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HomeMy WebLinkAbout0129 CHUCKLES WAY - Health 129 Chuckles Way Marstoos Mills A=IN—127 1 y i 112� TOWN OF BARNSTABLE LOCATION_�d 1 ��^VL��S �'Ja� SEWAGE #�O y VILLAGE 1n^�ii�?°`^S �^ 5 _ ASSESSOR'S MAP & LOT��/Z INSTALLER'S NAME & PHONE NO. �.' �t'S�d�� 77("(0 4 SEPTIC TANK CAPACITY d ud'U S LEACHING 1~ACILITY:(type) LCc� (size) dd , a Q61 s NO. OF BEDROOMS 13 PRIVATE WELL O PiJBLIC Vlr'ATER BUILDER OR OWNER�S� \"7J►�d�U� �d DATE PERMIT ISSUED S-, qq(D -- � DATE COLIPLI.ANCE ISSUED: VARIANCE GRANTED: 'Yes No Cr T C� Y co # Fxs.....� ....`.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �.01.)�. oF.......lA.� sAc -L ..................................... ApplirFa#iaan for Uiapaaaaal Warks Tomitrnrtion ramit Application is hereby made for a Permit to Construct (V�or Repair ( ) an Individual Sewage Disposal System at• ........... ...__......_..........Cl :u� .........old.. ...... --....-'----'-----...---.._.......-'----... 7................................... o ."o AddreS�,, ... .... • .......... ............................................ .•-- ----I............... .....-'------................................. . W O ten' 01 Address Installer Address d /J - �®l Type of Building Size Lot..... feet U 13 0-4Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder (✓Oj) Other—Type of Building No. of persons________________............ Showers — Cafeteria aOther fixtures -------------------------------------------------- - W Design Flow..................... 5...............gallons per person per day. Total daily flow........................__139 ......gallons. WSeptic Tank—Liquid capacity_1900-gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No............6--------- Diameter................ Depth below inlet...... ......... Total leaching area..... &.sq. ft. Z Other Distribution box ( Ll! Dosing tank ( ) , q aPercolation Test Results Performed by----------BMT .m.......4 .... _14�6------------------ Date..........S.."'.LL."°lR...... 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........................ ............................................- .............................................................................. ODescription of Soil------------------------ �� �9 M�1.-- ... 11_�--------•--•----•-••----•-------------------------•---------...........----- U --------------------•---••......------------------. -L--- fat,► ......1 .----------'---------------------------------.................------------. W --------------------------------------------------- ��----- .........A.sD.-----..�0,uno........................................................................... UNature 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 ' pera 'orb,until a Ce 'ficate of Compliance been issued e board of health. ' �' , L Signed ....... .................................. _� rU...--------------------------------- ---------- Date Application Approved By ............. ....Z) ..e...'.f.7-`.% Date Application Disapproved for the ollowing reasons: ............................... .......... ....... ................................................... ------- ......... . . .............................................. ... .. . . ................... ....................................... .. ... .. .. ................ . ...... ........................................ 2 Date PermitNo. ------ --�..-- - Y....................... Issued --------.................- ------------- --------.........--... Date No---14 L.& FEs...../.. G.... ....: THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............tOWO.......OF........ 1A! �".'_L_ .................................... Appliratilan for Diipaas al Warks Towitrnrtion a mit Application is hereby made for a Permit to Construct ( ? or Repair ( ) an Individual Sewage Disposal System at: // oc n Addres�: �./.�....... ». ........ ... . •. (.�. ... ..... .... -- I of a --/.S •••.. ..... ....................... O ess - . •----.�.. ..............•---•-• -- Installer Address dType of Building Size Lot....- t-001......Sq. feet U Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder (�✓C)j Other—T e of Building .............. No. of persons...._.................. Showers — Cafeteria aOther fixtures --------------------------•-------••---•--......._.._.... W Design Flow...................... .` ..............gallons per person per day. Total daily flow.___._.....................- Q......gallons. WSeptic Tank—Liquid capacity. 99Q�gallons Length................ Width................ Diameter_-.--___--___- Depth................ x p .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.----___--_[_.___.... Diameter.......... ...... Depth below inlet_...._......... Total leaching area....'_ �...s ft. Disposal Trench—: o. � P� P g q• Z Other Distribution box ( Dosing tank ( ) aPercolation Test Results Performed by_ ......Bhoroz-....,!n. ................. Date__ ..... '. a °f . ,a Test Pit No. 1...... ...minutes per inch Depth of Test Pit ...... Depth to ground water--------------.......__- f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------------- .............. r...••-••---- --------------------^----..--------------^^--------- •---- •----.•------------ ODescription of Soil........................ J. A; ............t ='�....:..... .---------•-----------------•-----•----•--•--•------•--.-• x •.. . 1 � ' h .•-•- i t_' c, 1 - -- - ------------------------------------------------------------ W -----•---------------------------------•---------------- =� �--------------- _c�. UNature 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 ' pera 'oFnl until a Ce 'ficate of Compliance been issued e board of health. ` � Signed 1a ` Date e Application Approved BY ---------------- ------- /!� ....................................... Date Application Disapproved for the following reasons- ................. ------------------------------- -- ------------------------------- ------------------------------------- . -- --------------------------------------------------------------------------------------------------------------------------------------------------------- -- --- --------------------- ---------------------------------------- Permit No. ( --�-� ---------------- Issued -------------------------------------------------------Date----- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ------------------I:.. `.W..Q.---- OF ------- �. et.----- Cfexttftxax#P of CITomyXta ttre IS CERTIF , hat the Individual Sewage Disposal System constructed ( �C ) or Repaired ( ) by-L�� �` . ----------------------------------------- c7 /�� Installer at1- ----------------------------------------------1//------ --- ....------ -------------------------------------------------------------------------------------------- has been installed in accordance with the provision of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .--.../ ..:-....-... dated ............................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS RUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-------------------- ---- - - -- -- ---- -- --------------------------------------- Inspector .. ---------------------------------------................. .....--- ---- ----- THE COMMONWEALTH OF MASSACHUSETTS _ . BOARD OF HEALTH CC�� .....OF.....................................................................•-----......... No...,!�' � FEE.-•••/ .............. i ran 1 rk strudion rrntit Permissionis hereby granted �---- -------------•-------•---------......-•---•-----------...........---•------•-........•-•-^•... to Constryact hx) or air ) an In vldual Sewage-Dis o al stem at No. ....7---- .fir`............... -- treet as shown on the application for Disposal Works Construction Permit No._ ..:_31�ated.......................................... ��� ----------------------•-••---•--- ---_--•� ................................................... Board of Health DATE..................------------------------------ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS Slt,.lGt� �oivMtt_�•{ - 3 �31�Tzao�vC , ' LP uo GArranG� Grit�.tn Qp i7dt t-.�( Flow a 1 tC• ,c 3 • 33b G.p.D, (oti � T-lG.-T• !K =. 3O,r ISO.% * A- �7 i USA- l oOp 6l�t-`• f Q` ,`V i .� 15Pos et_ PIT - u5E toQo --- �Cl�ac/At,.L AeEA• = lSo S.t=. �/ ,.;j. / G�J � � .•- — IG�O S-75 G.P.D. _._._.�$�iTOµ..a1Z1.-�•T'- ,tip-�-. ... /� .. i TOTAL -C:>ESl6w ToToL; valt_-t" Fc.aw:= 33O6.W. b -7: PE>-1GbldTlOtJ CZATE ; 1"Itj 2�trtttJ•Otz Lass. j . . � ' ZN of ,�,�, •�, T' 3$. � � ' < \' y CSC ,- PETER G� � \ RlCHARD ';,�LSULLI I Ilk BAXTER No.24048 Pdo..29733 Sp. � ' t �D 10NAt..E IN �4X Top 7 Fu o t o ., -,X, . 0 %,1 :�Y sv3sotL. �f'P/pe loon 1w. luv.• c, Z 4 lW- GAL. a6 6Aoy tuv f '8cx 6G G T- K lo' �i• (000. GL tuv luv • y Q GAt.. . 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