HomeMy WebLinkAbout0488 BAXTERS NECK ROAD - Health ("Hax—ters—N-e-ek—Ro—a&,-Mi-r—ston—s Mills
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��TOWN OF BARNSTABLE �
LOX-Al IGN _ SE NAGE #
VIIIAGE AW"1ar+s r l�s - ASSESSOR'S MA1-
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY —
LEACHING FACILITY: (type) Z ea (size) �a r1' 0
NO.OF BEDROOA.S 0
BUILDER OR OWNER �C a f 4/S u
PERMTTDATE: .3 -a- '`lS COMPLIANCE DATE: S 2 7
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and 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 of'ea •�' '
Furnished by_,
t.. r
1
s
w
ASSESSORS MAP NO. -7 s
PARCEL NO; ape)
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratiun for Di-tipnuttl Wurk.6 Tunutrnrtiun Frrmit
Application is hereby made for a Permit to Construct (,<or Repair ( ) an Individual Sewage Disposal
System at:
44'b (-%A>t FF_tiWe-�0-� AA AA i ti.S- L`-rr (.-,A, " PLA-W �a-�va 3 iG1 O r_ 6 C.............. --• •� --•---------.......--------••-K-----
Location-Address or Lot No.
Owner Address
W
Installer Address
Q Type of Building Size Lot...........................:Sq. ieet
U Dwelling— No. of Bedrooms.--_-___'S - ---------------------------Expansion Attic (u/A) Garbage Grinder (wiA)
P4 Other—Type of Building ...... .... No. of persons------ ... Showers (t4/A) — Cafeteria (µ/A)
dOther fixtures ............ o .............................................................................................................................
W Design Flow.............i.!2q...... per person per day. Total daily flow...........(06�__...._._.._............gallons.
WSeptic Tank—Liquid capacity._!Sm_gallons Length Width..s'....... Diameter... ------ Depth.. ' ).".....
x Disposal Trench—No. -------!............ Width-----f_1......... Total Length-----!�Q?_ Total leaching area....A`i:!.......sq. ft.
Seepage Pit No k l4A._...... Diameter.._....k-e_/A..___. Depth below inlet----- ....... Total leaching area.....tt�LA.....sq. ft.
z Other Distribution box (✓f Dosing tank (w/A)
Percolation Test Results Performed by------------_--_ ...................................................... Date........................................
Test Pit No. l..L 2.----minutes per inch Depth of Test Pit-----''� ...... Depth to ground water..H�1'±€..
f= Test Pit No. 2...� )A.....minutes per inch Depth of Test Pit---t.Aje.......... Depth to ground water...tiLA........_...
�+ -------------------------------------------------------------------•----•---•--••----------------•-•.........................................................
O Description of Soil....."—-L"I-' : �P +L_ P� .>=! _' -.;. + '3.:_ .�! az..� ?�9,.:�
-- ---------------------------- - -- - - --
U2!ly! - AAice"^--s! 7-►� w n+ ( /Mr�S a� G�D�4•r�i. 4'- 11. AAg.w.0?ng..s,q,�4�
:wA_I...fL--a----i f--`---------------•-•-----------------•----------
U Nature of Repairs or Alterations—Answer when applicable.---....t-:1)R-------------------------------------------------------------------------------
..--••-•-•--•-------•••••••-••-•-••-•••••-•--------------••------------•-----------------•---•-••------••----------------------•---•.......•---•............--•----------•-•--•-----•..........--•.•--.
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 in d by the board of health.
Signed ---------------------------- -- -------------------- ............................. .................D- -----------:
are _
Application.Approved - ------------------------------------------- ---=
Dare
Application Disapproved for the following reasons- ----------------------------------------- ----_.... ................................................. .........
.....:..................................... ------------------------------------------------------------------- ------------------------------------------ -- -----._-----.._................
Date�—
Permit No. ..- � � Issued ....... .."- c ----�-.��S
Dare
•` 5
3a
_VTH. E,COMMONWEALTH OF MASSACHUSETTS
_BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Diopooul Workii Toustrurtion rrutit
Application is hereby made for a Permit to Construct (�or Repair ( ) an Individual Sewage Disposal
System at:
...44a (ISAyc)�P_ bled= � AA �1A I L L.- L-oT__ro A - Pc_ytl,l (�x�ol_ 3 t� V�
-•-•-•-•--•................................. .._.•.;_
Location-Address or Lot No.
GA f2t_ .M . SG.... y_ H,tvT 1IS Co 1 ...... ---,oL S s A -, Ci1-?c.a....._.
