HomeMy WebLinkAbout0496 MAIN STREET (OST.) - Health qq6 /
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TOWN OF BARNSTABLE `
LOCATION ::// /` �/-4� SEWAGE #
VILLAGE ASSESSOR'S MAP & LOT JAZ
INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED: -9•-1 °- 7
DATE COMPLIANCE ISSUED: 9--
VARIANCE GRANTED: Yes No y
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L-0 C A ION SEWAGE PERMIT NO.
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INSTA LLER'S NAME & ADDRESS
BUILDER OR OWNER
L DATE PERMIT ISSUED
DATE COMPLIANCE ISSUEDo - 1r�- �
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��ppliratuou� ��� ,�x�p���� Worbi Towitrurtuon ram:t
Application is hereby made for u Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
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-- ~^ -� ------------------_---------_'--____-_-'-------' ^
or Lot No.
................. ...........1/a `� Address '
' `�
, . Installer Address -
Type of Building.-' Size Lot............................Sq. feet
ZhwcOing//-Nn. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) \
Other--Type of Building ............................ No. of persons............................ Showers ( ) -- Cafeteria
Other6xtoccu ...................................................... -_ _______._____________________
- Design Flow............................................ per day. Total daily flow............................................ .
04 Septic Tank--Liquid capacity............gallons Length_............. Width................ Diameter--'_---- Depth................
Disposal Trench--No..................... Width..................... Total Total area....................sg f t.
Seepage Pit Nu--_---.. Diaoetcc------- Depth below inlet.................... Total leaching area..................sq. ft.
Z ` '(}th�rD �r� zd000� ( \Percolation
tuo� )(Dosing ` '
~~ ��rco �n� Tea Results Performed by.----.--.---------..--------'----_ Date........................................
Test Pit No. l-----.-.nioutespecioch I)cut6 of Test Pit.-_------' Depth to ground water........................
� Depth to ground
0 D ofSo�------_----_-.` P ^��'----'-_------_-___.__________________________
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Agreement: —Answer when applicable—
U Nature of Repairs or Alterations __�6 .... ........... ...
The undersigned agrees to install the uforedeaocibcd Individual Sewage Disposal System ioaccordance with '
the provi3ions of TITI.S 5 not to place the system in
� ~ operation until CertificateLed
� ----------' ................................
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Application -Approved uy---' -c�~��c��m��*���~��.my�m�3�-~---' --4/-'���^�'.�',�^��---
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Application Disapproved fofthx following reasons:..............................................................................................................
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_-_------___-__.-__-'-'.-'___----____------_-_-----_-_----'--'---'_-''--_--_--'--------
Date
Permit No� "°= �
"
No....... —' .... -•-- Fmc............ .......
THE COMMONWEALTH OF MASSACHUSETTS 1-BOARD H H
-
r�jit�rr............OF. ................ ........
Appliration for lliiplaaal Worko C omlruflut rr�ti
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System al
.... I` � ....... ......... ...................... - -- .« ..+..__ ' -- LtN--
: -.... -
•Location- ddresss or o
........ --------- ---------•--- ...............................................--•----•-••-• --•-----•............--
/•��/+ wn Address
----•---- •-----.. .............................................____................--•••••....••-••-----•-------•-
'
Installer " Address
Q3.Type of Buildin Size Lot............................Sq. feet
Dwelling. No: of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—°.Type-.of Building •___________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
Otherfixtures ----------------•--------------------------------------------------------------------------------•-------•----------------------------•--•-•---------
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._._.._._______.'t.". Width__________________ Total Length.................... Total leaching area.....................sq. ft.
� Seepage Pit No_-,...............................;.Diameter.__...__....._.__.._ Depth below inlet.................... Total leaching area.................. ft.
Z Other Di3tribution 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........................
P+' ------••--•--••••-- ---- •--••..............................•---•-•--._.----•-------•-------•----...._._..----•._._.._..•-•••.....--••-
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Description of Soil.............................. ..-- -� •--------------------------•---------------------------••----------•--•-•-•••----------••----
x . .
W ---•-•••••--------------•---....-•••••••-••-•--••••----••••--------•.••-••••--••-•••••---••-•__.••-- F •-
U Nature o Repairs or Alterations—Answer when applicable, /
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in'accordance with
the provi,ions of iITI% 5 of the State Sanitary de— The undersigned further agrees not,to place the system in
operation until a Certificate of Compliance has ee is
ted b the 45ird,o ie th.
Application Approved By----- '' `. •," f at --
w--- Date`
Application Disapproved for the following reasons:-""-��-•-•-----••--••-----•-.............. ------- ----------.................................................
Date
PermitNo........................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF EALTH
�' ............ 1 ..OF..... ..( """........... .............
C�rrtif iratr ,ff outpliatta
T S I 0 C Y, That the I ividual Sewage Disposal System constructed ( ) or Repaired ( )
byler
_
W----------- "'---- -------
has been mstall'gd in accordance with the prslvisions of T i �j of4 he State Sanitary e�s described in the
application for Disposal ��Vorks Construction Permit No..`._ 1 __ ____________ dated-_ — r"t =__'
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
E �C 1 ,
-n
DATE.... .�....._.....-� _---• inspector._..----1------- .(,
SYSTEM WILL FUNCTION SATISFACTORY.---------• ---------••-------•--------------------• -•--.._....._._....--
THE COMMONWEALTH OF MASSACHUSETTS `!
BOARD F HEALTH.
..
t
try. 7 :�OF..:.. er-1G ...........................................
No._.. .. k y J £,, FEE......... .........""
Perna on is h by grante - ' • •- -••. .. .: C ' `'' !! .......... ..... .....• -•_... ........
to Cons `� or Rep r an ndividual Sewage Dispos tet ystem
at No.. 'rj�t'i
as shown on the application for Disposal` orks Construction Permit d• - ................
r Board of ealt ,
DATE-- -"^•-� '--...._... /.
FORM 1255 HOBBS & WARREN; INC.. PUBLISHERS -