HomeMy WebLinkAbout0014 PEONY LANE - Health Pay "e ,
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/00!�eTOWN OF BARNSTABLE
LOCATION�j /;r zm� 466::� SEWAGE # lv
VILLAGE -rg-P-S' H, / S ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO. 11 Le.� � 13��� �Od v9 -77.—
SEPTIC TANK CAPACITY �� c
LEACHING FACILITYA ype) � (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED: �7
DATE COLIPLIANCE ISSUED:
t
VARIANCE GRANTED: Yes No
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF _HEALTH q 3 - ? - i A
..,��.w�-....... OF.......... 1.�1S lr. .�C.. .....--...............................
ApplirFa#iun for Di-quual Works Tonotrnrtiun ramit
Application is hereby made for a Permit to Construct (x) or Repair ( ) an Individual Sewage Disposal
System at:
.. �,✓ !,'ice .7 ............................... •I-o T /7...........................................................................
Location-Address or Lot No.
.....................ZeUMA....1 .�...5;�►�. ! ................................ ---1� r?n. �f Z_eaa ...............................................................
® Address
/
Installer Address
dType of Building Size Lot.....1_f:1.1.?-.7-_------Sq..feet
Dwelling—No. of Bedrooms...... ........................Expansion Attic (4/0 Garbage Grinder (.U.)
Other—T e of Building No. of persons............................ Showers — Cafeteria
aOther fixtures ...................................................
W Design Flow...................................:3__..gallons per person per day. Total daily flow----_---------_--- 3�............gallons.
WSeptic Tank—Liquid capacity.1 gallons Length_4_1.�..-4".. Width-A-—0"_ Diameter----,— Depth..5__!g.4-.
x Disposal Trench—No. .................... Width...--............. Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No......�........ Diameter.....i o......... Depth below inlet........6......... Total-leaching area....ZS Z..sq. ft.
z Other Distribution box (;r,) Dosing tank ( )
Percolation Test Results Performed -----_•----.-.-•-----.-•.................... Date-----7`.?/_�, C..................
aTest Pit No. 1------ .......minutes per inch Depth of Test Pit-------1Z...---. Depth to ground water......
Test Pit No. 2..... ........minutes per inch Depth of Test Pit.................... Depth to ground water... -------
I H
sTeP
Description of Soil....0. 2 �, 7�,00 r y�1 �r � - ----- -------- ------ -- ------- -------- -------- --------- �---•-•ALL YN
-------------------------------------------------------•--•-•---------....... _.__.IAItLSON
W �No:30216.
••-•-------•----------------- --•--------••••--•.•-- ...... Q
UNature of Repairs or Alterations—Answer when applicable--------------------------------------------•.-----.-.-..-----.-.-.-.--.-- IS4
N
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in acc dance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system 'n oper tion a Cer 'ficate of Compliance s been issued by the board of health.
Signed ............. - - --- - ------ ----.. ...--- - - .... .......----.. .......�..--------.......----7--
Date
Application Approved By ........... t... . ---- --- -..... ------�
................................................... Date
Application Disapproved for the following reasons: ............ ........... . . .............. .. .................. . .. .. .. ............. ................ ..
.... ................................................................................................................... ----------------Date.---...-..........
Permit No- --------- --- - ;,
....-..�2 ��...... ............ Issued ....--.......-- --------..
Date. .......................................
S kv t"• ^t�P -
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Appliratiun for DhipasFal Works Tonstrurtiun ami#
Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal
Syysste�m, at:
Location-Address or Lot No.
.........................:1.:`-.I:.�s.:1... ._:_...:3}.'11 i 4l ...�,.�?r j.. ...�C_��:C�............
Owner Address
a •.................. ..••--•-....... ..... •-• -;-..... ._... ...................................................
Installer Address
QType of Building Size Lot_.../l .l_7?..._..Sq. feet
U Dwelling—No. of Bedrooms-__. ........•.............Expansion Attic Garbage Grinder (44)
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures ------------•--------------••••--••-•--•--•••-•-- ....
W P q P Y r t g Length
per day. Total daily flow......_______......_- Q............gallons.
� Septic Tank—Liquid Li uid ca acit ..i�*.*. .gallons per Len th__ '-�7... ``i �• Width..'.k..":9_t?.. Diameter...:.......:.... Depth__:?.._._.....
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No...... -------- Diameter......1.0--------- Depth below inlet.......... Total leaching area....A5 7..sq. ft.
Z Other Distribution box (XQ) Dosing tank_( )
Percolation Test Results Performed by.... .......................................... Date___--gzll?C_._._............
Test Pit No. 1........ _.....minutes per inch Depth of Test Pit-------A?....... Depth to ground water......
Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_. or
R+' •-•••-......•-•-••----- ---•-•............................•-----..............-•---....----•------....---------•------•........--- PHEN
O Description of Soil.... . 2.__.�._aa ��!a c��%__._ ..
W`�' ._..._..--•--------•-•-----...----�?'�==!-�°---r..._��.c.c�.lsi:^'a-----='r•,:�s��-�--._.....---•-----------•--.._.-----•-------••-•-•---•-••-------•----........ ....alVJi.SOJ�i
No.30216,p
•---------•----------•--------------•-•---....---•-•--•-•---------••-•............ •-•••-••----•-••----•--------•---•---------•-••---••••--••--..................••..........
UNature of Repairs or Alterations—Answer when applicable........................................................................ �lSx
Agreement: oq
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in actor ante with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system 'n oper tion a Cer 'ficate of Compliance has been issued by the board of heal .
/ Signed ` -
Dare
Application Approved By ......... --- ------- "---------------------------------------------------- >"
Application Disapproved for the following reasons:. ....-
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ....................................
Dare
Permit No. --------��. - �.'� u ......... - Issued ..---- '------------------------- -- ------------------"--
Dace
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.............--.......... OF-- -_---.-----'---'.."lf-----.a-°�.� �.�-----------------------------
Qlvrtifiratr of C11-0rayliaare
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( 3 ) or Repaired ( )
by .......... y -----�Q-'' ,�- °�
Installer
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. ....... .0 -_..4------ ..tt,,1�.---- dated ................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE ..�6NSTRI7AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE'.. ''` . . �� _ ------------------ -------------------- .. '---------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
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..........................................
No...... .�.:� � FEE.. .........
Uiopusal Work.5 %nnotradmp pamit
Permission is eby granted...._ .'�.._.~ . �....�......:...... ._.:.._ a'q �' r ''7-
s ice'
to Construct ( or Repair ( ) n Individual Sewage Disposal ystem
Street
as shown on the application for Disposal Works Construction Permit No.�-?, � _.. Dated..........................................
. •---- . ------
�i _ Board of Health
DATE............. ...............................................................
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS
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