HomeMy WebLinkAbout0362 WIANNO AVENUE - Health . .� = 362 Wianno Ave')u-z-'.
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Osterville
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TOWN OF BARNSTABLE
LOCATION �2 �d�✓lno /4ae _ SEWAGE#
VILLAG lI ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PRONE NO.
SEPTIC TANK CAPACITY
! LEACHING FACILITY: (type) /�� (size,)�y�e
NO.OF BEDROOMS �� �® ��`� o �� 617
169
BUILDER OR OWNER Mi A iL 1`• GG, a Von11on2
PERMIT DATE: COMPLIANCE DATE:
Separation distance Between the:
4 Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well an d Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet f leachin facility) Feet
Furnished by ���
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No...a . ....... Fs$. .... .................
THE COMMONWEALTH OF MASSACHUSETTS
Q
BOARD HE T
.............OF....... �- Ial .....
App iration -fur Uiupoiiat Works Tomitrurtiuu Prrutit
Application is hereby made for a Permit to Construct ( or gemir ( ) an Individ 1 Sewage Disposal
' System at
................... ..le-.�. .. ..........0,-
Location.Address or t o.
•.. - -• - ------------- .......................................
OwnA----Iq--------- . . . .
Installer Address •��
d Type of Buildin Size Lot..........'______________ Sq. feet
U P,
Dwelling—No. of Bedrooms-------------�_..........................Expansion Attic ( ) Garbage. Grinder ( )
aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
p' Other fixtures _________ ____ _ _____ ___
Desi n Flow -------------------_ _____ gallons per person per day. Total daily flow.......1� `7__._.__._-. allons.
W g �--- ---- g� P P P Y• Y g
R; Septic Tarik I Liquid capacity gallons Length................ Width-----------.---- Diameter--.------------- Depth.__._---- ._.
W Disposal Trench—No........... ........ Width._...... :_.. o Total leachingarea_....._...__._.__.._sq. ft.
Seepage Pit No...___� ____.. Diameter �` _..__.. e b�Len
ow in et------------------ Total leaching area., _.._-_sq. it.
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.-._-_-..____--_-.-._...
fi Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water-.._.-.--_--__.---__---
a •-------.....
O �
Description of'Soil------------------------ -----•-------•----• -------------------------------------------------------------------•-------
x
W -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------..
UNature of Repairs or Alterations—Answer when applicable................................................................................................
---------------------------------------------------"----------------------------------......................................................--------------------------------------------------------
Agreement:
The undersigned agrees to install the aforede ribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary o e—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b issued t rd of health. r
4
Signed--- ............--•..••--- --'-'-•• •-•-•............. ---------- ;L
ate
Application Approved By...... -;`i- ----•------- = =--------
a at
te
Application Disapproved for the following reasons-------------------------------------- ..-•....-•...----...---.---...........•.•....-----••-•.--.----•-•
---•--•-•--•-•-------'•---'--•----------------------------•••-'--'---•-------•----------•---•-------•---------••---••-----•-••--•'••---•---'---•--•. ----- Zte
------------------------------------
Date
PermitNo......................................................... Issued...... ----7- -7-3-----•-------••---
r
-......
No.... Fa$
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEA. T
.. ---..OF...... .....................
Appliratinn -fox Ubpoott1 Works Tomitrurtion Vantit
Application is hereby made for a Permit to Construct ( '') or Re air ( ) an Indivi >I.1 Sewage Disposal
System at: c. i r � f gyp°
---------_----------- - '�"' r¢, '.: " °.i...... --- � _ ems p--- !��.... ..... ..=
Location•Address or t 'o.
f
. . _ '' � "' '`' -•-----•----------------•------------
Own sL- A.------ -------------•-- -••------ �u� _ d s «
a -------- --
Installer Address ^'
Q Type of Buildin Size Lot............................ q S feet
Dwelling No. of Bedrooms.-._------------- ......................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building -----------------------------No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures --------------------- ___
W Design Flow. .................... .....�,, ..._e-gallons per person per day. Total daily flow.......�---------------------------------gallons.
WSeptic Tank Liquid capaclty¢f_` _gallons LeAgth---------------- Width-------_........ Diameter................ Depth----------------
Disposal Trench—No. .................... Width-_ — jotal Len Total leaching area..... -----sq. ft.
3 Seepage Pit No.___ _______ Diameterl_ __ epe "inlet . .. Total leaching area. '{,__._ __sq. ft.
z Other Distribution box ( ) Dosing-tank ( ) e ;'I ZI
a Percolation Test Results Performed by_______ _ __ _ ________ _ ____...................................... Date-----------------------------------------
Test Pit No. 1----------------minutes per inch Depth of ."Pest Pit-------------------- Depth to ground water.-----------------------
f14 Test Pit No. 2................minutes per inch Depth'of Test Pit.................... Depth to ground water-_.--_._____--_---_--.-.
........
Descriptionof Soil---------------- ------ ` = -----------------------------------------------------------------------------------------------------
x
U ..................................... --------------------------------------•---------•-•-------------...---------------•-----------•---------------.................--------.----•--••-••-------------
W ------------------------------------------------------------------------------------------------------------------------------------------------------------------ -----------------------------------
U Nature of Repairs or Alterations—Answer when�applicable..--------------------------------------------------------------------_--.------.--_---_-_-.--- �
Agreement:
The undersigned agrees to install the afoi-edescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary[ de—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bissued„� th - rd of health. ;l
Signed -- ..................
, ate
Application Approved BY- ---� V - �
---- s
- Date
Application Disapproved for the following reasons-..................................... ------------------------------------------ ----•---•-----•---•-•-•-------
----------------------------------------------------------------------------------------•---------------------------------------------------------------------------------------------------------------
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF� MASSACHUSETTS
BOARD OF HEALIH
... !4 ............ .....0F`... ... .......................
Trrtifirn#.r of Q-111rrntpli,nnrr
THE', 0 CR CJ fli/tthhe
Individual Sewage.Disposal System constructed ( ) or Repaired ( )
br =- ;- : ---•----- --------------- - ------- - •-•-•--- -•-•------•-------------------------••---•--•.....-•-------•••.
Insta
y� Pr"='� " ------ ----•-= ----.:. l _.--- ----------------------------------------------------------------------------------------
has been installed in accordance with the provisions of:Article of The State Sanitary Code as de cribed in the
application for Disposal Works Construction Permit No _-___ -� ;---•-__.-__. dated ..._ . _ :3............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE ` S A GUARANT E THAT THE
SYSTEM L FUNCT � SATISFACTORY.
��l 5............................. Inspector-------�%,__. � .•. ----_l.'�.�. -...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEALTH
....... O F..:.... c : �^u, .� .................:. .,,..
No...._ _ .._-.. FEE_ -` ...._.._..
i� n tt1. unlit rti rrttttt
Permission s ereby granted__=--- ` �.. . , _.
to Constru t ( ' ) or .Repair' ( ) as Individual S�g sal in
----------------
\, Street a w
as shown on the application for Disposal Works Construction : mrt N Dated_ __.__ ._._..._...
/ /�, �� Board of Health 1
DATE---� { ;.
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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