HomeMy WebLinkAbout0235 SCUDDER ROAD - Health PlCk,
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S M E A D
KEEPING YOU ORGANIZED
No. 12134
2-153LGN
SUSTAINABLE FORESTRY MIN.RECYCLED
INITIATIVE CONTENT tOS
Cotvfied Fiber Sourcing POST-CONSUMER
WWW.SfiDtOQtBm.OtQ - I
M41290
MADE IN USA
GET ORGANIZED AT SMEAD.COM
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cl, TOWN OF BARNSTABLE
LOCATIONS-a` --S—c-v,DB,EZ 2. SEWAGE
VILLAGE ASSESSOR'S MAP & LOT 439
INSTALLER'S NAME & PHONE NO. „�cr �Za7 �'QaJsi yam= $ �
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS 44—� PRIVATE WELL OR LIC AVA'rEK�j
BUILDER OR OWNER �f
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED: A 7/9
VARIANCE GRANTED: Yes C-No ,1
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+ A-A w�AS
No.. ��•... � Fps
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
TOWN OF BARNSTABLE
Apli iratilatt for Dispaiitt1 Workii Tomitrurtiott Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair (�) an Individual Sewage Disposal
System at: '
....X.i..'IL:......... .Y... ..ii.Jl..........i U................................ .............................K.._......_.......................................................
-� Ttio 1Address o� t No.
... d _.._ ----Qs �1�---------------------------------------- 5 Scuff±..__ .(�._... c. ..----------....................... ....------
O n r
4 dd
ss
a
P� Iec../UL0 staller�Q�i�1V�,�G.�•�s`-:'/rtf ��i(,Il�lc..�-CJ y s �r fhle.LB '--•----
UT e of Building Size Lot----------------------------Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e 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 ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
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........................
- ............-----....----- � � -.......----•�...----
W ( Y1{fA � ...-
7.
O Description of Soil...... jmv...... . .---•--- --- -------------�-- --•---....-•--- ... -------••------------
x �_ , �-- r _ _________________ � J........_._._.._____'__._.________._.____._......___._____..._._.._._.._.____._____.__.__....----------------
...................................................................................................----^___....._._........._............------.......................................................
U Nature 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 Environme 1 Code_ he undersigned further agrees not to place the
system in operation until a Certificate of Complia e s t - rd�-of health.
Signed -............ QQ.----
Application Approved BY ------ ----- ------- �``'��----
Application Disapproved for the following reasons- ----------------------- - --------------------------------------------------- -- ------ -- - ----------------------.....
----... ..-------- --------------------
Permit No. �gl------------------------ - Issued ..............-1..-`-z f ice.
Dare
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratiuti for Disposal Works Tonstrur#iun Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair (`� an Individual Sewage Disposal
System at:
7``
�. _ .._. A, ... os�'E U.
-_^.r-- �— do Address o Lot Now__..____ __.... M
a-- -C.-S2s�.1__.._� .0------------------------------------------ - - Sc ur•o� _�i_....1 1 -------
Y____.
Owner Address
a staller�tlV S/ A) 7t!/�
._
pq ,���/�L0 L �6� LifJ.�JL£�y✓ Ares .✓�,HIi�LS-
d Type of Building Size Lot_-------------------_ Sq. feet
U Dwelling—No. of Bedrooms________________________________ _Expansion Attic ,( ) Garbage Grinder ( )
Other—ad Type of Building -------------•-•----•------- No. of persons---------------------------- Showers CafeteriaOther fixtures ------------------------------------------------------------------------------------=-----------------------------
( )
-
w Design Flow--------------------------------------------gallons per person per day. Total daily flow----------------------------------------------
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-------------------------------------
a
a Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------
fT4 Test Pit No. 2----------------minutes per inch Depth of.Test Pit-------------------- Depth to ground
= water_____-__.•______-..._.-_
-----------------
. f t
- -- --DescnpUon of Soil
---------------------------------------- -------------------------------------------_- --
w
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
U Nature 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=�e undersigned further agrees not•to place the
system in operation until a Certificate of Complia nce� e€ is e t arrd of health. �' 7���%l"�
Signed �" ---- - - , °' T -'----------
A��lication Approved BY =_ - `.,, ='�-=b"-=------------------------------------- ��j ''.
Application Disapproved for the following rearons: ---------------------------------------------/.__.: -
------------------------------- --------------------------------------------------------------------------- -------------------------------------------- ----------------------------------------
Permit No. ,F. "z/f Issued p° a�---��__r"
Dare
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Cgertif rate of �IIripliunce
THIS IS T C% FY That the Individual Sewage Disposal Syste \ onstructed ( ) or Repaired ( -`)
b Cl=/O
Y-----.__.----...-------._.._ _ it La ...............—'�-:-�3=--- ---------Installer------......----_....__._.-'---------____-..__----_-._-------__----------------------------------------------
- I-V6�9 /�!lJ/ w` I
at ----------� ✓ y f�� �" �`!- — a 1 :� �~ z`� vim =.'6�' -
-------- ------------------------
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. _______ ___ -7 q/ dated ___ �'�
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED, AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISF.ACTORY.
DATE---------------------- f v ---------------------------- Inspector ------------- - ----•--------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
No...
� " F>a�.
Disposal Works Tonstruc#iun Firmit
Permission is hereby granted---------r!5� or a '40_..'`/ 0 P07�✓1�� -----------------------------------
to Construct ( ) or Repair ( V) an Individual Sewage Disposal System
at No.. xa _ _ "° /�, ee -trb _ � �! Wit,+ �
street
as shown on the application for Disposal Works Construction Permit No.-`'�`:7...��l Dated-------
�`��,�"^__ �
�/ soars`of Health
DATE--------- �-,,�� �_.� �------------------------------ v
FORM 3630E HOBBS Q WARREN.INC..PUBUSHERS