HomeMy WebLinkAbout0232 WASHINGTON AVENUE - Health a3a vwashi rn -ton -
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TOWN OF BARNSTABLE
LOCATION 2,12 SEWAGE
VILLAGE Cj�si��;,,%/� ASSESSOR'S MAP 6 LOT 1' '^ 60-
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY L
LEACHING FACILITYAtype) /�/T (size) (y ) LCroL
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED: 7—
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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:ASSESSOR'S MAP NO. PARCEL '7
LOCATION SEWAGE PERMIT NO.
VILLAGE - -
I N S T A LLER'S NAME i (�ADDRESS
QN\CA
R U I L D E R OR OWNER _
DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED
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APPROVED
No..!�1
Barnstable Conservation Departmeoi Frms.... ....30.:.00
L THE COMMO u �THMASSACHUSETTS
signed ""A HEALTH
TOWN OF BARNSTABLE
Allp iratinn for Uiipnoa1 Workii Tnmtrurtinn 1hrutit
Application is hereby made for a Permit to Construct ( ) or Repair X ) an Individual Sewage Disposal
System at:
.•232 Washington.-Ave Osterville
Location.Address or Lot No.
Ellis
•...................•.-----•---•...---••-------....---...--------------•---....--•--•-•----•_.... ......._...................-•------•-•------•-•---••-•-•---•-•••-•••........................--•...
Owner Address
W J.P.Macomber Jr.
Installer Address
d Type of Building Size Lot............................S feet
U Dwelling—No. of Bedrooms.............3...__._.._...__.__..........Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers
a YP g ---------------------------- P ( ) — Cafeteria ( )
d 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 ( )
1.4 Percolation Test Results Performed by.......................................................................... Date---------------......------------------
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
4 Test Pit No. 2................minutes per inch Depth of.Test Pit...:................ Depth to ground water........................
R-4 .---- -----
p nd_...8e Gravel.........•--•--------------------- ----------------------------------------------------------------------
Descriptionof Soil........................................................................................................................................................................
W
U ---------------------------•--------------••------------------•---------------------....-•-•--------------------------------------------------------...................................................
V � ggepair�� Aleatio whe� ��'li` le. Yi3ri� pit -------------------------------------� M ga1n �eac 10 gaonan -
---------------------------------------------------------•---------------------------------.........---•••-----------------------------...............................................................
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 Compli nce has be issued by he board of health.
Signed . .�� 11/27/9.1..----
,..........
Date
Application Approved By .. ... ----------------------------------------------------------------- ---11 1a ''/
Application Disapproved for the following reasons- ------------------- ------------------------------------------------------ -------------------------------------------....I.,.....
----------------------------------------------------------------------------- ---------- --------------------
/ ---- -- - -- ------------------------------- ---------- -- ---- ------------------------------------ --------- ----Date
PermitNo. .............L-.-'.-. - �a....................... Issued .....................................................- to
Daze
r
� � 3� `�o`J ` • Y 4,
No.52'�;/.� 6 Fizs....i.... .0
COMMONXeA, YTH.,OF MASSACHUSETTS
-^�--BOARD OF HEALTH
TOWN OF BARNSTABLE
App iration for Eli_gpaaal lark,`Tomitrnrtwn ramit
Application is hereby made for a Permit to Construct ( ) or Repair TIX an Individual Sewage Disposal
System at:
232-_a.5h:—71- ?o..Ave...Os to r-Ki lle----•------•- --------------•--...-----•-•--•--•----.........---.........._..--•--------•------.........--------
Location-Address or Lot No.
F .�7.S
.-__-._-_--•--_...__.».....----••-----•..................•------------------------•--•--•-...... --._......._.......----------..._................................................................
Owner Address
a J_.P.MacAmber_.Jr_._. ....
Installer Address
Type of Building Size Lot..........__________------"Sq. feet
V a Dwelling X No. of Bedrooms............ 3_ ________Expansion Attic ( ) Garbage Grinder ( )
04 Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
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......... ft.
Z Other Distribution box ( ) Dosing tank ( ) 1 I
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........................
------------------------------------•--•----------------------.._..--------._....:.---....---------......-•----•-•----•-------._......----------...._..•••-
0 Description of Soil.........................Sand & Gravel
x
-- -•- -----•....•.--
W
UNature of Repairs or Alterations—Answer when applicable------------------.._.-_._..____________._._______________....___.___..___..........:..........
1-1000 gallon tan) 1-1000 gallon leaching pit.
•---•---•-------------------•---------------------------•--•---------••-••----------._...•••__----------•-------------------•-••-•-•----------•--•--•-------•-•••-•-•••••-.._....__......_..........----
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 Compliance has been issued by the board of health.
Signed . -4t_Gsi !JI .... - � 7/ ..-...
Application Approved B �Jr U -t/,�:y ---------------_------ --.-----.---.--------- `11--�� --
PP PP y -------------- --- ---------- Date-.
Application Disapproved for the following reasons- ---------- ------------------------------ --- ---- --- --------------------------------------------------------
- -------------------------------------------- ---- ------------------------------------------------------------
Dare
Permit No. 3 .-...... Issued -----
Date
THE COMMONWEALTH OF-MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE ,
101Ex#ifi a e of Cfomplianre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (XXX)
by-------J-,-P Mac-umber-..Jr
Installer N t
at ........ Washingto s n Ave 0terville.....
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. .......... ------t-3-6-.-- dated ................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. \
DATE-----------------------------------�----- --°�f-`�\-...................................... Inspector --.----- ...-....-----
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
FEE .........0••00
Uispwial lVorkv Tlni#rnrtuan amit
Permission is hereby granted J-------P' -----------------------
Macomber Jr.
to Construct ( ) or Repair (X ) an Individual Sewage Disposal System
at No....232__ Washington Ave Osterville
......................................... -----------------------•----•------------------------------•--•---•---..........
Street 2
as shown on the application for Disposal Works Construction Permit N - —J��__ Dated__________________________________________
Gq ........................... .........................................................
DATE. //' / - / Board of Health
FORM 3650a HOBBS h WARREN.INC.,PUBLISHERS