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HomeMy WebLinkAbout0201 ROBBINS STREET - Health (2) 201 ROBBINS ST, OSTERVILLE A= 142-076 �- °i �i 1 e b ASSESSORS MAP NO- PARCEL NO: 7�0 No.... :..� � Fss... ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiou for Di►ipo3a1 orlai Towitrurtion Vamit Application is hereby made for a Permit to oristruct ) or Repair ( ) an Individual Sewage Disposal System at: Location-Address or Lot No. 1_.Pftr./._ ... r >f ---- � `�j a/J ........................................................... JO '[Ier /— 1'[Clil / V/V Address a �! 1.... -•---•------ ----(--•--•--------- -------------------•.........•----............................................................... Installer Address UType of Building Size Lot-..'. .!175�.....-_..S•q. fleet Dwelling— No. of Bedrooms.__-__---__4-------------------------_-Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ---------------------------- No. of persons--------------------------- Showers ( ) Cafeteria ( ) dOther fixtures -----•---- ---------------------------------•-----_-._---------------------------- .............................................................. W Design Flow--------------------------------_S_.S.____gallons per person per day. Total daily flow.....44ll_..............................gallons. WSeptic Tank—Liquid capacity/6,A40gallons Length.lv.-_4__ Width_$7. k..... Diameter--- ..._........ Depth_..(. _elm..... x Disposal Trench—No. ............:...... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..............Z-.. Diameter-------//....._..-_ Depth below inlet..... .......... Total leaching area..44_6.....sq. ft. Z Other Distribution box ( L,,) Dosing tank ( ) W Percolation Test Results Performed by....,+ _. P _Z................... Date._ ........................... Test Pit No. I___—"_'-'-___minutes per inch Depth of Test Pit---/.__ ......... Depth to ground water-----. ......... Gi, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ ® Description of Soil.----- ....... V ....--•••-•••-••--••••-•-•-----••-•-••-----•----•---••-----•-----•--------•-••---•-••-•---•----•-...-•--------------•-••----•-••--•-•---•---....-••-----•---------••-•--------------...-----•-------•-- W UNature of Repairs or Alterations—Answer when applicable................................................................................................ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-------...----•• 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 Complian • has been isuled by the board of health. Signed ..... ............. - __ Application.Approved BY -� -------------------- ------------------------------------- --- Dgm e Dare Application Disapproved for the following reasons- ------------- ------ ------------------------------------------------------------------------------------ -------- ------ ------------- ---------------------------------- --------------------------...-----....-----__-------------------...--------------------------------------------------------------------...- ---------------------------------------- Due Permit No. ......:.......: .. �P Issued �� �®..'9.`1�..................... Dare �N9--J- ..... Fmc �ft,Z�'?............ t THE COMMONWEALTH OF MASSACHUSETTS -� BOARD OF HEALTH TOWN OF BARNSTABLE Avy firation for Uitivmi l I'Vor1w Towitrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: �-------� a_1..........iZ�,,3���;�/.S...........:. ��s'%_.... ------------------......`�------------------------------------•-----------. Loc-ation-Address or Lot No. — ...:....._•` •!Jf'—�---•----•-•---•--• -----•-••-------•->--•---•------------- •-•--- •- .......................... Owner r Address Installer Address Type of Building Size Lot....'_'`_�`�'-'______-:Sq-feet .-t Dwelling—No. of Bedrooms--------------____--------._-_---_.--.--Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons-_.._-.__.-________-_--.-.-_ Showers ( ) — Cafeteria ( ) 04 Other fixtures .-._._---.-�------------------ - W Design Flow................................S.S__..gallons per person per day. Total daily flow-----4 40------__-.----_--_--_--_----gallons. WSeptic Tank—Liquid capacity�1�_ _gallons Length_4?-::. . Width_�'�:_ ----- Diameter_..._--._.._. Depth__ .�_r ._. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------ '.......4_ .- Diameter___.-._-�/.._..._. Depth below inlet.......9_......... Total leaching area... 6..._.sq. ft. Z Other Distribution box ( v) Dosing tank ( ) '- Percolation Test Results Performed by---- c'`__ w ��.............. 3' -_- S......... Date aTest Pit No. I...G::z-___minutes per inch Depth of Test Pit___-�_ .._....... Depth to ground water (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......................... 