Lot No.
......`.- ('-1j �f �t, !_��tr'� . _ i2t ._Cs,�` _..\`� `... t lF,.li 't ..... -----
Owner Address
W
Installer Address H�
Type of Building Size Lot-___`---------_-_
Dwelling—No. of Bedrooms.._. _�3._.�.D� ors�_5T�' Expansion Attic (1t�(� Garbage Grinder Vc)j
'PL4� Other—T e of Building No. of persons............................ Showers — Cafeteria
QI Other fixtures ............................ _
Design Flow......7S._ _��" ..........gallons per person per day. Total daily flow_.:__.���__-_��__________________________gallons.
WSeptic Tank—Liquid capacity.X` allons Lengthl�� Width-.S.... Diameter__."'"'.... Depth...' `E-a
x Disposal Trench—No. ..... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.........Z-------- Diameter.......VC)------- Depth below inlet.__.......... Total leaching area..J' .. ....sq. ft.
Z Other Distribution box (yETz, Dosing;,t x
ank l�C
Percolation Test Results Performed by.... ,Z��.G: `�_._ : .. _____________ Date__7!-r15.3___..__._ .
Test Pit No. I___ %'___-_-minutes per inch Depth of Test Pit-----IZ.......... Depth to ground water_.. r..lZZc t)
f= Test Pit No. 2._G2-_....minutes per inch Depth of Test Pit.....4�------------ Depth to ground water----).4UG_W_OukI IL r
Description of Soil...... M t-' = 5�.._. C (�/ ` - �-�-c._ ..__
A� ... _ .. _ r
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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 ha been issued by.the'board of health.
Signed ....... - ---------- G' -------------------
--------- ------ -----------------------------
Date Application Approved By`.�.......�.. .... c......s ".....� .... �'_ �j/� � .........:....-
l Date
Application Disapproved for the following reasons: ...... `-- ---------------------- -------------------------------------------
........................................
Permit No. /"f '°.--.`:------- ..G�...�-.. Issued ........... .:- --..�'�°:.-�?....:"�....-..---
Cate
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
r.. ..mow.
-------------------------------------------------
�lertiftrate of (VEIIittylianre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( i� ) or Repaired ( )
by -mot , 7 ' — — — ...... — — —
+ ;:.
t !'Icstaller / ++ f _ f f
// r t / V 5��.4 �. L.V
at ............................................. D-s t h .-=-- ' 2 CJ2
has been installed in accordance with the provisions of TITLE 5 of The State Environmental ode as described in
the application for Disposal Works Construction Permit No. - '.d dated -'., --''- -
------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUESS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE............. #.. .. ' --. Inspector ........-- ............................................................- .. . -...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
ll..d -!r' l OF.. L
;.C, ?ry ? 1.` ."�� ( ............................. 1 J
FEE........... ::
�t��ai�ttl�. rk� . agn,��rnr#uan rrnti�
Permission is hereby granted------' V..P Z/ ----- ---V..................................................................................
to Construct ( � c Repair ( ) an Individual Sew.geDisposal System
at No....................... ��I S('j1-.,�___L��.C---•--. .� �)_L.......C�------.(-L.0 .-�`l�`
Street a q f
as shown on the application for Disposal Works Construction Permit No..................... Dated----- --------�------•--�-•.....
-- ------
/ _ Board of Health
DATE................ ` .......................
-� FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
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