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HomeMy WebLinkAbout0047 GREAT BAY ROAD - Health 47 Great Bay Road Osterville A= 093 007 I i TOWN OF BARNSTABLE /�,t© _ SEWAGE #LOCATION VILLAGE ASSESSOR'S MAP LOT(2& l/ < INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY_,e�e5 _ LEACHING FACILITY:(type) ize) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC 1dAlYw.R BUILDER OR OWNER. �DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: / t VARIANCE GRANTED: Yes No r i' r s" f r ®� P15r. � � o TOWN OF BARNSTABLE L(UCATION'�� G/6Af ao, IeC. SEWAGE# ff-7YS' VILLAGE OSTc.fv,&. ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY UUp LEACHING FACILITY: (type) 3- Plow (size) NO.OF BEDROOMS 3 OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) / Feet FURNISHED BY SAC [r �^f A P O B 3 � 13 a ►�` iy 0 3 EE it 4541 THE COMMONWEALTH OF MASSACHUSETTS BOAR® FHEAL -- .. .....OF.. ....................... Appliration for Dhijimial Vorku Towitrurtion 11rrutit Application is hereby made for a Permit to Construct or Repair ( �nividual Sewage Disposal System at: ..............................................................Ed.. ............. ' 71 . �v LOC I Ad jet or Lot No. ............is..L.14.................................... ....................................................I.............................................. Address ..... .... < YL .. .. . ....... ........ ............................. ...................ijz. ....................................................................... Installer Address PQ 1 �4 Type of Building Size Lot----------------------------Sq. feet U Dw6ling—No. of Bedrooms............................................Expansion Attic Garbage Grinder ( ) C14 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria ( ) PL4 Other fixtures ............................................ W .......................................................................................................... < Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity............gallons Length................ Width.........._...__ Diameter__...._..._..._. Depth....__.._...._.. W x Disposal Trench—No. .................... Width..............._.... Total Length__.................. Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter.........._..__.___. Depth below inlet.._................. Total leaching area..................sq. f t. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit................__.. Depth to ground water------------------------ GT•, Test Pit No. 2................minutes per inch Depth of Test Pit.............___._.. Depth to ground water________--___._-....____ 9 *-------*------------------------------------------------------------- --------*------------------------------------------------- 0 Description of Soil........................................................................................................................................................................ W .......................................................................................................................................................................................................... U ................................................................................................................................ -----------Z-----------------------------------­---------------­-- U Nature of Re air or Alterations.—Answer when ,app1V*cable_/1/t/,e1eV-----5.X.5r!40?--—---------5*71_YA_.,<---------------- .......... ..... ................................................... -X- ----/-;:S, ---5 /-,,44­...................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TTLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in A.— operation until a Certificate of Compliance has .been * ....ed.. Signe ...... .................. ate Application Approved By.................. - ------------------------------------- ............ V Date Application Disapproved for the following reasons:................................................................................................................ .........................................................................................................I............................................................................................... Date Permit No........n_.—_Iv.s........................ Issued....................................................... THE COMMONWEALTH OF MASSACHUSETTS BOAR"-------------OF. ....................... Aplifiration for Uhipasal 10orkii Tonarurtion Pun fit Application is hereby made for a Permit to Construct or Repair (�n'TaiVidual Sewage Disposal System at ...61r��k, .......... ..................................................... L n-Ad or 0 fett Lot ... .. ............C...I---14..................................... .................................................................................................. Address W ��4 f............ Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder ( Other—Type of Building ............................ No. of persons...._._.............._..___. Showers Cafeteria ( PL4 Other fixtures ------------------------------------------ -------------------------------------------------- < "_­------------------------------*-------------- W Design Flow............................................gallons per person per day. Total daily flow.............................................gallons. 1:4 Septic Tank—Liquid*capacity............gallons Length________________ Width........_._..... Diameter.._............. Depth................ Disposal Trench—No. .................... Width.................... Total Length................... Total leaching area....................sq. f t. Seepage Pit No..................... Diameter.._..........._..... Depth below inlet...._._............. Total leaching area..................sq. ft. Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I----_---------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...___.._.__.._......... ............................................................................................................................................................ 0 Description of Soil....................................................................................................................................................................... W -----------------------*-----------------------------------------------------------------­---------------------------*­*-----------------------------------------------*----------------*----------- .................................................................................................................................. ---------------------------------------------------------- U Nature of Re airs or Alter tions—Answer when applicable_4_40_-,��----- -------5: _----------- ---------- -- - ----------------------------------------------------------------------- Agree-m/ent: 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 been i bp ed LJ jr,d, f h5 Sign( ....... ........................ Date Application Approved By................ ..................................... ............ Date Application Disapproved for the following reasons:............................................................................................................. ........................................................................................................................................................................................................ Date PermitNo........ ........................ Issued........................................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAITI­j OF.....& �5 tu /:::�/C .......... .........­.....*­...*.......­­­.......**....................rdifirate of Toutplianre T H� t IS,�-TqgERTIFY ZhW he Individual Sewage Disposal System constructed or Repaired (Z—), by.... .. .................. .................... T. ------------------------------------------"­------------------------- --------------------------------------------------------------------------------- -------------- at.....f;:�� ....... ....... 'instilled in accordance with 'islo has been the pr isions of TITIE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......1.ft._..-17.-'-/..� -_....... dated-............................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................... ......................... Inspector.............. -------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOAR OF HEALTH ...... ...............OF...Z�% Ah.- le............................... No....IK FEE-LC).... Permission is hereby granted.......... .................. • �/�.......S----------------------------------------------------------------------------- to Construct or Repair an Individual Sewage Disposal System at i ................................................. -'�4/---------A/--------------- p..... -4ri e? as shown on the application for Disposal Works Construction Permit No. --- -5.. Dated.......................................... -- ---- ... .................................4:....... ................................................. Board of Health DATE---_-------- .................................... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS