HomeMy WebLinkAbout0192 WIANNO CIRCLE - Health low 192 Wianno Circle
_ A= 140 - 109
�. Osterville
TOWN OF BARNSTABLE 1�
LOCATION ` � lv.f�f�C� Cy— SEWAGE # , �J
VILLAGE �tlte ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY CSC® CS`C L-
1
LEACHING FACILITY:(type) �c ��( t �(y5 (size)p�.�-� cS te G
NO. OF BEDROOMS S PRIVATE WELL OR PUBLIC WATER
4B wt OR 0 W N E R
DATE PERMIT ISSUED: 30 ({
DATE COMPLIANCE ISSUED: Cl 1 1 I cl 'l
VARIANCE GRANTED: Yes No
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C3 a 130 K
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A H o - 1o�
No.. `.' �..� Fps... CT� d..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratiun for Uinpuiittl Workii CSumitrnrt un rprmit
Application is hereby made for a Permit to Construct ( ) or Repair ( Van Individual Sewage Disposal
System
y ........ scam. ..... L\x.........os csvil...............L.O.A...Aft...13-__�...........................................
Loc ion-,1 ss or Lot No.
t-c�L�e .....-L:........�-.... ---------------------------------------- ---- -------s w�- ......-----------............-----------------------.......------.
r Owner Ad ress +.
a ��. G . �t��-x�- l'c._ ------ ---��-�.--. .k - ......0 S tea...---- ...7 tS
Installer Address
UType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms.___.__..�..'______________________--.Expansion Attic ( ) Garbage Grinder ( )
'k Other—Type of Building No. of persons____________________________ Showers — Cafeteria
Qt Other fixtures ________________ _ ___ _ _ _
W Design Flow................................. gallons per person per day. Total daily flow............................................gallons.
Gd Septic Tank—Liquid capacity__... allons Length---------------- Width_.____._.____..- Diameter................ Depth................
W Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
x
3 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______.______--------._.
(% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a .........................................................
ODescription of Soil........................................................................................................................................................................
x
U ..........................................................-..............................................................................................................................................
W .............................. --------------------------------------------------------------------
UNature of Repairs or Alterations—Answer when applicable._ !-_ .-.... .�Sfit - cS'SO S
7
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 be t e oard of health.
Signed ...... =- ..�.... ..... 1�6/ 7
Date
ApplicationApproved By ............. . ......................................... ................... ................................. ........................................
Da cc
Application Disapproved for the following reasons: ............. ............ . ................ ................................................................
......... . ............... . -f,� ,..........1.. -- . . ................ ............... -- . �...... .................... .......................................
Permit No. �" e
Issuedd-
Dare
o - 10�
No.(. 1 `� FEB.............d.......�.......
THE COMMONWEALTH OF MASSACHUSETTS
/ BOARD OF HEALTH
TOWN OF BARNSTABLE
Allpliration fnr Mirp Sal Vor1w Cna mitrurtiun rrrntit
Application is hereby made for a Permit to Construct ( ) or Repair ( V an Individual Sewage Disposal
System at:
Loca'on-{k rIr ss or Lot No.
Ott, S
•----•-------------------------•-----•---------........------•--
'"' `
Owner Address.. (. `c
Installer Address T
Type of Building Size Lot............................Sq. feet
�., Dwelling—No. of Bedrooms........��_"----------------------------Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures ------------------------------- --
W Design Flow.................................... gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity-_ _ U allons 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........................................
4 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........................
P4 ---•-----•------------------------------------------------------------------------------------------.........................................................
0 Description of Soil........................................................................................................................................................................
V ....-------•---••-----------------•-•--....----------------•--------•••--.-•-•-•-•----------•-----•----•-------------------•----------•-----------.-------............................................
--------------- -----------------------------------------------------------------------••-----•--•---...... .. ------------...
UNature of Repairs or Alterations=Answer when applicable.- ___�_G�_ e.......e..x...�s'F
17
Agreement: �, �•�
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with i
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 De sued-b the board of health,
Signed -------- 7.. `J.. ........................... ..... j�6
Date --
ApplicationApproved BY . ........................ ......... ................. -- ..................................... ........................................
Dace
Application Disapproved for the following reasons: .......................... .. ................................................................-- -- . ..
.......... .. .................................................... . ................................:................. . . . . ................................... . . .....................
r7 /�' Date
Permit No. ...�.....7.....�.....��.�`��....... .... 'Issued .......e."... .�� �4'��---.......
Date
-------------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
VTT Ertifirate of Tomplianre
THIS IS TO CERTIFY, That the.,Individual Sewage Disposal System constructed ( ) or Repaired (L//)
by �?Gt> � M.�.�-s.. Vim......... -- ...... .......... ............. .......... ........_ .. ............................ ....... i
Installer \
has been installed in accordance with the provisions of TITI. 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. �.�-�_,�r.�A4�1�------ dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE - t°... - - ... Inspectors..-:•-......:::. ... - ...:. ..... ------ --------------------
Al-
----------------------- -----------—------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
6'
TOWN OF BARNSTABLE
No........................ FEE..:.... �r
Rapogal Workii Tlanntrurtion Wrntit
Permission is hereby granted........... --------------------------------------------------------------------------------•------
to Construct ( ) or Repair (V an Individual Sewage Disposal System
at No.......... f--.0
street
as shown on the application for Disposal Works Construction Permit No�`..."'x._`��'Dated.._Tf��.__���-��<..�
...................................................� ��"'�
Board of Bealth
DATE............ . ..... d.�_.. .o............................
36508 HOBBS 6 WARREN.INC.,PUBLISHERS