HomeMy WebLinkAbout0018 HINCKLEY CIRCLE - Health f
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TOWN OF BARNSTABLE
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LOCATION /f Ana SEWAGE #
VILLAGE ASSESSOR'S MAP & LOT/�'/
INSTALLER'S NAME & PHONE NO. ��► �,�(��R Svn -a�1C ' 53?�'
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) �'oo r> (size)
NO. OF BEDROOMS "j PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER oy,. PIZ
DATE PERMIT ISSUED:
DATE COUPLIANCE ISSUED: V - 2 -7
VARIANCE GRANTED: Yes No �..�-
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LSOC6 ION
_ _ _ 5 W l!,C,E PERMIT
VILLAGE
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.N.TED COMPLIAMCE ISSUED
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HE-ALT
oF.... ............................ ......---......................
Apphration -for 4iipoiial Works To'nstrurtion Vrrmft
Application is hereby made for a Permit to Construct ) or Repair ( an Individual Sewage Disposal
Syst. at:
--- --•---•. ......... ----- . ... -- - -:._- -----------------------------------••----
Location_Address or Lot No.
' fi4z� ' dM Address Owner
3 s aE.Yt
W � .................................................
pp,¢ i. l f.. Installer Address
5{ R.u... r.
Type of Building Size Lot----------------------------Sq. feet
Dwelling o. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
Q, Other—Type of Ruilding ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Other fixtures
W Design Flow............................................gallons per person per day. Total daily flow...........................................gallons.
P; Septic Tank—Liquid capacity------------gallons Length................ Width................ Diameter---------.------ Depth...-------------
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 ( )
Percolation Test Results Performed by------- - ............................................................... Date------------------------------------....
Test Pit No. .1----------------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------------------------
-------------------------------------------
O Description of Soil________ _ __ ___ .
x
------------------------------------------------------------------------
UW ------------------------------------- --------- ---------------------------------------------------------- - --- -----------
Nat re of Repairs or Alterations A�tswer w n applicable._ ___ :_ -.--_--._
greement: �.�.
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Cos — The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been sued by t e b rd of health.
Signed---,--- -- - - ----- ...... .--- ---I---..
Date
ApplicationApproved By-----------------------------------I -•------•••-•-------------•-------------------------------- ---------------------- --------------
Date
Application Disapproved for the following reasons:----••----------------•-•-------•--------------------_-..-_.----•-•------_--_-•------------...-------••---------
---
.� Date
Permit No. Issued---•••..f---------- .................................
Date
No.......................... Fas... ..................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF ZHEALT
�1��-C..............OF....'.. '. -. ''.....:�lr�'^G'. '"......_...._........ .........
Applirtt#ion -fur li,ipuoal Workii Towitrur#ion Prruti#
Application is hereby made for a Permit to Construct ) or Repair ( n Individual Sewage Disposal
Systgn at: ��E
'6Z................ L.ZZ . . ..........................................
T
Location-Address or Lot No.
-----
Owner /t Address
Installer Address
Q Type of Buildin,g,,,e Size Lot............................Sq. feet
U Dwelling LZ'No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons.---------------------------- Showers ( ) — Cafeteria ( )
a'' Cther fixtures ................................
� -------------------
W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons.
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 tank ( )
Percolation Te:.t Results Performed by-------------- -••-----------------••------•--------•-------•------ Date---------------------------------------
a Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water..-----------.---.-__-.
fi Test Pit No. 2..........:.....minutes per inch Depth of Test Pit.---.---..._-__.__-- Depth to ground water_-_.-.-_-_.-----__-_-_..
P4 -- --
ODescription of Soil------- -fit-. -------•--------•---------------•---------------------•---•-----------•-----•-------•-••-----.------------------------------------------
x
W -------•-••-----------------•-------------------------------•---•-------------•---------------------------• --"
V Na re o RepLirs o Alterations . Apswer w}Yen applicable.: ._� ---. ............ ..
� �y-
%Agreement:
The undersigned agrees, to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Co,�e—The undersigned further agrees not to place the system in
operation until.a Certificate of Compliance has bee"issued by he and of ealth.
Signed !�/' �-?" 'c ! �✓` ---
} Date
ApplicationApproved BY-------_-------•-•--........ • ----•--•---------••-•-----------------•--•--•---------------- -------------------.-----
Date
<, Application Disapproved for the following reasons:-----•-•..............................•----•----------••-------•-----------•---............----------•-----
------------------------------------------------------------•--------------•--- -------------•------••--•-•--•-----•...---------..---•------------------------------------•----.............------..----
Date
Permit.No-------...............................--------------------- Issued.........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........ .......OF.... ........
Tntifiratr of f�llutphattre
TH9 � �ERTIFY hat the dividual wage Disposal System constructed ( ) or Repaired
�.�°'..
by--�....� -----------------------------------------•------------.
' nstaller
at-----------' �---------'---- --- --- -- -----•------ - ,!'����,, -
has been instal'ed in. accordanc ith the provisions of Article XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No......................................... . dated__...-----_-__-_------__-------_-_--------------
T1 E,ISSUANCE OF THIS CERTIRCATE SHALL NOT BE CONSTRUED AS A.GUARANTEE THAT THE
SYSTEM-WILL FUNCTION SATISFACTORY.
DATE............... Inspector------------------.-----•-•----•------------•-----------•------------•--••------•--
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEA T
............. ...OF.. G ._ .... ... ............................
No......................... FEE-- -••--- .........
....._......
in u r, hurt rur#iiaat rixtt#
r
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Permission is hereby granted ! G_ -. t .._._. _... -- ...............................
to Construct ) Repair an Ind ual-S age Disposal yste ,
� ` `
at No.., -- --
y:''
Street
as shown on the application for Disposal Works Construction Perit :_ ... Dated_. .._
Foard of Heal J`
DATE---= ----/--------�-----------------------------------------------------
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS