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HomeMy WebLinkAbout1139 RACE LANE - Health La 7 a� Y _ G TOWN OF BARNSTABLE LOCATION �13� R�� GaV�, SEWAGE VILLAGE �'qgCS65 ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY l j�-00 LEACHING FACILITYAtype) l, `- A4of5 (size) �6 x I� NO. OF BEDROOMS ]/ PRIVATE WELL O PUBLIC WATER BUILDER OR OWNER P-0 gl/S'c� Q)y'6d i�, ca. J�� ; a DATE.PERMIT ISSUED: l� DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No i 7 r� z-3' of t No ...�.. �a� 47 Fas...- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for Diri.pn!3ttl Mirkii Cnunitrurttun Vautit Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual Sewage Disposal System at: �n 0.....2r�e....................................... ................... ---- ........-----------------------•----------- Lo dress _. 1� ............................................. .......... .... .----....----------............---•--. a .SYSC✓-..-/--------- Address -•---.. --_^..__.-----•.......................... ........... V -- -•---_...._..........._............_..._... Installer Address /; % _3 /�/ q Type of Building Size Lot..__..................... .Sq. feet Dwelling— No. of Bedrooms--------------------------------------------Expansion Attic (Vo Garbage Grinder (60) p`4 Other—Type of Building -t�"�?-. No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures ------------------------------- - - d ------------------------ --------------------- --------------------------- Design . ._ . ----.•_._gallons per Imo' per day. Total daily flow..............:3.___._............_.._....gallons. W Flow �/U 3 WSeptic Tank—Liquid capacitv------------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 Resu is Performed by-------------------------------------------------------------------------- Date........................................ ,a Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ (1 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...--_-_-----__-.-_-_--. f�: r ---- O Description of Soil....... ..... ............ W 1 �� ----•------ --------------------------------------- ------ --- ------ ----------------------- "......... U --•--•------•••---••---••••-••--•-••--....•••---•-•-•---•--•--••••••----••-•-•-•••-•--•---•........•-•-••••----------•-•---•----•-••----••-•---- W -------------------------- ----------------------------------------------------------------•-------------------------------------------------------------------------•--------------------...••--.--••-- 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 Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed � �-- . -------------------------- r j................._. Dace Application Approved B '�'�� PP PP Y r .e............. � Application Disapproved for the following reasons- ------------------------------------ - - ........................ ....... .. .................................... .. ................... ........ .........._.................... . -- .................... . . ............................ Date Permit No. ... Y...r`. [f.....� ----------- Issued .................................��--. . Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ,� lirttti�vn f0f-Diivilpasal lRathB Tomitrnr#ion ierntit Application is hereby made fora Permit to Construct' (✓) or Repair ( ) an Individual Sewage Disposal System at: .............. .. ..................................................... ---- .......----........-•----..---........ Loc lion A dress of - t Nn ( (� Owner a '� f ............................................... ---- -••-Address-•-----•--•................................ 1_/ / Installer Address /-(..6 fIG � Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms........3-------------------------------Expansion Attic (n/O) Garbage Grinder (4(,t) aOther—Type of Building/ .t No. of persons---------------------------- Showers ( ) — Cafeteria ( ) 04 Other fixtures ------------------------------------- --- ---- -- g -gallons per pe�xs� per day. Total daily flow............................................gallons. W Design Flow.................. ... 33 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 Resu is Performed by........ -•---•-------------•-••-•••-----•---------••-•--•----•......•-•-- Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water..:._. G14 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ f� . D Description of Soil.......=• -='4----• a.... �... ...... ........ t x W 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 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 the board of health. f Signed . �^�. -� ,_..G� ...... ............ Dare Application Approved-By -.. � '-------------- � ......�. Application Disapproved for the following reasons- ---------------------- -------------------------------------------------------------------------------------------------------------- ------------------- --------- ----...............----...--------------------------------------------...-----.................-------------.....- --- -------------------------------.......... ........................................ Date Permit No. 1�Issued ................ .�.:y( Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cfer#tf rate of Compliance THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ✓ ) or Repaired ( ) by---- ---Installer at --------- //3 9 t9CE Z_Ir /✓F' vYJ /3'!a-Z 5 ....................- ............------.----------- ------------------------ ---- ---------------........._....---------------------------- --------------------------------------------- has been installed in accordance with the provisions of TITLE of The State Environmental Code as de cribed i the application for Disposal Works Construction Permit No. �. - -../.U�D dared .... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BC�CONSTRU A A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE----------- ..- '---� ..... ....... /....--` --------------- Inspector _.....----:---------- _- ---. ------------- ——— --_ --.----- -- — ------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No.. TOWN OF BARNSTABLE ` �1. FEE ...................... DispofiaLlUorkii Tiamitrudion Vverntit Permission is hereby granted.....`.0 /��Z l 5 COL L C to Construct or Repair ( ) an Individual Sewage Disposal System at No... ------"'i4C ...... /$kjE 1-H M (I-" --------------------•--------...-----•-••-•---•-••---•-•••----------•-•--•--------•-- ............................ str ae as shown on the application for Disposal Works Construction PermiyN�' ,'1�-y',� Dated-- DATE.......... -'J- 3.•-`-.----- .y..----------••-----------•-- - Board of Health FORM 36508 HOBBS&WARREN.INC..PUBLISHERS 41 _J OV R l E-: �\ 9 -- -- - d EL IV A- - l�f Ys'ne N L � J t , t { 3 /ALL 4 MAY, wAZ+Z AT lD, ��� 1Zu�.(bF� c'S tZEGM26�t7 / ,f 7 , i ?2D en St.D S F L 1 i i....A.I t— t=�aCG W 11}4 Clc C E t n\TE7 ki \\, \ '•, \ p \ \ our. 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