Owner Address
W ............................ r ^ ..... -y--------------------- ---- ----------•-..-----------------------•---•----••-----------------•-------------•-._._._._..__..
a "-• \ Installer� Address /4r--¢i--5
d Type of Building Size Lot...-_IL_`'_�_______..S 174eel
Dwelling— No. of Bedrooms------- ...........---------------------Expansion Attic (w/A) Garbage Grinder (,�/A)
Other—Type of Building ------ ......... No. of persons------- otice--------- Showers (t4/n) — Cafeteria (wA)-
p`' Other fixtures ........._tea-r=
Design Flow--------------I. .......gallons per person per day. Total daily flow-..........G(.. ....gallons.
WSeptic Tank—Liquid capacitv.-!Sa'..galIons Length_e'._' .__. Width..s:§_.'..... Diameter... __--
x Disposal Trench—No. ....... ......... Width.....1.L`....--.. Total Length-----�i A'-_...._ Total leaching area----�k!�L7.......sq. ft.
3 Seepage Pit No.....t-I JA...._.__ Diameter......tt!_/A------ Depth below inlet.....!:!f e_.-_._.. Total leaching area.....tz�.LA__._sq. ft.
Z Other Distribution box (v'� Dosing tank (,.IA)
Percolation Test Results Performed by..................... ------•-•--•------------•--••-••-•-•----•------••--- Date........................................
0-1
0-4- Test Pit No. L. .----.-minutesperinch Depth of Test Pit-----!'t.a E,,+
'--_- Depth to ground water-- -- ;--rEaera
G14 Test Pit No. 2_-_-1.).A.__._minutes per inch Depth of Test Pit--- ...... Depth to ground water....tt�.i,A_...._......
a -------•--•----------- ----------------------------------------•---------------•---------------•---.........................................................
0 Description of Soil..... -2')i' rbPso,&_ - P�1- �,�qro� s ,a -_�_ s.:. �. T_.n P, ..:
_2t1L� - g• .'._.M_E':plloJ,M--•!•-}-t�l"7J0 \1J 1T-1- na/t'Ti YJ'S a4. e-z-PA,f�"1..- , 4'----'I -�-----_tii�_OJ l_.tM„SPt I_+_(,
W \N A I-� O 12 G.. ...................... r.
.......................... ....... ................................................................................................................................... . .. .... . ... ...
V Nature of Repairs or Alterations—Answer when applicable.... ..._..................._--.---...._.......... .__.._._......
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 ------------------- --------------- -
-.,- -_'' ^•�.....�"'�' Dare _
1 Application.Approved �` ' �� - ................. ....... ........ �- .-..
Dace
Application Disapproved for the following reasons: 1\
....... .. -..... .. - -=---------------------------------------------------------------------------------------------_--------------------------------------------- ----------------------------------------
Permit No. .----------------j------------- --- Issued -------4�
Uace
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Trdifi ate of Clomplianre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ✓) or Repaired ( )
by -- -----L`_ . ,. - =— '- -�f---------------------------- ---- ---- --------------------------------
In staller
at .. a+P----P,AxT-V_ ....i 1 - c5A-'�_,. .._.M. ¢.5 77`�5 "'l.).lr.�-s.� �"''-°tss. -------------------- ------------------------
has been installed in accordance with the provisions of TITI. of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. /..�� ... .-...... dated ...«
THE ISSUANCE OF THIS CERTIFICATE SHALL N T BE CONSTRUED AS A G ARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY!
DATE----- ------- .��-. 7......_ ----_------_----- ----- Inspector -----------------L1-:�_......... :--.---------. ------ ----. ----:--...----
_ ————
THE COMMONWEALTH OF MASSACHUSETTS�����
BOARD OF HEALTH
TOWN OF BARNSTABLE ��
IN ..1........ // FEE.....................
UWposal Works Tonotrutiou "rrutit
'1
Permissionis hereby granted----------------------------------------------.-----------------------------------•---------------------------------------------------_-------
to Construct (✓S or Repair ( ) an Individual Sewage Disposal System
at No..448 1'�A r ............................. H^t� --=s_,_aNs M_ 1- 5- .
strce?o_
as shown on the application for Disposal Works Construction Permit��JJQQ _____
---••--__-•...._..•-•-•-••-----••-••-•-------•----------------------•••-----•--•••--•--•----•••••---•--•-
Board of Health
DATE................................................................................
FORM 36508 HOBBS Q WARREN.INC..PUBLISHERS
TOWN OF BARNSTABLE
LOCATION (;� �i y�� / /VQ. R _ SEVIAGE #
VILLAGE Atl'/ergs 117,IIS ASSESSOR'S iv1tiP &LOT -_'
INSTALLER'S NAME&PHONE NO. 14�iA ' C,-w s tf �9�
. .
SEPTIC TANK CAPACITY �S t
LEACHIIVG FAC II.TTY (type) e a (size)
NO;OF BEDROOMS
B1;JILDER OR OWNER
COMPLIANCE DATE:
PERMITDATE
f Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching faciliVy) Feet
Ed Wedand and Leaching Facility(If any wetlands exist
i' 'I.4iihin 300 feet of aching faci
Fuinished by
or — ZN
S �
' t
III