HomeMy WebLinkAbout0221 CHUCKLES WAY - Health 221 . Chuckles Way �
101-128 Marstons Mills
TOWN OF BARNSTABLE
LOCATIONv2ZI /,-1 SEWAGE #
VILLAGE ASSESSOR'S MAP & LOT 101
INSTALLER'S NAME & PHONE No. jz , ✓ d �ti.5/ ��5��'. C `
SEPTIC TANK CAPACITY /lf:�:50 D
LEACHING FACILITY:(type) EGN ST/�i T' (size) /a OCa-fir
NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER T✓z/`G
BUILDER OROWNER. -
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED: Lo lrvq
VARIANCE GRANTED: Yes : *No ��
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vco THE COMMONWEALTH OF MASSACHUSETTS
� 1 ' BOAR® OF HEALTH
TOWN OF BARNSTABLE
P CO; Applirttttun for UaupuuFal Wor u Tonstrn.rttun runfit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System !
1.... .. .................A. ./As �'
ddress .................•••............ Lot No.
Owner Address
Installer Address
Type of Building Size Lot----------------------------Sq. feet
t.t Dwelling—No. of Bedrooms._..--\sg.............................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers — Cafeteria
a' Other fixtures .._......_.
W Design
Flow............................ allons per person per day. Total daily flow............................................gal
lons.
WSeptic Tank—Liquid ca acit DOj allons 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 Test Results Performed by.......................................................................... Date........................................
1.4
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water---------------_..........
44 Test Pit No. 2................minutes per inch Depth of.Test Pit..._................ Depth to ground water........................
Descriptionof Soil................... -----••--•--••••. ... ... --. ---• ------ --------•---------......----------.......-------•-•-•-•----------------
U --------•------------------------
---- --- -•----
.....................................................
W
.............. ...................... ........................................................................................................
U Nature of Repairs or Alterations—Ans er when ap icable...............................................................................................
--------•------------------------------•---•--------•------•---•--------------------•-..............----•-•...--------•----•--•---------------•--•------------------------------..................•-----
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 .%rther,agrees not to place the
system in operation until a Certificate of Comp s'been isssss ed by e ar of la t
Si ned ........ . . ..... G
g .............................:: . " ... Die
Application Approved By --- . .... . . l/......//�.----'-- '- ............
� ................................. �� �� l
Application Disapproved for the following reasons: .........................................------------------------------------..........................................................
. . -' -"----'---.......- . ...... " ...' ' ' " " " " ............
f� Dzre
PermitNo. ------ --- --------------- --' ...... ........----......-. Issued ----------------
Date
No./.-- Fss........ D�
J, THE COMMONWEALTH OF MASSACHUSETTS
<t + 2, BOARD OF HEALTH
l
` TOWN OF BARNSTABLE
L
.Applirttfiun for Diipug al ur s C�uniirnrtiun ramit
Application is hereby made for a /P�errmit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System ....` !!!.l. ._ j G .... .........................................
. ddress or Lot No.
............ ��S. .. .............................................
..----••-•----------..•.
Owner ---•........................................Address
Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms... Attic ( Garbage Grinder
a g ) g ( )
p� Other—Type of Building ............................ No, of persons............................ Showers ( ) — Cafeteria ( )
P4 Other fixtures ........................ .
W Design Flow................................. allons per person per day. Total daily flow............................................ Ions.
WSeptic Tank—Liquid'capacit}00 alIons 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..........................
Gi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
W ------------------------•------._....----••-----------.•-•-------------.---••......................................................................
Descriptionof Soil--------•.............. ... .......•. --- --.•.......... •• -- --. ---- ------ ---------------•-----••----......----•----------------•--••-•••...---`
`x
U ..
Wx -------------------- ----•---------------- ----------------------------------------------------------------------------•--•------------------------
U Nature of Repairs or Alterations—Ans er when ap icable...............................................................................................
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 Complia. as-been issued by t e boar off .i
Signed ....... E}... G ---- ------._� ------ . - --
ApplicationApproved By ----------- --- --- --- -- ------ --------- - - -------- ------ -- -- - ---------------------------------------------- ..
re f
Application Disapproved for the following reasons- --------------------------------------------------------- ------ -- ------ --- ---------------------- -
................. . . :...... ................
Dare
PermitNo. .. .. .......... Issued ---------------- ------....----------------...---.-- ----------
Dace
/ ' t
r/ THE COMMONWEALTH OF MASSACHUSETTS
li BOARD OF HEALTH
TOWN OF BARNSTABLE
Tertifi ate of Tomplianre
THI S TIFF, T t .' id e sposal System constructed ( ) or Repaired ( )
by.............�. �� ... .. . --- ---------------------- -
I taller `
at . It-.... . - -,a-- rni -
' f -----------
has een inalled in accordance with the provisions f T LE 5 he St onmental d in
the application for Disposal Works Construction Permit No. ....... ....
! dated .... --
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARA TEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. ✓ d + r
DATE 1 .iL --------------------------- Inspector
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
f TOWN OF BARNSTABLE
No........ ....... FEE...��. .—
Map
Permissio ' hereby granted--------- - -= .. ------ ---------
to Construct ( � A ft%or ep ) • d�i`�'d 1 S . rage osal y t
at No. � I 1 ice/ + --street r / .-/......
as shown on the ap lication for Disposal Works Construction Per rt o..r.,( _._�_ ._ Dat --- � .... . .. ..
.!.... .. .
........................ .. ...... -----------•-.
r
DATE-------- - ------ - --q-�--------------••-----•----------... Board of Health
FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS I
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