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HomeMy WebLinkAbout0211 CEDAR TREE NECK ROAD - Health �211 Cedar Tree Neck Road, �� A = 076-025 Marstons Mills �) 1 TOWN OF BARNSTABLE k OCATION e k �al SEWAGE # S=7// V`YI;L AGE �h�ar61 ohs •mil,/�S ASSESSOR'S MAP&LOT o7� INSTALLER'S NAME&PHONE N0. SEPTIC TANK CAPACITY /ODD L EACHING FACILITY: (type) ? - SDo 110/ Lfi C`i'vff t 65 116 OF BEDROOMS 3 BUILDER OR OWNER PERMTTDATE: 3" — 9— 9S COMPLIANCE DATE: Separation Dist�nce Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet "within 300 feet of leachino facility) ;::lFurnished by �I OS' i r 3 TOWN OF BARNSTABLE LOCATION // eF rLF IVr-Lk RV SEWAGE # VILLAGE Z1 uV I'ohS •&A ASSESSOR'S MAP&LOTS-7-6 - 01L INSTALLER'S NAME&PHONE NO. 1w e-dlz D, ZZAn-0-5 SEPTIC TANK CAPACITY /OBO LEACHING FACILITY: (type) ?-500 b"i01 LF_w,� G'h�iyis� 65 SX 1,5 NO.OF BEDROOMS 3 BUILDER OR OWNER ToM BZI-ee gW-2 PERMITDATE: COMPLIANCE DATE: b' - S"12 Separation Dist nce 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 leachin facility) Feet Furnished by -� r _ 3g, IL 68• a so. n vnap_4 .0 No. ......... ... L Fps .........c........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for Diti-puual Mudw Cnunstrurtiun Prmit Application is hereby made for a Permit to Construct ( ) or Repair ( �n Individual Sewage Disposal System at: Location-Address or Lot No. a IV --�� q ner Address M Iustaller Address UType of Building Size Lot............................Sq. feet ., Dwelling— No. of Bedrooms.-_-__--.-_------------------------..-Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures ----------------•--------------------.--.-----•------------------------ --------------- ----------------------------•-----------••--•---•--•--------- W Design Flow............----------------------_---__--gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity............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 ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ ,.� Test Pit No. 1----------------minutes per inch Depth of Test Pit._.__-_-_____-_-_-- Depth to ground water--_-_....._-_-__--_-_.-. (1 Test Pit No. 2................minutes per inch Depth of Test Pit_-----•--_______- Depth to ground water........................ a ---=---- -----•------•-•-••••-•-••-----•-•----•-••--•••-•---•-•---•-•-••--••--•--•-•-••-•-•-•••-•-•-•'-•••-••--•----......._......--'•••--- 0 Description of Soil................... ... . x U •••••-•.................•----------•--•-----------•---•----•---•-----••--•---•--•--••--•-•-•••------------••---•----•--••---• -- W ----•...---•-------------------------------------------------------------------------•-•-••---.---- ----- - ---- �'`� --------------------------------------- U Nature of Repair or Alterations—Answer when a plicable--.-.. ` `� � .�. o� -------------------- Agreement: S The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance Ywitl 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 Comp 'an e has been issued by he board of e lth. y � �qG� Signed,.... ...... ...... .. - -------------�_ * .. ----------- s .1...�.(..5...... Dgace Application.Approved • =-4" - ......{ e9S.--------- 7 .• Application Disapproved for the following reafonr- ------------------------------------------------- ............... ........ ----------------------------------- ------------------------------------------------------------------------------ --------- ------------- ---- ---------------- ------------------- -------------------------------------------. ......3 .. :.... � Permit No. ..... ... - - .. ... Issued ... -- 3...�..�".`.T.�....... Dare Q 1 Lo THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for Divi-Vttnul urk,s Towitrttrtiun Vantit Application is hereby made for a Permit to Construct ( ) or Repair ( Woan Individual Sewage Disposal System at: . m < Location-:\ddress � or Lot No. (� ,nec Addres s ' a v,i + ...--.._ 1r\ Y S�l. _ J-Lt .�i_�A..... Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms_____________ .___._-__-____-----_.--Expansion Attic ( ) Garbage Grinder ( ) aOther—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__.___---_-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 ( ) Dosing tank ( ) Percolation Te__s��t, Results Performed by-----------_-----_..................................................... Date.........------------------------------ 1.4 Test Pit 1Vo. I................minutes per inch Depth of Test Pit.................... Depth to ground water--___---.._-_.---___-._. fTo Test Pit No. 2................minutes per inch Depth of Test Pit._.-_._-..__________ Depth to ground water........................ --------- ----------1---•--------••--------•-------•------------•---------------........_---------•---------------•------•---•---------------•••--...... DDescription of Soil---------------Q — 1 -- '---------•--•-------------------------_.. ............................................................................................................. D-o--?'----�.f s V}!k 1---------.-.-...-----......-•---•---•---.-..-------•-----_-- U Nature of Repairs or Alterations—Answer when applicable--__ s..��-_. .�_____ X.�. _..�. r .................... �................ Agreement: �-ey5 The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in acc�dan Ice"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 ealth. Signed .../,-`..�....._........ ,�..- .. �L.�e...L���!ll���.--- - - - Daze Application.Approved y- /y .� � .- .............. Dare Application Disapproved for the following reason.- --- ------------------------------------------ ---------------------------------------------------------------------- ---- -------------------------------------------------- -- ------------- --------------------- ------------ ............. ...... ............ ..----�'..._ '" ..y ... .e2 Date Permit No. ------/- � '' E /`.. -Issued ....._......_............... ... ` :r.... Dare a THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE CPrtifirate of Cantylianre T�sHIS IS TO CERTIFY, That the In ividual Se age Disposal System constructed ( ) or Repaired (4 -I" by ----l--.... �(`t,. Z . �' •- `. ...:: ...... .........................._..... ....._... at ....... - ...... ..5�. ? cl-, ,.:..... ll'�`' 1 P-��-� 1` ... 1` �..... ...j_.1.. ------------------------------------------------------- has been installed in accordance with the provisions of TITLE of The State Environmental Code as described in the application for Disposal Works Construction Permit No. dated ....�.. f --r .. ���.�.... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. c� "DATE............................- � . Inspector ..... � ............... ---._.. -... --------------- Tom e>L,4,,ov s- THE COMMONWEALTH OF MASSACHUSETTS �^ BOARD OF HEALTH © � Jl TOWN OF BARNSTABLE � �� No................ ... ....... FEE ....I.........•- a�_unntrns�uan �rrnttt Permission is hereby granted 'c --` ?v`- "^ v� =................................. to Construct ( ) or Repair) an Individual Sewage Disposal System (l at No..._r .a�__..._�'_�° / `J r �l`............=---------- l 'X_1._i(S' Vj �' = strc q as shown on the application for Disposal Works Construction Permi_../�,, ._`_ 1 ..,_,Daateed'__�._'S._�__1. ..... Board of Health DATE....� - -S -•------------------•--•---•------------------�---^-.�----- FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS