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HomeMy WebLinkAbout0045 PINE LANE - Health 45 PINE LANE Osterville A = 118 - 087 t- TOWN OF BARNSTABLE ::OCATION z41S pi YV'f i,,jA-A-4e. SEWAGE # VILLAGE _re�A���c2- ASSESSOR'S MAP: & LOT .INSTALLER'S NAME & PHONE NO. �(¢��� l.-�•'wL� '��C- SEPTIC TANK CAPACITY LEACFJNG FACILITY:(type) (size) j NO. OF BEDROOMS 3 PRIVATE WELL OR BLIC W DER BUILDER OR OWNER �O (V- r v1Z "� DATE PERMIT ISSUED: DATE COUPLIANCE ISSUED: VARIANCE GRANTED: Yes No �1 lY' VI No., . ?_:��:3 F�$.. ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliratinn fur Binpnuttl Works Tnnntrur#inn 1hrutit Application is hereby made for a Permit to Construct ( ) or Repair (/,,--Y"'an Individual Sewage Disposal System at: , -Location-Address or Lot No. ner y� �p i a _L O P - qk . -- > A1 ' — `— ress ) f 1.� ........... M Installer Address Type of Building Size Lot........................./Sq. feet Dwelling—No. of Bedrooms...................._....................___Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building .....................:...... No. of persons............................ Showers ( ) —,,Cafeteria ( ) dOther fixtures ..._...... :__._.. :..�--------------------=�... ............................ � Design Flow____________________________________________gallons per person per day. Total daily flow.......... `..$ ;:......gallons. Septic Tank—Liquid ca.pacity.....__.____gallons Length................ Width................ Diameter_...-�_______.epth................ W Disposal Trench—No.......1........... Width....7__.___..... Total Length..../Z/.__.. Total leaching area....................sq. ft. x 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.- Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-••-••-•••••-•••-••-...-----•---------••--•-----------••--•--•--------_. Date...........---------------- •------------ a 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........................ A+' ---------- •........ ----------------- -----................... ---------------------------------- --------- •------------------__-_------------------------- ...- 0 Description of Soil--------------•---••--•---•---•-----...------------••-•-•---........._.....__...---------------------•--------------.....-----------------___....-•••---•--..._...___--- .................. --.......... ---------- ....... x -••------•---• ------•--•-•----•--=---=-----•---•••--------•------------------•--••---.....___._ --------------------------------- .......................................................... Alterations when applicable..- U Nature of Repairs or ..............6 .. .:---- ..v... ..? w ......e c r 4 w Agreement: J The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT E. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board oLhealt1j. Signed-..--__ -- --- d _ Date ApplicationApproved By.-................................................................................................ ....................................... Date Application Disapproved for the following reasons:................................................................................................................ ......................•••:•--•-----•------•----•�••-•-----------------•--------...._..__._._._........._...---------------------••••••----•-------•----•-•------•••------------••----••-••-------••--- q Date Permit No.....:� ...._Z4.�2-----------•------.._. Issued_....................................................... Date Fizz THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration for D spnpl Works Tonstrud on Vprrntit Application is hereby made for a Permit to Construct,( ) or Repair (Glan Individual Sewage Disposal System at: .............. `�.._...:� ............................. ............. T. :_r .� _1 Location-Address ............ ,......M Y_1<n := ........ -•---••------- Lot No------- W VA y j e j� 1, � {. `Address � a�� Installer ....01, Address Type of Building Size Lot.................... .....Sq. feet Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—T e of Building ._......... No. of persons ................... Showers YP g ------=---••- P ( ) — Cafeteria ( ) Q Other fixtures ........ = --•----------------------------- ----------....... ----------- . ..........•-•------------ WW Design Flow............................................gallons per person per day. Total daily flow.__................_..................._....gallons. C� Septic Tank—Liquid capacity............gallon s Length................ Width................ Diameter................ Depth................ Disposal Trench—No.......1........... Width...7. ........ Total Length....1.6........ Total leaching area....................sq. ft. 3 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........................ f�. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ------------------•---------------------...-----------------....--------.....--------...--•-----.............................................................. O Description of Soil..................................................................................................-..................................................................... - ---------- ------------------------------------------------------------------ -.............. ---------------------------- -----------------•.... •-•••-•-•-••--....••••--••••••••••••-•-•-••••••-•-•-••-••--•••••....••••••••...........-••••...-•---•............-•......•.------------- •••-••••• ------------------ U Nature o ..... if Repairs or Alterations—Answer when applicable_..._.i' �:s fS T" .I .._. '?�!..a _._._t-,•::. .............�....-`•--•^................ .....................................1_.1*------ Agreement: �) The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1E 5 of the State Sanitary 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,. t Signed.. _ ;. --��"'1 ---\\ �" L .. Date ApplicationApproved By..••••••-••••••-••••••••-••••--•••••....•-••-•••••...-•-•-••-•.................•••••......-••-•••- Date Application Disapproved for the following reasons---------------•-------•-------•-----...---•-----------------••----------•-•----•------------------•••........... ...............................•--•--•--•-........------------------------.......---...----------•........_...------------------------------------------------------....--------....•-•.....••••---...... Permit No.....� `' Af .... Issued ............................ ------------..Date....... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _ Trrtifiratr of Tontplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( } or Repaired (Z.) l7 L. 14.._P/J ? �T- 1 �" by............................ - r---------- .........................�-•----•-----------...............---......................•...... Installer at..............•-...........................j"-- " V"'Y`-`� ei [ 1'e••1) 1 ) )_.n has been installed in accordance with the provisions of TITLZ 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No------ ......... dated...... ._. ---------�` v .. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........ ........�•:-. _/ �? ...._.._.... Inspector........ - - - - THE COMMONWEALTH OF MASSACHUSETTS . ------vY BOARD OF HEALTH t51�r� r�,t.�� a� No...F� �`' ..:.......................................OF.................,......, ...! :._. ............ FEE Disposal Works Tonstnulion erntit Permission is hereby granted............:5 14.E -L.Id_Iv- ----= �-•---------------...................................... to Construct ( ) or Repair (/4-)-an Individual Sewage Disposal System at No............... '-) �. f ra.. .•._./._ �1 a.:.......:...r'�"?:r�t . .Yz�' - ' r...4 Street ��i�.K.1 , _..-. -- ......_ .. as shown on the application for Disposal Works Construction Permit No.. . _ Dated___'�..__9._�`r_..___.5' . -_----••--.•-.- Board of Health DATE............ ., b..r"- ;g---•-----•- AsBuilt Page 1 of 2 TOWN OF BARNSTABLE SE WAGE VILLAGE f9�`IY'si�.���t2 ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. C A- f),9- 1�Y�'wy SEPTIC TANK CAPACITY �%� LEACFJNG FACILITY:(type) --Vru t'(z S (size) 1 �Sy& NO.OF BEDROOMS -3 PRIVATE WELL OR BLIC W R BUILDER OR OWNERS r�.j DATE'PERMIT ISSUED: DATE COMPLIANCE ISSUED; U -.Z.G Sf 7 VARIANCE GRANTED: Yes No i r _ http://issgl2/intranet/propdata/prebuilt.aspx?mappar=l 18087&seq=1 81/24/2017