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HomeMy WebLinkAbout0441 GRAND ISLAND DRIVE - Health 441 Grand Island Drive Osterville A 051 019 I F BARNSTABLE y. Ys 0/0 0 LOCATION C iud n , SEWAGE # �6 / ,0 V VILLAGE Q JISI ASSESSOR'S MAP & LOT 4 � 7 7 , .INSTALLER'S NAME & PHONE NO. C A gl 1tiIW9) SEPTIC TANK CAPACITY / rt LEACHING FACILITY:(type) (size) /00 NO. OF BEDROOMSja PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE .COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No pj' a �> J .SC TO N F BARNSTABLE SYS LOCATION'c�/CV(VRh)vd -r-sx, Ai nd SEWAGE # VILLAGEQy,,s169 t7i9R ASSESSOR'S MAP & LOTS= 5/ l INSTALLER'S NAME & PHONE NO. ',qa / -A-W 6'F 9 -SEPTIC TANK CAPACITY 40®0 (9A \LEACHING FACILITY:(type) 1,5 Ar- /"f I .(size) /®Od / NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATE Gt///c � Q)BUILDER OR OWNER �pI f�'S !ej cRS DATE PERMIT ISSUED: DATE COU. PLIANCE ISSUED: VARIANCE GRANTED: Yes No I Nol.Eg.&.......... ----------------------------- TA COMMONWEALTH OF MASSA`a�RusE'rTS BOAR® OF HEALTH �r _ Ja .................OF t2.►, _ C1 Applir�a#ion for Dispas al Works Ton�rurtiun amit Application is hereby madp for, a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal a � . Aj stem at: )00 _.. .. .. . -1 LortPAddress or Lot No. ............ . �71. � ......................... ....•-....:..... ......---•--------................-----•-------.-.- ....... Owner % Address ...................................•......••........_.........................•.................. Instalfir Address d Type of Building Size Lot_._1&A(.............Sq. feet U Dwelling—No. of Bedrooms...........)...........................Expansion Attic (IAA Garbage Grinder d Other—Type T e of Building ............... No. of ersons......................_ Showers — Cafeteria C4 YP g ------------- P ----- ( ) ( ) p' Other fixtures ------------------------- - ----------------------------------------------------- W ..�' ..............gallons per person per day. Total daily flow............................•.......--......gallons.Design Flow.....7�5 WSeptic Tank—Liquid capacity.600-gallons Length.:30:nb... Width.Z'�.... Diameter....--....... Depth.s .-_. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......Z,--------- Diameter.......1.9........ Depth below inlet.....(a.......... Total leaching areaJ8'5 �._._..sq. ft. �— z Other Distribution box qaj DosipA tank (j 0 A � 83 9 Percolation Test Results Performed by... _TC-2 .LV`l .�.9 ....................... Date..�®..y.?....83........... aTest Pit No. 1...G .._..minutes per inch Depth of Test Pit___A_Z`......... Depth to ground water..��..� AC[Y.2i R Test Pit No. 2..LZ.._..minutes per inch Depth of Test Pit...12.......... Depth to ground water----- ................... ' a •••---•-------------•-----------------•-------••----------..........------. -•-•----.......................... ......... Description of Soil.....T1...L z.........0=125. f - --��tai s_ Lt..a... W,�......tZ,_ ....... -----•--------------------•------------------------------------------------------•---------------••--------------------------------------------------------•------•--------...........-•----------•---- 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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b issue b he b rd of health.SiEne ` . -• . •-------- ----- --- --------•-----•------------ ................................ D �A Application Approved BY --•--•-•---- ------------ '. ..... ====_ Z b Date Application Disapproved for the f ollowing reasons--------------------------------•------------------------------------------- •................................. _ ....-•.....................•--•-......----•-•------------•--------.-----...........-----•---._.........--••-•---........-----------...----•-......--•---............•............................... Permit No..... ........( .` 1 -------- Issued................................................. . ._ ;�� �r Date •xJ�,ii P'`a rrit� li�f i���- No THE COMMONWEALTH OF MASSA'w-HUSE'-FTS BOARD OF HEALTH l..oui. ------- 1.1.........OF �Z.►J S+ C... , ....... Appliration for Bispaa al Works T000trurtion ramit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: ���6L'4 '_Svc .--. hs?. ��.s�.! �:,`!!a� `iS► iL � �2� -LoT 1.0 Locatio -Address or Lot No. ------.•--- .C� S.... Owner - ....................................................... Address ^..•.•• 9Q Install Address UType of Building Size Lot.....k"_t(10-...........Sq. �feet Dwelling—No. of Bedrooms...........Jam...........................Expansion Attic (lacy Garbage Grinder ( T$ S a Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures W Design Flow...... ...r. .............gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity_t.0 gallons Length---10- ._ Width..:? ..._ Diameter................ Depth..---..--- . x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.......Z---------- Diameter........A........ Depth below inlet......D.......... Total leaching area.6? ...sq. ft. Z Other Distribution box (yat Dosing tank (�j o) a Percolation Test Results Performed by._. ?� ._ !_ ..'<V4..._.................. Date---G-.ti..7.`..8.3... Test Pit No. 1..._ -. .....minutes per inch Depth of Test Pit...._ ......... Depth to ground water.._ fs, Test Pit No. 2...4?.....minutes per inch Depth of Test Pit.....111......... Depth to ground water.___.''................' " ri .....................................................................................................................W...... .. __ O Description of Soil...... 1 .. ._... ----- ---`--- ---•--•-•---•---------------•--••----------------------------------•--•--•---•--•-•-------••------------•---------------------••---•.--------••••----•--•-------•-•••--------•---••------....-•-------- 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 TITLZ 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issue ;by phe bo d of health. U ...... .......... ---------••-•-------••-- ----- ------. -----••. Application Approved B ? Date Application Disapproved for the following reasons----------------•----------------------------•----------•------•--------•------•---------••------•-----••-•-----• ---------•---------------------------••-----•--------------------•--------•---•--------•--------•------------------------••-----•-----------------------------•-••--•----•------•---------•-•----.....-- Z: Date Permit No...... . ........ .` v-------- Issued....-------•----•-----------------•------- -----•----- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF,HEALTH ........... ..............OF............ ...... .................................... Tnrtifiratr of Tamph anrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) bY.........................-L . P .....................................------...-----.....--------•---------------....--------------•-...•-------.......----------------------- /�____ r ..........at L. •--•--...J..4� �r --•--•. �Gn ------ - � n --•-••-- ----- a.. n- �..�._._... has been installed in accordance with the provisions of 5 of The State Sanitary Code s desc�ibed in the ___.- application for Disposal Works Construction Permit No..___._..�.._..�.2 ..... dated__....__' ................................ THE THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...... 1 - 2 ......................... Inspector....._ j'F'1 '-7 THE COMMONWEALTH OF MASSACHUSETTS BOARD O --- EALTH - OF...--•...................................tu....................................... .......... FEE.......-•-••............ �io�ooatl orko �onotrnrtion �rrrutit Permission is hereby granted--------- ', ------•--------------------------------•-----•-•........................................................ to Construct ( ) or Repair ( ) an Individual Sewage Disposal System _ at No............ ...........<S_-<c�. ' ` ` � .J.� ,L,.�ct� Streeett as shown on the application for Disposal Works Construction Permit l_ .. ?............ 2� Board of Health DATE...... --------------•-- ...................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS ff #vr6c)1,-s hc) • `lU lair) . 7 \J fair GCAMC ®0 VIN o-opct4ed ccAsed ,. �1-4-1 Grc((,,nd Ts Ir,4 tk), Iw i `f-4- 1 C�rck vlc) L col o/ 1 loo �a Y1 ------------ <Fl 1 CL TO 4.1 TTT-ilk, C2 ti ti � r i I . I e .. C 3 � ,,' /VT- un -o 4cc,�v Afe p d le-e C4. Del itst�- Oc. r IA vr6 ors 16 F Gc Lt✓ p c1 C.- u hde r roo ;,) P V 0 t LOT >! P 1 w �' r � � Y t-t �- G n. 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