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HomeMy WebLinkAbout0044 GRAND ISLAND DRIVE - Health a d�2� v�3 / r- i,_� 1 F TOWN OF BARNSTABLE LOCATION L 0 � qZ G��'�c �l�M 'B,� . SEWAGE # I VILLAGE f�ASSESSOR'S MAP & LOT 67a_ 6L3 INSTALLER'S NAME PHONE NO. '7-7 l -L 0q,D. SEPTIC TANK CAPACITY �,1-00 U&I LEACHING FACILITY:(type) �, ���cu}ars CZD� (size)&� x \-L' NO. OF BEDROOMS y PRIVATE WELL O PUBLIC WATER BUILDER OR OWNER ® �y5, DATE PERMIT ISSUED:/ - z5 93 DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No '(./ r � � i3 '�1 e �' �Hr �� �� � _ N ed�L �� s� U �E � �ldw � � +' _ � � - - _ � _ -- A No....�, .'... FEB......../4010........ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF .HEALTH TOWN OF BARNSTABLE Appluation for Dispniial Workii Tomitrn.rttnn ramit Application is hereby made for a Permit to Construct (4or Repair ( ) an Individual Sewage Disposal Sys,em t• / ... ..• Gl ..... 0 •................................•------- .......- .-- . ...Locatio - dre. Lot No. .. —....... ..... ......•.. �............... -----•............................... ...... ..... O er Address W = ---------------------------------------------------•• •••. . .. Installer Address d Type of Building allaor'lf — Size Lot...------.9-----�-----Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '14 Other—Type e of Building No. of persons............................ Showers — Cafeteria f� YP g ------------- P ( ) ( ) Other fixtures .................................. ------------------------------------------------------ ----------------------------- 75 W Design Flow...............1.40......._...._.___..gallons per �sfm per day. Total daily flow.._.........................................gal 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 nk ) '~ Percolation Test Results Performed by... ._...._._. .�_� -----------------------•---_•.. Date..._�c� —!(.._ -_9oz as Test Pit No. 1...<:�-_._minutes per inch Depth of Test Pit....... �..__.. Depth to ground water...... ! (s, Test Pit No. 2................minutes per inch Depth of.Test Pit---:_--_---____.... Depth to ground water........................ ...................................... O Description of Soil......L .. Gn'1--------------------------------•:- V ....................................................._.................................................................................................................................................. W x -•--------------------------------•------------------------------------------------•--------•--.....------------•--•---------------•------•-•--•--•-------------•-------------•--•--------...........•-- V Nature of Repairs or Alterations—Answer when applicable................................................................................................ -----------------------------------•---------------------------------------------------•---------------•-----•--------------------------------------------------------------------------•--••-•--•------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage isposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The unders further agrees not to place the system in operation until a Certificate of Compli e has bee issued by the b r of health. Signed -----... .....---.... ------------------------------ ................................... Dace Application Approved B Application Disapproved for the following reasons: ........................................................................... ................................:................... .............. ------------------ ------------------------ --------------- ------------------------- ----------------------------------------------------------------------------------------------- ....................------------------ Dace PermitNo. ....... .. --.................................... Issued .............................------------....------------.-- Dace A No.... -. FEs......... /1en........ram.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for Disposal Works Toustrnrttun rumit Application is hereby made for a Permit to Construct ( V�or Repair ( ) an Individual Sewage Disposal System cflr t .............................................. ddress 2 wo>j of No. ............:..................................................................................... .......-•----.....................•..... _....-------•---••--•--.......................... Owner .���f...Address Install Address U Type of Building 0 tl Size Lot_._.....I..9.6-�.�Sq. feet .-1 Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type e of Building ............................ Showers � YP g No. of persons--------------- P ( ) — Cafeteria ( ) Other fixtures ............................................ = rt r e------------- Design Flow-------•-•--•-.Z- g P P "P Y Y W l .......................gallons per erson er day. Total daily flow ..__..._.___...__.__._.._._.................gallons. WSeptic Tank—Liquid capacity../: gallons Length----L........... 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 ( ) a Percolation Test Results Performed by---------------------------------Z r --------------- Date........................... Test Pit No. 1.....(..�"__minutes per inch Depth of Test Pit___.__ _' _._____ Depth to ground water---------- G . fro Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -•- --------------=--•-•--•--...•--•----•----------•-•-------••••........•-•--._.................................................................. 0-4 Description of Soil....... �2 .r��"'� U -------•------------------------•---•--•--•--•-----...---•-•-•......_....-•------•--..........------•-------•-•-...•---._...-----•------•••------------•------•-------••-•••-•••-•......---........__.. 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 undersifile-d further agrees not to place the system in operation until a Certificate of Complia e has been issued by the b© rdlof health. Signed ` . � -.- --------------- ...........................----------- \ V V Date ApplicationApproved By --------------- ....7 .............. .......................... ------------------------ ......� Application Disapproved for the following reasons: --_-- ------------------------------------------------- -- ----- ---------------.................................. - -------------------------------------- ------------------- ---------------- , QQ Dace PermitNo. .---------.1- . ..--------------- ----------------- Issued .....------.......--------------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD-OF HEALTH TOWN OF BARNSTABLE t ertifira#P of C�1azttylian e / S IS�TO CEt That the Individual Sewage Disposal System constructed ( V ) or Repaired ( ) by .�._.. .6.... ............................................'-- -------..'--- ----------- V Inst Iler ............................-.--.-........-...------------..........--.-..........--........ at ---- ..._.....----- -�C --------has been installed in accordance with the provisions of TITLE 5 9k �The State Environmental Code as described in the application for Disposal Works Construction Permit No. --------- .3....-- ---------------- dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL //FUNCTION c}SATISFACTORY. DATE.. 7-- --.�- -f-- ----------------------------------------- Inspector ..............................................--------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No....7 .-.. d.... FEE..... ........ Disposal- urkii Tuns#r ion amit J .b (e lSG0c1 -- Permissionis hereby granted-------------------------------- --- ••.-----•--------------------------•-----•----------•-----•---......--•--......................... to Construct ( v)�or <jepair ( ) an Individual Sewage Disposal System, / at No...��-11 _12"-4"i d R -e�G1 1':w....__...0,t•- _._(' G..z- L4 VStreet q as shown on the application for Disposal Works Construction Permit No--- !::- .... Dated.......................................... ---------•---•-----•----•-•-••• r .......................................................... DATE............. ..�._a_ Board of Health FORM 36508 HOBBS A WARREN,INC..PUBLISHERS �I►Jh1.E FAMILY d� 13EDQDU1�ts DA I Lam(-�'�Lo>F.I.=d�C,►a f5o:�:+ ' �.. ;. . -r'i. - DPI 'F3f[X;.`.�s:JtD =-_. SEFrn(,, 7A OI(. LA C— LEAc IuG sYsT�,in Mix �� 20=3�x�'i�Jnc. APFWGATIOI AeCA REQUI - " Spa"' AF"PLI- -AT OW. AZI A I&N �. µ avv PEP_GOC-AT►ot l P�'(� �, �j E L I I I 1,t. I I i 1z ZA�tI+J%.es� i .v _.._ .,_�_...._ . ..... .._.._._i._. " F __INFIl.TM4TV10 DST, vc f' �$ ' TAlL of: 1✓ISPOSdI. , �'IF� 1, 7J - ' `q�t 4y .OF PETER u 6AxfiEi9 w rNo.. 73 �3_pO1SToNEt ASHED:STb(IE pr icn& I _ TF=2o, . Pe, ICl/ I(c , Z,, - DIST Its 15oa' V. LEAN: . .r�tea. iuv. 6-AL AM IL ion MAC' 1 2 s , Pl.dl I r: -C�e'tl -I�I� -P T -. t. . r LnGAT I t�N Dy STIriZ. I AtZS MS r hea�asE�t . . PLAN R «EPAW-Z— kNM�L�f� 5 ID€LIVd E L O1- lzF.�UIeEM z PF.TNE TowN of-RdRtJ5T,4rit.E , aNb. I,S I I�cATM,+*t I IJ .A crop 7t1 h CC F PA I� ZoilE RM SSI L LA 5 2 _PAT fIZ 3r7 �J2 ��E 8A xrr� � c�,�., t? o � o rl Q i PeDFess,o a� Ln D SVzVe/or, ITT BASED .04 AQ ,IIJST1ZUN E► t l SUEVEY GI�/I L t l^�J lo,w,cL� 'i'11EJOr S CTS. �s�loUc p 0STEUVI u.J, o MASS, Au0' blor AC" 'USED, TAu s N P2opC eTY °IU AFN C AW'r-:: ��y S iDE F3 u i l b , t} Itl.(, . `�0. OF SAIJ�OZfl MAP '72 Pci 13 2 1901°12 EL-I I'l wD �' i W i tj / CL j � '� � •�is�' _ � 12� '.;,� i_' W laIre,- M dr/ .Ie wq t I $ / t 2I'30� ; • o 'la. 3 '..' N .P��,•(,O HUR - E_ RICHARD ULLIVAN srxrr`w a No. 29733 `