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