HomeMy WebLinkAbout0785 SEA VIEW AVENUE - Health c�J SE'.GL,�7 i e e.�S �7+�NJ��r
SUBJECT TOtAPPRdVAL
Fx$....`-....................
BARNSTABLE C®N
SERVATIC �
THE eftikoft.E3,qTH OF MASSACHUSETTS
r ' `BOARD OF HEALTH
)J
............OF.....
g s Appliration for Diipnsa1 Works Tonstrnrtiun Vamit
Application is hereby made for a Permit to Construct or Repair ( an Individual Sewage Disposal
System at,
..--. .- t - - ....0 g
-1 ------------------ocation-Address or Lot
Owner J. IAddress
.... 3/:. -------------_--------•- ------.^.------.-------------------------------------
Installer Address
Type of Building Size Lot...__.1:.. _. .........
't
.r Dwelling—No. of Bedrooms....................................Expansion Attic (��j Garbage Grinder �S
'q Other—T e of Building No. of persons............................ Showers — Cafeteria
d
Other fixtur ------•-----
W Design Flow................>........................gallons per person periday. Total dail flow.._........._ .U._.................Olons;.,
WSeptic Tank—Liquid capacity� .gallons Length-_'1{ ........ Width_..:'�.... Diameter................ Depth.4c`�a....
x Disposal Trench—No..................... Width......,1..---------- Total Length..............p._._..Total leaching area....................sq. ft.
Seepage Pit No........Z--------- Diameter......k`R....... Depth below inlet...... Total leaching area..................sq. ft.
Z Other Distribution box (�� Dosm tank ( )
Percolation Test Results Performed by..- •- E'' ....... Date.�_".�.-rl................ 1
a
Test Pit No. l..n.Zfninutes per inch Depth of Te Pit-__-_ .. Depth to ground water---C kf P_X....1;Z�
Lr, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
9 t•---•-••----- - - .. -----+-----------•---V..-----•---•. ..... ------
Description of Soil------oZ------ 3� 1�....`. Z ,�' � 1 �.:. =
x
U .------•-----------•..................•------------------....---------•--. .• •• -------------------------------------
•---------------
-------------------- -_
U Nature of Repairs or Alterations—Answer when applicable._...... _ -----lnr '
------------- --------------------------------------------------------•-.......-----..........--•---------•-•--------------------------------------------------•--•--•---._....__......-------•--•-••.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee i ed by the board of health.
Signed.... �...1. ...... -- ----- .......... ................................
Date
Application Approved BY • ',�'�•-- ----•-•.....................• -'�- = f
Date
Application Disapproved for the following reasons:..............•-----------------•----------------------•--------------------••-•---------------•---------•-----
....••••------------------------------------------------------•--•••---------••-•------•-•---------...__....._....------------------•-•-•-•-•-••--------------•--••.....------... -•----......._
Date
PermitNo........................................................ Issued........................................................
. Date
Fx s..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
Appliration for Uhipoii al Works Tomitruaw atui#
Application is hereby made for a Permit to Construct or Repair ( an Individual Sewage Disposal
System at
.. R10 Al) .. 'v� - -C"..::..... -c� �,�' ::1.�:...:...-
.... . .. .............. ....... -- -- t
-Address r
__... _ . ocation.. .._.. . ot �
.............. .._.__.. .........................
Owner
--- -...........-- ;- -
Owner ♦ Address
----------------... ........ .
----------------------------------------•
Installer Address ~�Type of Building � ` Size Lot_____.I.._-f.6..___._.. t
U Dwelling—No. of Bedrooms............................................Expansion Attic (U')J Garbage Grinder ( j
pa-1 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtur-es ----------------------------
w Design Flow............................................gallons per person per iday. Total ddily flow............................................' .� gallons.
WSeptic Tank—Liquid'capacity............gallons Length...Ki-........ Width.A_'4.:.. Diameter................ DepthA .._.
x Disposal Trench—No. ................... Width.......q............ Total Length----_.......:..___ Total leaching area....................sq. ft.
Seepage Pit NO-------- ._ Diameter....._,- ...... Depth below inlet...... `_......... Total leaching area..................sq. ft.
Z Other Distribution box ( Dosin tank ( )
1 fir'dear "1 fyt .
a Percolation Test Results Performed by ---•• ==-`1 Date. r .-
l Test Pit No. I................minutes per inch Depth of Tes Pit__.._�_;:........ Depth to ground water...a_ -__12.
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
t
-- ; ' �-------------------------•_------••---•--------__-•--
ODescription of Soil_ - ...0 '-�--..............................................................---Ci ; ' � - 1 � V '.••• -----• ... ----•----------------------------------
x
U fNature of Repairs or Alterations—Answer when applicable._-____- ___--•---. -----•-_-•-_--.--_.
.!"....
Agreement: i
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE: 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee5�s?6ed by the board of health.
/ Date
Application Approved B "'_ �''t' ' ' /G 'err? -------•-•----- `� -w rS�1°
PP PP Y-
OY Date
Application Disapproved for the following reasons--------------------------------------------------------•----------------------...............--•------•-••_...--
...................•.......-----------•--•-------•---------------•-------.....--•---•--•----•--------•------------------•-----...---------------•-----------------------•----------------------....-----
- Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OFIJEALTH
.� 1L...........OF..................:.....;.:....... ......... ........................................
Tatifirtttr of To" Mpliaurr
THIS IS LQCERTIFY, That the Individual Sewage D�posal System constructed ( ) or Repaired
by.............- .
--.......... ,........_..
`��.._�/ � Z � I alley �r
at................•-•-....--•••••••••••-•-•-••--•• .... - -----•- .....-- 'a'..'..`------•----------------------------------._...--------------
has been installed in accordance with the provisions of TI ` of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No. ___._ ... .............. dated------------------------_.......................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATI• FACTORY.
DATE._•_•__••-•.................................. �.-------__-_.. Inspector............. I --------------------------------•---•-
THE COMMONWEALTH OF MASSACHUSETTS
_ BOARD OF HEALTH
Noo ...._.... � ....................OF.----- ' s�" .................... FEE... ... v
�'i 2 ,o-
Map os al Vorkg %". nidr ilan rrmit
Permission is hereby gran e .- - -- /"V ------------------•-------------•--........-----.............. ....._..
to Construct 4e�ir -an Individual wage Disposal s
at No................................................ -`' G`''`
----------•----...-----•---•-----------------•---•--••---•-•------.
Street
as shown on the application for Disposal Works Constructio it No......................4Dat d•-_••-:____.........................._....
D ..............•.---•---•---_._....- °ard of Health
DATE.......�1, ....._ �
� t
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
L 9 SZA T 10W SEWAGE PERMIT N0.
VILLAGE
I N S T A LLENos NAME i ADDRESS
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BB UILDE R OR OWNER
-77K (FAjjj�
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED �y/roT�j
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L A T I0{! �° S E W A G E PERMIT NO.
1NST,A LL'ER S NAME i ADDRESS
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' DATE PERMIT 1sluED
DATE COMPL.IAN'C ISSUED
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