HomeMy WebLinkAbout0194 TOWER HILL ROAD - Health 1 )4 Tower Hill Road
Osterville
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TOWN OF BARNSTABLE
LOCATION a ( }�� �(,� SEWAGE #
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VILLAGE a-R�IUI ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO2L(K p.C� 11 �1 1.
SEPTIC TANK CAPACITY tom� `li
LEACHING FACILITY:(type) (size) d ��
NO..OF BEDROOMS PRIVATE WELL O 'PUBLIC WATER v.
BUILDER OR OWNER
DATE PERMIT ISSUED: '
DATE COMPLIANCE ISSUED: I�o=C7
VARIANCE GRANTED: Yes No
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Disposal Works Tnnsirnsiion ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( l4--an—Tndividual Sewage Disposal
Sysit at:
....... .......................__���.. .......`... ...........................
.... ��..........)c�=C�
ess �. c_. .- •- -- •----•-•----•- -• -•........................•-•----- ---------•..........•...
er Addres s
--------------- _ m ....... 1�c �xr��--�. :.. ���
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Installer Address
d Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms......_.....................................Expansion Attic ( ) Garbage Grinder ( )
P4 Other—Type of Building ....... ............... No. of persons............................ Showers ( -) — Cafeteria ( )
Otherfixtures ---=2!77�---- ---------------------------------------------------------------------------------------------------------------------------------•
W Design Flow.................................. allons 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 ( )
Percolation Test Results Performed bY..................................................-....................._. Date........................................
Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................
f14 Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................
Q+' ........•....................................................................................................................................................
0 Description of Soil...............................................................................------------------.....................................................................
W
U Nature of Repairs or Alterations Answer vJh applicable
plicable_____.._//0- _ ..__. _�-----.__—
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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 Compl- nce h en Iss y t board of health. pp
Signed .......... .. .. . ...... -------------- . . ....... --------- -- ..:.l.Z.
ce
A lication Approved B Y pp PP w - .�.... 3..
ce
Application Disapproved for the following reasons: .................................... ................... -----......:....... .........--.....-- --.
Permit No. . / .. '. Issued .....a.d... .. ..Dae......
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A , O/
No.�!. ._....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Disposal Works Tonstrurt#inn Frrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( (4-anlrnndividual Sewage Disposal
System at:
L onC- d essNo- Lot�To.
--^-- -- �•_.....^___::_��''a._--a�-�- 4` 3.�!-------.._.�--------- ---------------------------------- �7(AYdflres�s,._ _
Installer Address i
UType of Building �� Size Lot----------•---------------Sq. feet
Dwelling—No. of Bedrooms-------------_------------------------------Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No. of ersons---------------------------- Showers —
a YP g ---------------------------- P (----)--..----------------------------
DesignCafeteria ( )
Other fixtures --------------------------------------------------------------------------------------------------------------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 ( )
1.4 Percolation Test Results Performed by-------------------------------------------------------------------------- Date---------------------------------------
a Test Pit No. I----------------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-___-__-----_-_----__---
x
0 Description of Soil-------------------------
x
U -------•-•----------------------------------------------------------------------------------------------------------------------------------------------------------••------ ___--
w
x --------------------------------------------------------------------------- -----------------------------------------------------
U Nature of Repairs or Alterations Answer wh9n applicable y-
--------•L '�� 9?�k--------�� --- -----------S M'^z------------------------- ------------------
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 Compl' nce h Ri en issued y t board of health.
Signed .---------- ` �.h�------ - a- -, ---------
A
pplication Approved BY m ---------------;< - --- - y-�------------- ------ /r'��
-� W. , r- ,
Application Disapproved for the following reasons- --------------------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------............................ - --—----__------------------------------------------------------------- ----1 ----------------------------------------
Da
Permit No. _/- -- - 3� -��.,�......-- Issued -�/ I /
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH ,
TOWN OF BARNSTABLE
(9er#tftrak of Guipltttnce
THIS LS-TO�C " TIFY, That-the In 'vidual Sewage Disposal System constructed ( ) or Repaired (L��
by - ----- . ...-------- - -`� =----------------------------------------- - ---
Ins�n
at -----------t-q-4-------- C ................ ----------------------- ��� �w�L�-- .----------------
has been installed in accordance with the provisions of TITLE �f�'he Sate Environmental Code as described in
the application for Disposal Works Construction Permit No. ___ __. '2,. .._ dated -------------.-____.-_--.--.-_.--._.---.--
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE ----------�"��'- - -�-Z------------------------------------------ Inspector v ----------------•---------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
-0 TOWN OF BARNSTABLE
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,nrk� e��n� �rtiun err i�
Permission is hereby granted.--------------------- ti�----•----------nQ--- ----------...-------;-�---------------------------------
......._.__..____
to Construct ( ) o R air Individual a age Disposal System
t5l
Street _7
as shown on the application plication for Disposal Works Construction (Permit ._______._� No �_.___-_ Dat�n__�_.�________________________ fl
- ----r-------- /�
DATE..------/
------------------------------ --------- Board of HealthI-h3A�
FORM 36508 HOBBS&WARREN.INC..PUBLISHERS
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