9 --••----•--•---•---------------------------•----•------------------ -•---------------....•----------......................................................... Description°of Soil S .�i.... 1. .. x -----------•--- U ---------------•-••---------------••-----•---•-------•--------------•--------------------...------------------•---------•-----•-......------------------•--------------------------.....---------------- W - UNature of Repairs or Alterations—Answer when applicable............................._._.............._.._.____..-_..................................._. Agreement: 44 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 Compliancelhas been issued by the board of health. Signed > .. ...,+ �t' _ . ....� ......`... ` } �f _ Die Y� Application.Approved By ............ '_^ '2 t�. '. - ...... .... ...: '. Application Disapproved for the following reasons: ................................................................................. ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------- � Date Permit No. ............9.---- ---. ._ ._ ,.............. Issued --------- -------t"_5.................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Te>r#tf rate of C11omplial cce THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) by ------------------------------------------------ ----------------------------------- -- ---.-----------....-----------------------.------------------------ -------------_----------------------------------- ........ m,t sue. Olt ------------ -vim...._... x 9 r - ca 5 .--------- ... -. .-----._...-------------------------------------..........----------...._----------------------------- has been installed in accordance with the provisions of TITLE 5 ,f The State Environmental Code as described in the application for Disposal Works Construction Permit No. ..... :..,_. .. --------- dated ........ ...-. ..-C,i.. .:.... THE-ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. '' ------- Inspector ---- ----------- ............., ---- GTHE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE FEE....... �.... Biapiti tt r � �un� ilan lernti� Permissionis hereby granted...... Z ...........................v ...................... ------------------------------------------------------••--••---.... to Construct (V) or Repair ( ) an Individual Sewage Disposal System atNo.....................R O.....PAg&-M�A = r tn..A --------------....-------------------- Street _ as shown on the application for Disposal Works Construction Permit-No._A:__-�3 Dated------ �?�._..__...>�._..... �....,.�i��.. Board of Health DATE.. ../ -------•--•-----•----------- FORM 36508 HOBBS Q WARREN.INC..PUBLISHERS V 1 b�: 1�GZ°ice _Gr&L. AA 1 - 9rhT, t3,*y s �II sty ti Y i j 4�� C1_` 71-\ G I TS( - f r—qc 2 II I NA, P, I N,4-I I -IFoP7p A- �Iu� �( LG DIUtiI .(o A I FI�Ev/_��IG1.1Gi lC� .fit N 15., iUM r> I "rt�Ni �� GA> J TOWN OF BARNSTABLE LOCA111ON SEWAGE # VILLAGE �7`-�/`(J�`Ile ASSESSOR'S MAP & LOT/ INSTALLER'S NAME & PHONE NOpr'�/6 y�S1'GICr/0/IA SEPTIC TANK CAPACITY /S"6O aa_z Do J /CL�'7 LEACHING FACILITY:(type) S`CJ� (size) („ NO. OF BEDROOMS PRIVATE WELL O PUB 1=WAT:�E:Ri- BUILDER R OWNERS'Cj/����o DATE PERMIT ISSUED:���/�J�9Si DATE COMPLIANCE ISSUED: IIL VARIANCE GRANTED: Yes / N�—o v 1 a i APPLICATION FOR PERCOLATION TEST AND OBSERVATION PITS �OCATQN -� DATES �. VILLA E a . ems;-E � c ' „FEE �� GL� �DDRES ©57-' TELEPHONE NO. . «onrefundable, NGINEEF� /- L C.4-i' _.✓l �f !d f!/�i,.rl,� __TELEPHONE NO.27a' 6�>S'Y '. ,DATE SCHEDULED (Applicant' s signature ': C•.•q�. 0 0 o • • . . C . . O.. .. C *'0 . . 0 0 0 0 . ..• . • • • O • 0 0 0 0 0 01 C . . . . . a ASSESSOR'S, bW & LOT NO: yz/� SOIL LOG - UB-D VISTON NAME DATE a TIME C/.13o A-M -•., 'XPANSION AREA: YES YI NO �T (4 , i��>�- ENGINEER u:u ` �5 3-2 •� .' BOARD OF HEALTE TOWN• WATER ✓PRIVATE WELL 7 EXCAVATOR , . SKETCH: street name,etc. ,dimensions ,of -lot, exact location of test holes and . percolation tests, locate wetlands in proximity to test holes) NOTES: dk r� t ' .1 vY�' t4Sµ��•r f. v 1 1 1 : 1. �r gQ •' "'�, i� 4� p 'F r ys"��4� t • n i 7 ?ERCO :RATE: ,K LEST HOLE„„N0: / ELEVATION: TEST HOLE 'NO: Z- ELEVATION: 3 t t.�_3, S 4 4 • ' 6 8 8 9 9 12 12 13 '13 , 14. 14 15 15 ;UITABLE 'FOR SUB-SURFACE SEWAGE:, LEACHING FIELD BLEACHING PITS g , ., LEACHING TRENCHE . JNSUITABLE FOR SUB SURFACE SEWAGE. REASONS: FK = TOTE: ' ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION )RIGINALa: = COMPLETTED JN ENTIRETY Y Pt E., ANRETURNED TO BOARD OF HEALTH 'OPY RETAINED BY APPLICANT - - —