HomeMy WebLinkAbout0025 MANOR WAY - Health 25 MANOR WAY .
A= .116- 123
Osterville
TOWN OF BARNSTABLE
LOCATION a-5"hh1101pbtw1 SEWAGE # �
VILLAGE ASSESSOR'S MAP Cz LOT
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (size) 7�x A a
NO. OF BEDROOMS-PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED: &�qz
DATE COMPLIANCE ISSUED:
T
VARIANCE GRANTED: Yes No
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
TOWN OF BARNSTABLE
Appliration for Dhipas al Works Tanstrnrtiun ramit
Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal
System at:
v� $ /y*V oR W A a
................`........ .....a.. -• ddr.e-•-...............................•.. --....-•-•---•----.......................... •-••.............................................._.
L c ti Address or Lot No.
.......
Owner ----. ddress
.../wn.�.. ...... ... ...
� Ins aller Address
d ype of Building �/ Size Lot............................Sq. feet
U Dwelling=No. of Bedrooms............/...............................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other 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 Test Results Performed by.......................................................................... Date........................................
aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
�rq Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................
9 •--•••••--•-----•-•------•--••-•--••---•--•••-•--•••--••-------------------------------•------......................................-........................
0 Description of Soil....................................................................-----••----------------------------------------•-•----------------------------------------------••-
x
w
x -------••-------------------••-••--•--•---------••-----•----------------•----------•-•------•-----•-----•--------•••••. ---- ------------------------------- ---------------------------
U Nature of Repairs or Alterations—Answer when applicable.____19 __________ ____�� __.__. �! �� �TS
-----------------------------------------------------------•----------------------------------......•-•-.....•-•-•----••---•----•--------•---•••-......-••-••-•-•--------•-----•--•------------•---•--••
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 undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issued by the board of health.
Signed �...............�.... ---- & .-- ......
Application Approved By -- = - - - -------------- .. ..
Da
Application Disapproved-for the following reasons- -- ---------------------------------------------------------------------------------------------------------------------------------
......................................... --------; ------------
J
Permit No. ----------- .............. Issued -----.�Q.. -1...------Dace------
Dare 11 I -
CY
OW
Fxs....
No.--- f .�!...
s THE COMMONWEALTH OF MASSACHUSETTS
�3 BOARD OF HEALTH
TOWN OF BARNSTABLE
r Appliratiou for Dig mal Works Tumitrnrtinn Prrmit
Application is hereby made for a Permit to Construct (X) or Repair ( _ ) an Individual Sewage Disposal
System at: `
S .-14/ 0/R- W g ' r -a
....................................... -•------..........---------•--•--------•------...------------------.........•---
(� L}/catio .Address _ or Lot No. •���-- -
...�C!l�/.d4�11 �!.'n--•...................................... O../%�q/!/(......���......--.0�..................................
Owner • Address
Installer Address
�(Vype of Building Size Lot............................Sq. feet
U� Dwelling—No. of Bedrooms............Y.............................Expansion Attic ( ) Garbage Grinder ( )
`4 e of Building a Other—T yp g ____________________________ No. of persons.......:................... Showers ( ) — Cafeteria ( )
dOther fixtures ------------------------------------------------------••••------------------------------•----•-----------.....---•-----------.....------------------.
wDesign,,,Flow............................................gallons per person per day. Total daily flow.............................................gallons.
W Septic Tank—Liquid capacity_=_...i .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 Test Results Performed by.......................................................................... Date........................................
�4 -
Test Pit No. 1................minutes per inch Depth of_Test Pit...........--....... Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit---...........--.... Depth to ground water......--.--..--.........
P4 ------------------------------------------------••-------------•--•-------...---------•-•---•-------.........................................................
0 Description of Soil............................................................................................---------------•---------•-•------------------------•-------------•-----...
x
U ..--------•-•..................
w
x --•-- ------ ---------- ----•-•--------------------
U P PP 6.- ......-1�I s ...-! sr // irTrcS Nature of Repairs or Alterations—Answer when applicable .- �� ------------------
U Nature
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 undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issued by the board of health. _
Signed .......
Application Approved B
PP PP y --... -------------- ..............
--- ------
Application Disapproved for the following reasons: --------------- ..------------------........------ . ------.....----------- ------------.------...--------
- - ------------------------------------ -- ------. . .....l .............Da ------------
Permit No. v�.1.......... .................. Issued .......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
(11rdifirak of (11ontylinure
THIS IS TO TIFY, That t Individ a/le age Disposal System constructed ( ) or Repaired ( )
by ...... t / -- (� (J .. . ............. �� --...------------------------------------------------
has been installed in accordance with the provisions of TITLE 5 T e St onmental Coe as4escri e in
the application for Disposal Works Construction Permit No. ---------- -- dated --... ... ...... ..
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE NSTRUED-AS A GUARANTEE THAT fAE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE -� ......---/...�------------------------------ --- Inspector .... - :....... �' '/."" f..'-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE /
No.......r......... .. FEE...R,;i !..�.
OiIPn11V nrk ToIn )�)r#' �e mit
Prmission i hereby granted ...0. l,lPT..(. .-----------••---.---......-•.............................
to Construct or p it ( �) a Individ a e gage Dis �� `' Y `��:-
atNo.......... . r ,---------•---------- .
Street /
as shown on the application for Disposal Works Construction Per � ��?�ate dl (�/ 1.... .�
_ - r....
. .....
C�- ._._.....--
DATE.....--- s/�• C*- ..-- •--•................................ y Board of Health
FORM 3830E HOBBS 6 WARREN.INC..PUBLISHERS