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HomeMy WebLinkAbout0129 BLUEBERRY LANE - Health I r` TOWN OF BARNSTABLE ACATION. � i-� : '„ SEWAGE VILLAGE _ 1(Y� ° 1k S ASSESSOR'S MAP & LOT .j0 L^ �' INSTALLER'S NAME & PHONE NC jL�o_ �a3 tf-c SEPTIC TANK CAPACITY LEACHING FACILITY:(type) , (size) l NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WAMER- BUILDER OR OWNER ct C ) 4 C. t DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: 7 VARIANCE GRANTED: Yes No N-l� 9� v r3c� ♦o La C � T ION SEWAGE PERMIT NO. VILLAGE INSTALLER'S NAME 6 ADDRESS S U I L D E R OR O-WNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED 64, r z1. l(T l9V Q s r k r r� FFims. ..........�.�......._ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH �. .. .--•-- ---......OF......I.JP ................. --` t................................... . ppliratiou for Di-qVagal lVarks Tonotrurfi it Vantit Application is hereby made for a Permit to Construct ( ) or Repair �A an Individual Sewage Disposal System at* .............. ...................� .._.R 1..,t -..- ' -- ...... ..- - a �-� l Coca ion-Ad ress t or Lot No. VIM ---- Installer Address Type of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms.-_..._._._.�.........................Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) p' Other 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. 1-_--_--_-----.minutes per inch Depth of Test Pit.................... Depth to ground water---_-.---_----__-..-.--. rX Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 -----•------------------------•------•----------------------------.............:....._...'-"--'---'------------------------------------- -'--- -------------- 0 Description of Soil........................ .�1-__ ---------------------------------------••-------------------------------------------------.............---- V ...........................••-------•---'----•------------------------------------•------...---•-•-----•-••-•-••----•-•'---•-•-------••-----•••-••-------•-----•----•-•----------------•---------•---•- W x V Nature of Repairs or Alterations—Answer when appl�ble .-... ..-. .. .^---------- _S.. - ��____________________ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TTL:p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b9T issued by the board of jjhealth..Q� q Signed.. -------1 -�`...-------••••-•-----. ....... . Application Approved By........... ....... _. e Date Date Application Disapproved for the following reasons:.................... --'----•--•----•...................................................... ............_ ..-------'-----------•----------------------------------------------------•-----------------------------.•-----••----•--------•------•-•-----•-•---•-----------•----------•.••••-------•--••••---------- Date PermitNo.-----. -------------------- Issued....................................................... Date o FEB,.. ................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH L' ..... .........._....OF.--- Q` ... �._ _.o _... Appliration for Disposal Works Tonstrnrtion thrutit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: 1 ................... ......................•.`.............-�c................. --••-•.....�-------------- t�9 ,.� r �-� �. . . ........- -• a � Loc tion Addres 1 or Lot No. \1 Owner A ess Ls7 G� r `x�w XA .... � .... �►� ------------• 1--- - Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms........... ..........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) al Other 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. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Li, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •-•-•---•----•-'------ • • ••-•---•'--•------•..............•-•---•-•---•....................................................................... ...O Description of Soil--------------------- �.. :-------------------------•-----------------•--------------------._...------------•--------------------------- U ----'--•---'••--•-------••-•••••-•••••-'•-••'•--'----'-•-•-----'••-•••--••---••'•••---••--••---•----......•-•-•--'-•----•-••---------••"--•••-••-•-'•-•--••••----•••----•-•-••--•-...........•---'----- VW - ---------------------------------------------- Nature of Repairs or Alterations—Answer wen app bl Yale.`._:___ .�...................... iN Q w l7 !9 lnA.!! ._ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT.: 51 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has issued by the board of health. `�j Signed.. '------� ..... _"" .. 9 /T ? l Date Application Approved By...-....2__i.... ........ K��""'°"" ---•--- ------ -------- -------------------- ----•-------------- f Date Application Disapproved for the following reasons:-----••-----------------------------------------•--•--....-----------•------•--••-------------------............ -------•-------------------------•-----------------------------•-•--'-----•-----------•••-••-•----------•-••--•••.....••--•••••-•-•---•••-•----•-•-------.............................................. Date PermitNo...... ....... -------------------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH ...................1..`..f...............OF.......�......�' -....................�.. .�.................. C9rrtifiratr of T-amplianrr THIS TO CERTIFY, That the Indi 'dual Sewage Disposal System constructed ( ) or Repaired'(} y �': = ( Installer t 1 ....... .... r r L -` 1� has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..,a 7_'...m�...l•�.a'._...... dated-............................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................. r:. tS.7............... Inspector....._..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H ALTH NO .7.�.W!l. 1.4. ........................©F.._...... .- ........................_.. FEE........................ Disposal Wor s Qonstrnrt' n err it Permission is hereby granted. ---• ... ................ ........................ to Construct ) or geplair an Individual Sewage Dispol System ....................'-,... --- - ------...••... ....................................................... Street as shown on the application for Disposal Works Construction Permit NoF2tK/,$... Dated.......................................... Board of Heaith 1 DATE................ ------•- -•-- .--------••-•----••.••--- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS