HomeMy WebLinkAbout0093 BARBERRY LANE - Health (2) 9� 13 4ex
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TOWN OF.BARNSTABLE
LOCATION?/ ai-befy '� L -S'EWAGE # �63-
VILLAGE .;ASSESSOR'S MAP LOT
INSTALLER'S NAME'& PHONE NO. /�Ii F z? ��f-�✓fs
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type)pf l �s' (size) ,/000
NO. OF BEDROOMS PRIVATE WELL OR `PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED: '"
DATE COMPLIANCE ISSUED-
VARIANCE GRANTED: Yes 'No
�eaP,
' µ
'] 3 9.
3 No._ _ .._...m V Fss.. ! �........
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
Allp irFation for UigpuaFal World Tom3truriion Vanat
Application is hereby made for a Permit to Construct ( ) or Repair ( V)"an Individual Sewage Disposal
System at: th
---...--....................... ------
ik
- --•--------------------------------------------
� Address ---mow ���� •e�5 ` t '---
-----------------•----------------......_....
Owner Address
W �4V,w...._�t�c.��` ....--•................................................... .............� `.......AT b �E W`..c,@lJw,t _
Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building .............. p ( ) ( ).............. No. of ersons___._.._._.______..._...____ Showers — Cafeteria
Other fixtures ----------------------------------------------
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
G4 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................
xDisposal 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 ( )
PercolationTest Results Performed by.......................................................................... Date........................................
,.-I 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________________.._____.
R+' ••••-••••••-------•-••-••---•••-•••••••--•••---•-•••--....•-•••-•••••••--•••............•....................................................................
O Description of Soil......... ' 2— Sv •-••--���......•-••S....a✓
U ----------------------------------------------------•--------------•------......------------•-•-------------------------•-------------------------------------------------------------••-•-••-•••-•••••-
-•----------------------------------------•--........--••--------......-••-•-........... J......---------------------------------•----------------------------•---------...........................
U Nature of Repairs or Alterations—A�n's�wer when applicable__�!� ......�_�z Y`l�J�........
` �D. bw jF811S.V� �� v`�� �Z�Cj U p►
l ` ��
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
T t1x-+
the provisions of 'I"ly LE 5 of the State Sanitary 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 `''--�""' 1 D f
Date
Application Approved By__.
Date
Application Disapproved for the following reasons: .----------•-------------------------------------------------------------•-----------•--••••.._.....--------
---------------------------•-•-••-- _._ -----•-------••------------------------------------------------------------ --------------------------------------------------------------
Date
Permit No.- (�/ ......... Issued-------------------------------------------------------
.�I
l -. -1r
No.6,. 3
Fm3A.o......
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
l..`.!._ - ----------"--OF.....r..- ....................... ----
-- Appliration for Disposal Works Tonstrurtiun Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: 0
L n
Q. i! ..............••.-'.•--.-_• ......-••--.-•-••__.-•.•...-•.-_.._.....•-••.___
n^ oc tio�Address w`� tpr W p`o.
Owner �,j Address
Installer Address
dType of Building Size Lot............................Sq. feet
U
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers — Cafeteria
P4Other fixtures -----•-----------------------------•---------------------••--••••--•--•--------------•--••---•---•-•----•....-----•-•---•------------.........._.....
W Design Flow............................................gallons per person per day. Total daily flow-------.....................................gallons.
9 Septic Tank—Liquid'capacity.....__.....gallons Length................ Width................ Diameter................ Depth................
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. I................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........................
C4 ----------•-------------------•---•••--•-•-•----••---••------------•••-•------------.__..._.........................................-------------------------
O Description of Soil......... - �G"------ .� ..........-•------•-�
U ...........•.............................................................................................................................................................................................
W _
UNature of Repairs or Alterations—Answer when applicable._.` -".' .____.`*"__ .z. ��.v'? -._.....__ _�_S_.`.`
__
............................�`a� . ...--•---...Q G„v................................... ay....�,.,�............................... ,
Agreement
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of'T'IE i of the State Sanitary 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............ �r.
Date
Application Approved By... .-• ....... .. -°-------- - ----•- ---._._.... ....................
Date
Application Disapproved for the following reasons. . -----------------------------------------------------•----........_
........•-•---•----•--•----•••--••• ----------------------'•-----.....---•------..................•-'•---'---'-••--...--- ---••-'•--•----•----•------•--••-----•-•--•---•---•••---------
Date
Permit No. ---k./--6.-�-3------•--- Issued........................................... at-------
L:._..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
i�
Trrtifiratr of TompliFaurr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( Lj
a� t-��C
by ._...1 . :V .....-• ... .......... R ---------------------------------------
----------------
has been installed in accordance with the provisions of 'II"_ of he to Sanitary Code as described in the
application for Disposal Works Construction Permit No._ �__..6.-�j dated_-------- ..................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR AS A GUA"ANTES THAT THE
SYSTEM WILL/FUNCTION SATISFACTORY. f
DATE...j a:�.V.... � Inspector .....=----�� I
�1- THE COMMONWEALTH OF MASSACHUSETTS
BOAR--D� OF HEALTH
433 �`:1 c�W ill...................OF..... ..�.;Z N S .. ..r•...
No.. FEE.. -•-••
Disposal Works Tunstrnrtiun rrutit
Permission is hereby granted_..._...... -c
to Construct ( ) -or Repair ( u<an Individual Sewage l)
,oso Sy tem
at,No..-- c+,( tic S t?t'� L-4k S _��
street _ Q
as shown on the application for Disposal Works Construction No._ _ ated... .. .. .•....... .........
•---------- - -.---- ----
1�- -•------ --• •--.........
