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HomeMy WebLinkAbout0156 OLDE HOMESTEAD DRIVE - Health i �� 0L.& 140we s{e-64 I©(,(,j r TOWN OF BARNSTABLE Cv" LOCATION bQro't SEWAGE # �S—�� 4,V, ILLAGEASSESSOR'S MAP & LOT04.2STALLER'S NAME �;:PH_ONE NO. 1 L= (y0/yr " ?7l-ft/?_q SEPTIC TANK CAPACITY`''.- J,pd D LEACHING FACILITY:(type) (size) goo NO. OF BEDROOMS — PRIVATE WEL OR PUBLIC WATER BUILDER R OWNER DATE PERMIT ISSUED: 3�-Z•31 9 3 DATE COMPLIANCE ISSUED: S,L 1-23 VARIANCE GRANTED: Yes No � i 1���-'�- �� 3� so ��� - �� � _._ ,, 3 60 THE COMMONWEALTH OF MASSACHUSETTSa / << BOAR® OF HEALTH TOWN OF BARNSTABLE Appliratiun fur Ui►ipwial 'IVurit,q T nutrurtiun Prrutit Application is hereby made for a Permit to Const*uct ( or Repair ( ) an Individual Sewage Disposal System at AZ .............•--- ...D r � � r L.C(' /is - ........ �rtt'.n- d�nj�•ss�qJ�� .......... .:_........ c.V._r!i •-------- ••----•---- ------------------------------------------------- Address ,/ t Na //y�/ acne/ ------------- ------------ Installer Address UType of Building Size Lot.. 1 p........Sq. feet �., Dwelling— No. of Bedrooms...........______-----------____________.__Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons.__.-.___---_-__•-______.___ Showers ( ) — Cafeteria ( ) d Other fixtu ------------- ••-------------- •------------ --------------- W Design Flow................ .........___............gallons per person per day. Total daily flow......__ __......_....__.._._...__gallons. WSeptic Tank—Liquid capacitt 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 Test Results Performed by.......................................................................... Date........................................ 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........................ O _ ..--•• t ... .......... �,�`'d .............y,.....-• �7... -------_:. --••-� �`_...__..... Description of Soil �' ..._.. .f.��� 01`" ...... ............... x UW ••.••••-•-•...............•------•--...•---•-•••--................-•-•-•---------------------•---•-------------.._.........----......---------•-------••-•-------•--•--••-••••-•-•--•--................ 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 Environm- tal Co e—The undersigned further agrees not to place the system in operation until a Certificate of Compl• e h s n • sued by the board of health. Sig ....................................................._ ........................_................. ........... .................. Dace Application Approved By ...... ......... ----- ......................... .... .......... to Application Disapproved for the ollowing reasons: ........................................................................ ........................................................... ........................................................................................................... ........................ ................ ....... . . ... ...................... ................ ........................ Date PermitNo. ...... . ........ . ............................ . . Issued ................................................................... Mm 1_— �i....���.++may'.r•--.rv^""t..�..._�i'^:.-.--'--1-�-.-..�^--•"`-"+�+-.-w,..,�•,r��a..+...-.-....�....J-1{"'�"'"`+..r•.:--...-...•ti..:.�`�-..-._-._.,��.,�w �..._-..-...:-'-w.r.�.--...-••^-�..+-_._`.t... .....`.,..��....yam.. No................._....... FEs..- ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration fur Diripwial Wurk,6 C ontitrurtinn amit Application is hereby made for a Permit to Const uct ( V,<Ortepair ( ) an Individual Sewage Disposal System at: _ l ----. ...---•_.._ ... ._.....---•--•-•- r........................................................... Location-Address of �,ot No. ............................................... 51----------------------- r��t'!`' �l�/l�..................................................... O�cncr '•'� ' W,a .................................. Add ��<v -�� `.1 .- •�-!--------•---- ----•-.... ------ - -- = -•-----------------••--•----••---.......---•----ress Installer Address UType of Building i/. 3 Size Lot..,1 f ........Sq. feet f ..� Dwelling—No. of "Bedrooms---------______________________-------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther'fixtures ----------------------------------------- W Design Flow..................7J._. ................gallons per person per day. Total daily flow........... ........................gallons. Septic Tank—Liquid capacitl _gallons Length________________ Width................ Diameter---------------- Depth................ W Disposal Trench—No. .................... Width.................... •Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No.......... .......... Diameter.._.. -__-_-_- Depth below inlet._.____________ Total leaching area..................sq. ft. Z Other Distribution bbx ( ) Dosing tank ( ) Percolation Test Results Performed bY-------- -------------------------------------•----------•----•----------- Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.,.................. Depth to ground water........................ 0-4 lit Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ . . t✓cI _.... D Description of Soil-•---�-=.0 �L-1 � f l� �� � ........... - U --•---.....----••---------••---------•--•-•------•.......................•-. -----•...------•---•-----•••---------------...--•-••-------•-•------.._...•----•-•--••-•••-----•---•---- W x ..............-----------------------------------------------------------------------------------------------------------------------------------------------------------------------•------------------ U 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 Co#—/,The undersigned further agrees not to place the system in operation until a Certificate of Corn liar ce h s kden i§'sued by the board of health. Signed��- t Date Application Approved By ............. ---- -------- ....... ( .......... .................................. �.........D e.........��.. Application Disapproved for the following reasons: . . . .............................................................. ......................................... ................................................................................................................................................................... .......................................... ........................................ Date PermitNo. .................................................................... Issued ................................----.---............................ I Dace -----=ate - -----.mod=a---_...--- -- - - -- - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE TPrttfttrate of Q.1, �t2�ztCE THIS IS TO CE TIFY,.That the Indi�ddual Sewage Disposal System constructed ( v) or Repaired ( ) by . f ft=.�._ �G'u 2 -- ---- - ---------------.- ......... .._._...............................'. -..................../ Tt,uet e. .. at ................../..:.>.. ...... G- .......: '1 fr'< G' 1.. � .`� ........OC..� /` -r-- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ..---- .3� .......7f._--------- dated .._...-............... THE ISSUANCE OF THIS 5ERTIFICATE SHAH NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION S�AT(SFACTORY. ° 0 DATE ...... Inspector .. r------ -------- -- - ` ......... ....... .... ---:_-----_„_-- _,----- _,---- _---_--,,_— ----_ -- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No.... ............. FEEZ............... Uisposa fork,/i Tonstrwrtion ramit Permission is,hereb ranted______.. -�l�`? rl-.___.__ f_:�-'-:��� ��._r�'' Y g -----------------------------------• ........ to Construct (I/) or Repair ( an Ind• idual Sew,- e Disposal System at No............... 1- /C'-/fi/ --- �' >]/ .� �� Street as shown on the application for Disposal Works Construction Permit No �?'"f Pl'_-____. I,�ated�=________________ DATE...... ....................... Board of Health .-- ---•-••------ --•----•----•-- FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS is cb 47),AF-C% 2bPL FUG +UC`. .�.c -( ; .. 3% %tb'K - 3� ES t�D' y ;� /'ter' F-TER j. ► 10 1c 1509'v 49$ zit- �i SULLIVAN. 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