HomeMy WebLinkAbout0723 RACE LANE - Health 723°Race Lane
. A 103—096
Marstons Mills
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TOWN OF BARNSTABLE
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LOCATION r ;�a � - 't SEWAGE # ��'�-�
VILLAGE �''`����ti ASSESSOR'S MAP & LOT 163-O
INSTALLER'S NAME & PHONE NO. ; . � 0�_ L29 7
I _
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) fur- (size) 2 r
t / t S ► �
NO. OF BEDROOMS_.. PRIVATE WELL OR PUB IC ATER
BUILDER OR OWNER A711
DATE PERMIT ISSUED: �("�..� �I
� t
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No tl-/
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THE COMMONWEALTH OF MASSACHUSETTS
A"RO.VW `OAR® OF HEALTH
tea G�oevartmc
^� TOWN OF BARNSTABLE
txtt tli i-spnou1 Works Tomitrartinu Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ()) an Individual Sewage Disposal
System at:
Address �� or Lot No.
...................... .__........_.[./.___.._.._..___._._......._......_._....._...._... __._.._...__._.. _.---........................____....._.....__1 .._.._.
14-
Installer
� Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms................ .......................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers
a YP g -------------•-•------------ P ( ) — Cafeteria ( )
Otherfixtures ---------------------------------------•----•--------------•-•-•------------------•-•-----......•--------•----------•••••-••-.......•---...----------
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity_______-----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 ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
fX4 Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................
P+ --••----••-•----------------------------------•--•-•-•-•---••-••-•--......-•-•--•--••-......._...---.........................................................O Description of Soil................................................................................................................-.......................................................
x
U -----------------------------------------
•-------------------------
-_.--------------•-------------------------------------------------------------
•------------------
-----------•-------••--------
UW ----------- - - ------------- --- ----------------- ----- ------------ ----- -
Nature of Repairs or Alterations—Answer when app icable____._A/3_Y_/t -_-___-Z -- �
ld7.� , - 7`--4 .----.4- �"'-----------------------------------------------------------------
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 Compliance has been issue by th oard of health. p
Signed ....................... y�. -.. %��. C Z
------------ --------------------------------
A lication Approved B �' ✓
PP PP Y -------- ---------------- ------- ...............-..............-------- ...
Dare
Application Disapproved for the following reasons: .............. ....................... ..---------............................-...............................
------------------------------------------------�......-------- . . -------------....---------- ----....--------------------- -................................................................ .......................................
Permit ....No. / �'.... �� � e
...... .... �.--.....--- Issued ............. -- ---------------- ----
Dace
r I �
/el :3 c�
THE COMMONWEALTH OF•MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
r A;ipftra iou for Uiipniia1 Works Tomitrur#ion rami#
Application is hereby made for a Permit to Construct ( ) or Repair (,') an Individual Sewage Disposal
System at:
7;a3....,. ....... -... i .............. �� r... ...........-.._.....-----............._.
fjocarioz�Address - or Lot No.
.G-. L� .. .......................... `' �'= ,..............................................................._..---
owner Address
Installer Address
Type of Building Size Lot............................Sq. feet
I—I Dwelling—No. of Bedrooms................2�.__-------•-._.__.__._---Expansion Attic,,( ) Garbage Grinder ( )
aP4 Other—Type of Building No. of persons............................ Showers
YP g -------------•-•---••-----•- P ( ) — Cafeteria ( )
Otherfixtures ......................................................E...............................................................................................
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............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........................
a •••-•-•-----•--•-•••---•-•-----------•-----•-•----•----•---•-•-....--•-----------------------•------..................-•--••......._............---•••.......
0 Description of Soil........................................................................................................................................................................
W
U Nature of Repairs or Alterations—Answer when applicable_____-lxl..�. _.�....../2zv•...�?A 1•--..._.7,qluoz�
1 a
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 Compliance has been issued by thc�board of health.
Signed ---------------------/.. -------------...............
re
Application Approved By ... ..... ...:21. .c. ... -----------
Date
Application Disapproved for the following reasons: ................................................. ---- ------------------------------------------.....-----------------
---------------------------------------- - -------------------------------------------------------- --------------------------------- -------- ------------------------------------------------- -- ....................................
Permit No. -- ... '� ................ Issued ........ `......./"
Date
THE COMMONWEALTH OF MASSACHUSE17S
BOARD OF HEALTH
TOWN OF BARNSTABLE
Cez#tfirate of Tompltttnre
THIS IS TO C RTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (� )
by-------------------- N l �--N.tP
� �.. ....
------77 /� ,�/J� Installer yyJ
at !.. - f�i -------------------------- ( ' �l i << _! .................................................
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. ..,?,.-...,'....�"-, .-. dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.....................z-----:y--_)..- z .... �n------------------------------------ Inspector -------------�...--------------- ..............................----------_-------
/ 1 .J d1 \/
THE COMMONWEALTH OF M'ASSACHUSETTS
BOARD OF HEALTH
Gay TOWN OF BARNSTABLE
Disposal ,_Works Tonatr ion rrutit
Permission is hereby granted......� _¢X._. -c� ...................................
to Construct ( ) or Repair (� ) an Individual Sewage Disposal System
atNo.---• 2_---z: .....� 5 —. . . .................................................................................................................
Street
as shown on the application for Disposal Works Construction Permit j7o,' Dated.._ _
-• .
Board'tFIea1tH
DATE-------------------------------•--- ---•-•--
FORM 36508 HOBBS&WARREN.INC..PUBLISHERS