Board ealth
DATE_
_-
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
►� j _ ,O.
LOCATION SEWAGE PERMIT NO.
VILL CE
� �I
ti INS A L ER'S NA E A ADDRESS
� - 14 ����
it
n B U I L D E R OR OWNER
DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED /�/Sl �,
t
�� ��
�..
.� �
� ��
�/�
t
. � ���
Fnic
THE COMMONWEALTH OF MASSACHUSETTS
OARD OF HE L�H
TO0/'�Y 0 F...... ..........................................
Application is hereby made for a Permit to Construct A or Repair an Individual Sewage Disposal
System at,
Own f
-in 'r Address
q. feet
W i
z Other Distribution box Dosing tank ( ) r, 4Z-01)-
Test Pit No. 2?��.Iiinutes per inch Depth Of L�_.L L IL.................... Depth to ground water.......el
�
U Nature of _ Alterations_,___ _ _______ _ __ ap
plicable____ __ .........
________�r�_��nc«�~ �
��
'------'------'''--------'--------'-----'—'---'--------'-------- --�--'-----l� �
Agreement: /v/y— ---- -
Tbe undersigned agrees to install the aforedescribed Individual Disposal System in accordance with
the provisionsofTL ITi Q3 5 of the State Sanitary Code in
oobl u Certificate 6ua been �ao�dbv �
| operation— '� ���� �
� - w
�
-------------'----------'—'--- '— — — — — — --' '
C3
No.... ...y:, . .?. Fps.. ........:Y.;;......
THE COMMONWEALTH OF MASSACHUSETTS
- ®�AgOAR® OF H E/L�I-0
`'..
Appliration for Diiipoiial Workg Tonitrnrtion "rrmit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at
..............•••-•..L_Q ..... 1`� &V�� 4"'ev.....---------- .s%� s ......
Location-Address or Lot-No.
.......... ., '1..V...... �..�.-f. .. .................................. ..............15---.... �1� :..........1� . ...
P✓ C
Own � 4 .• Address
W ..vo-�5.... ... - .r[� 1 ---•--•-----. •--------•----------.. 570.---•---- .'
Instal er Address
Q Type of Building Size ..........................4q. feet
U Dwelling—No. of Bedrooms............................................ Attic �i Garbage Grinder
Other—Type e of Building No. of persons............................ Showers
a YP g --------------------------•- P ( ) — Cafeteria ( )
114 Other fixtures ..._...-----•------------------------••-------•......-
w Design Flow................... gallons per person per day. Total daily flow............1?...
g � g P P P Y Y D... gallons.
W Septic Tank—Liquid capacity_j b v U-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 ((,y/� Dosing tank ( )
Percolation Test Results Performed by............................
JE nc:,:S.5kv?k%f) ,�Z(�(....... 4
1_4 Test Pit No. _..minutes per inch Depth of Test Pit...... .... ... Depth to ground water........4%wI. I` r
Test Pit No. 2� imutes per inch Depth of Test Pit__._. ... Depth to ground water...j- ^.�04M
Description of Soil ---•--•--------------------------�11170•- �.........------......V--- � ' Y S•U!-t.
x 1 1 -
U ---------•---• ---------------------------------------------- �" -�--...•...C.•.A•.� _------------�- --------
w
UNature of Repairs or Alterations—Answer when applicable.____ _)a e rtp y� ,/4-7 .r-r� �y�- /�c-_�r
�✓�— EGG �Jlisc=� rllu 5.....G r..Lrf-i%' ,
Agreement: /"'/ r-
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 no t place the system in
operation until a Certificate of Compliance has been issued by the-board of health
Signed.........................
r Date
Application Approved BY--------------- -----------------------------------------------•----------•-•-•-•----•-•-•---....
--•-----------------•-Da-t-e---••----------
Application Disapproved for the following reasons:..................................................................................................____........._
.......---•-•--------------------•---------------------------------------......_..--•--•---•-------•-•-•---••---------•---•------•--------•--•-----------•-•---------••--••••••-------•---•--•....._.._.
_ Date
7 /
Permit No._rQ_`1..=��p---•.....................•----•_. Issued__... ...�••-/-------•.......................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.......O F.............�� (�t . `�..`��f/..� I .................
CIrrtifiratr of Toutplittnrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( )
bY.....
st511 +..�.... ^^ h f
.................................................. n er
at-----------------------------------------�() ................/-`�--. . 4--------------- .. 19..../...... 1V....---. ..�M ---
.SA l�
has been installed in accordance with the provisions of TITL.. 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No---- ._��:. '_ '..j..____.-.._ dated_...-_-._..�!-.7-of e /
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEMWILL FUNCTION SA ISF �TORY.DATE..........-•------•--•-•---•---•.....•••. •`' --k•--•--•------ Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
T
BOARD OF HEALTH _/ l9
�f- �f 7 �........ .... .wLti.....OF........................
No. �"..5� ./` ........ FEE......:................
Disposal Workii Tonotrnrtion Vrrmft,
Permission is hereby granted................................. 4.z....: .....------. lJ�� Q. /-----------.................•..
to Construct (_4 or Repair ( ) an Indiviijual Sewage Disposal SystemSystem LAl ,,,0,0%o,.A
Street
as shown on the application for Disposal Works Construction Permit No...../............... Dated..........................................
------- ... ....4...-- ............................................................
1 DATE---•-------------••----......------.._._....._. :..._.�---�1.-•- Board of Health
FORM 1255 A. M. SULKIN. INC., BOSTON
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COLFoQMS To THE ZoQ W6 LAWS
1q musiKF�eT LAME p(Z,BY: J.Q-.E of BAP-OSTA LE, MASS.
C��Cr�l�L I MASS., 02l032
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