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HomeMy WebLinkAbout0020 OYSTER WAY - Health t • �t C �DGEO�STREE�OS�T �2- No. 4210 1/3 BGR + ESSELTE 10% O 0 0 0 of O OF BANSTABLE ` S ��` LOCATION � . SEWAGE # s VILLAGE ASSESSOR'S MAP & LOT 0' •03i " INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) %L`/� (size) ,��D�o� i `� �N' NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Dis &Bee: Maximum Adjusted Groundwater Table and 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 S d � No(-C .._ 7 ZFE. .0:60..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ApplirFatiou for Diti-po!i al Wor1w Tomitrurtion 1hrmit Application is hereby made for a Permit to Construct ( ) or Repair (L-j"an Individual Sewage Disposal System at Location-Address or Lot No. of w �'S Cr✓�- Owner w ICJ. ►+e. ......L-e w Address Cs to ry -- _ ..... ---------------- ..-. ...... Installer Address Type of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms------------------�-_----.-----._--.-_--Expansion Attic ( ) Garbage Grinder ( ) aOther—Type .of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures ------------------------------- -- d •-----•--- 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........................................ 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........................ a' ------•----------------•----------•-•••----•-••-••----••------•-••--------•-•---•------ -------•.--.---•---•-------------------------------------------- 0 Description of Soil----------------------------------------------•---------------------------------------------------------...--------------------------------------------••--•---•-•-•---. x c, W ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- UNature of Repairs or Alterations—Answer when applicable-------fAP.-..q.re.<1_te.....T-.!__ - e....27................... --------•------•....--•---------••----------------•-•-•-•--------•-••-•---------•----•--•--•-•-------•••---•----•---------------------------•-•-------•-•-•••----••••-•-••--••-•-----•------•--------•-. 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 ...... W--� ...-C ��* .... --- ---- ---c�.�a...r-�.:.�i�... Date Application,Approved J Da.e%- Application Disapproved for the following reasons- -------------------------------- ----------------------------------------------------------------------------------------....--..__...------------------------------....... .. .. .................. ........... ----.....----------------------------- A Date Permit No. ------/ ... � - ...... .-.� _ Date-Y_7..... ............. Issued `�j.-' . .-" 5 NoZ........R..V 7 Fps....?--�..©.:6G..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Allp iration for Mit- iiiial Workii Tomitrurtion Ilerutit Application is hereby made for a Permit to Construct ( ) or Repair ((--)-an Individual Sewage Disposal System at: �- (� tG Q s e r v• i 1 e C C� f C' L ccP a 2 Location-Address or Lot No. � r-b �s G P G S ter '..i--�---------------------------------------------------------- Owner AL G ddress ------•. . ----- ------------------------------- �� -_. 4 - U Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling— No. of Bedrooms.._........ ---------------------- Attic ( ) Garbage Grinder ( ) Other—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) a' 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........................................ 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........................ W -------••-----------------------•--------•------......-•-•-•-------------•-•--•-•-•---........•-•-...•-----•---------...-•---•-•••---•----...............---- ODescription of Soil........................................................................................................................................................................ W V .......................................................... ...............................•.............................................................................................................. W ---------------------------------------------------------------------------------------------------------------------------------------------------------------- --------,. U Nature of Repairs or Alterations—Answer when applicable-------!Ap----TC-cm;;(e------17�..t`... ............................... 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. s Signed --------I /N.. a✓ -----� pry ................L----------------------- Dare C_ - - -Application.Approved By -- ---- -- -` ,p �- ,- -� - ?.:-. ., -.f_S Ti------------------------- ` ----------------.................------------------------------ .Application Disapproved for the following reasons: ------.-� - �.. \._.... ...........- .................................... . ..........Q...y -----------------------------. - ---'"-------------------------------------- ........................................ Permit No. �.-....v f Issued =', - . ...._.....7..`....... -----7 j - Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ti Qtle tifiratr of 01-lompli2 nve THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( cam--) by ................ ......... -. .tea 5------------------------------------------------ ..... .. ......--- .....-.. ................................. ... lnscauer �»' at .. ...................��.c:.�. � e._.. C .S.- e. "�L_r.1.. .----- c.C �.. ...��.l�.e...-)--------.-----_----------------- has been installed in accordance with the provisions of TITLE 5 of The State Environment)l Code as described in the application for Disposal Works Construction Permit No. -----_.... -.... ..U............ dated ......... ..1--- °- _. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT Bk CONSTRUED 3,--1.- S A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........ -�. .. I.. ----------------------- Inspector _.. ....----........:...... -..... ---------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No...!.�2�:... FEE �:OG �t��n��tl >�rk� C��ra���ri�n rrmit Permission is hereby granted---�i( Gl.l '} �.�_...�-C w 5-------------------------------------------------------- to Construct ( ) or Repair (' —Y`an Individual Sewage Dis.osal System , r at No............ e.!•ctCI 5 0 5 /✓ // _e......�-oG .. e--F �t ;I------•--•--.....-- jStreet � g, 7 f _ PP P fP. ------- Dated _ `�r f ` ......... as shown on the application for Disposal Works Construction Permit No-_._:-.-=•.�-- - Z- C�_�?�........................... �J Board of Health DATE Y---•- FORM 36508 HOBBS Q WARREN.INC..PUBLISHERS �v on TOWN OF BARNSTABLE n LOCATION t SEWAGE # VILLAGE ` `AfSSESSOR'S MAP& LOT a7 .1)61 INSTALLER'S NAME&PHONE NO. SEPTIC TANK.CAPACITY. LEACHING FACILITY• (type) (size) ,/�ZX02 -1,>1' el '"NQ OF BEDROOMS . ROiI DER OR OWNER PERMITDATE: COMPLIANCE DATE: /g Sepaiation Dis a Be. n the:.: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Piivate Water Supply Well and Leaching Facility (If any wells exist ..''bn:site or within 200 feet of leaching facility) Feet 4hebf Wetland and Leaching Facility(If any wetlands exist ` .within 300 feet of leaching facility) Feet Fiirtilshed by I_ , f