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HomeMy WebLinkAbout0093 PRINCE AVENUE - Health 93 Prince Avenue Marstons Mills A = 076 - 035 ; TOWN OF BARNSTABLE V LOCATION Lo-r / FRI�CF R-U-5 , SEWAGE # 77 -- 65- VILLAGEMO-S—r®rjc;� M JL_L� ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. 1� �� � Y321 y2—l11 SEPTIC TANK CAPACITY Cz ) LEACHING FACILITY:(type) �� (size) f 0 NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATERJ,0_10� e _ BUILDER OR OWNER I G DATE PERMIT ISSUED: -?"16 — DATE COUPLIANCE ISSUED: VARIANCE GRANTED: Yes No IN QN �l � t THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH . T J oF.....,.. 1 ..1...... a .................. b � Appliration for Disposal Works Tnnittrnrtiun famit tA tion is hereby made for a Permit to Construct X) or Repair ( ) an Individual Sewage Disposal _ C ................................................ Lcation-Addr ss ..........................................or Lot No. ... .r ' .`. ' ?1 ..-----. -� ----------------------------•--•------..........---- �_ O ner Address W *.......... Installer Address Type of Building Size Lot.......dl___._.jL...Sq-feet- U Dwelling—No. of Bedrooms--._ __________________________________Expansion Attic ( ) Garbage Grinder Other—T e of Building No. of persons............................ Showers — Cafeteria Pa Othe fi ures ........ ................................. - W Design Flow........... ........... -_--_.gallons per person per day. Total daily f ow.. . ....................gn)lo WSeptic Tank—Liquid uid ca acit i. - allons p Len th.10.'- _ idthy'�-::a... Diameter................ De th _._._q..... x Disposal Trench—No---------------- - Width... . Total Length.................... Total leachin area....................s . ft. P q� P Y g �- hm rea....�. ...._s . ft. Seepage Pit No--------------------- Diameter-__-�______.__.___. Depth below inlet _____ ___..__ Total leac g a q Z Other Distribution box ( ) Dosing tank ( ) `-' Percolation Test Results Performed b _. _. = .�� '. `- �f-d ate ___ll a Y-- - . .... .............. Test Pit No. 1....�?=......minutes per inch Depth of eat Pit_9.............. Depth to ground water..-.--•.............. Test Pit No. 2................minutes per inch Depth of Test Pit.-I!.............. Depth to ground wated0Q.11.............. ------•-----------------------------•--•- -F.P.- 1..----....��._..... ._. ....�..... -----.._ - � d: _."..� O Description of Soil .......--••---•----•--- ------------ 0 W ••-•----............................. .1........-------LY / ---�� 1 ._�.� h�! --V-------•V�.--...------•-- 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 iITI.i� 5 of the State Sanitajbe Code—.4ar e and signed further agrees not to place the system in operation until a Certificate of Compliance has _ o of health.--•-----•......................•----------•-------•-----......._..__....--- --•------ Signed...... ._ e/ -----..........------ Date Application Approved By............. ---------------------------------- -.-------- Date Application Disapproved for the following reasons---------------•-------•----------•-----•---------------------------------------•----------...---------•••....... -------------•------••----•--•---•-••................•--........_......--------•----------•---••------•••--------•---------.........---•---------•-----------•------•-------••--•••-----•--------------- Date Permit No..... _-._ ..S.s`�---................... Issued....................................................... Date 1 - 5 5 FEs. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration for Disposal Works Tonstrnr#inn thrmit Application is hereby made for a Permit to Construct X), or Repair ( ) an Individual Sewage Disposal System at: ..........' :� G ::....- '�: ....................... ............ •..........�-.Q- �- ....................... ......... -........ L cation- dd ss or Loto. R ` : ?.W�.------.. 1' ----------------- -----------------------------------------•----- ----------------------•---................. owner Address Type Installer Address &4 �� T e of BuildingSize Lot.��'._o _..�.. _C..._ U Dwelling—No. of Bedrooms... ...................................Expansion Attic ( ) Garbage Grinder ("( _ aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' 0 he4 u es ...._.. d ..........................•--•-- W Design Flow.__.._. ......... ......gallons per person per da�f Total daily 4�gw__._..._.. ....................galloys�� WSeptic Tank—Liquid capacityj.►r�__..Qallons Lengthl0.'"L. Widtl6t_]'.—1... Diameter________________ Depth5! x Disposal Trench—No..................... Width_._.. ..._._...... Total Length.................... Total leaching area......•...�.......sq. ft. 3 Seepage Pit No.....Z.._...... Diameter.._.16_. ..... Depth below inlet_ri.-.7....... Total leaching area ).:,.....sq. ft. Other Distribution box ( ) Dosingtank ( ) Z ng Percolation Test Results Performed byA.� __.'= -��`y�1 '•��vatX/ ..R.. ----------- 1-4 Test Pit No. 1...a;"......minutes per inch Depth of test Pit_9..V..___.____. Depth to ground water..K.-/--------------- (4 s Lt, Test Pit No. 2................minutes per Inch Depth of Test Pit..+f_�.............. Depth to ground water } _....i,�......_._____ R+' ................-•...---.----• Description of Soi1Tle 6 •••••. .. 7 .s S - ��,..._.... �.J� = W ��--�--•-�b---r- '1' ' C'� .... ---1� `"-I...I----G 5�:��..� �� v 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 TITI,% 5 of the State Sanitary Code— The and signed further agrees not to place the system in operation until a Certificate of Compliance has be y oar of health. 3- Signed...... ---.---- � Date Application Approved By.............. _Z...2. ............ - .... 7 Date Application Disapproved for the following reasons:.............................................................................................................. ......_..---••---•••......---•--•••-•---.....--•••--•-••----•------••----...--•-----••-------•••-••••----I---•------------------••-----•-•••-••-•-••-••-•••-•-••-..................••---•--------•--...._ Date . r Perms ..................... g Issued--------------------------------------------------•---- 4 Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 04 ... �px .............OF........... . .............................. Tatifiratr of Tomptianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by......................M.......... -•-------------...........---------.......-----•-•---•--.....---•-------.............................--•--•-•--------.....-- Installer at...........L. _ .....1f--,(....... arc. .,,. ----- : -------------------------- : j-----------•-------•--------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.... 6--- dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......................... .. Z -------------------- Inspector......................_: t--. ....------....•....................•........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH n LG-�->...........O F...... _. ..t.,. c�,X�> ............................. No....��j']....�,� 5 FEE.-,r�-...v .T Disposal Works Tnnotrnrtion amit Permissionis hereby granted------..... .--;..... ................................................................................ to Construct or Repair ( ) an Individual Sewage Disposal System at No..,A.--- ------------- .M / j�_y�.a,. �°.4.--.... ................. ..�..../-K/-'Street -•-•----------.....----•------ ------•--•--•-------......-•---•----......_. as shown on the application for Disposal Works Construction Permit No. `j):/.�_57Dated.......................................... ..............................._ ......................................................_ 3 � /G` Board of Health DATE --- -- .---. �g FORM 1255 HOBBS & WARREN. 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