HomeMy WebLinkAbout0025 RASPBERRY LANE - Health I a2-090
TOWN OF BARNSTABLE
LOCATION ` SP lam- SEWAGE
VILLAGE ,� I� ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO. el
I
SEPTIC TANK CAPACITY VQ-0
LEACHING FACILITY:(type) (size)�x -- 1
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WADE&
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
�o�
THE COMMONWEALTH OF MASSACHUSE17S
BOARD OF HEALTH
...�j C1W....-sw....o ±f `G
Appl ration for Disposal Works Tonstrudion 1rrntit
Application is hereby made for a Permit to Construct ( ) or Repair ( can Individual Sewage Disposal
system at:
Location- s Y Lot No:-
.c1.1�1[L .Y.._ ....................... 5 -W ... ...._..........._...._.......
Owner ddress
G••:-_•�•••" ^1c-V ..lt67 ............. .�.` �l. 1. ................................
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms.....�---------------------------------Expansion Attic ( ) Garbage Grinder ( )
py Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures ............... ..............................•--
W Design Flow............. .......................gallons per person per day. Total daily flow......I L', _._.....................----gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length............ Total leaching area...................sq. ft.
3 Seepage Pit No........I........... Diameter......(.D`-...... Depth below inlet-._0c........... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
1.4 Percolation Test Results Performed by.......................................................................... Date........................................
1.4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
0-4
f4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a --------------------------------------------------------------------------------------- ---------------------.........
0 Description of Soil........................................................................................................................................................................
------------------------------------------------•-------------------•-------------------------......--.........-----------------------•--•-----------..........-•-- ....................
U Nature of Repairs or Alterations—Answer when applicable...... K(a....... `T............ .`..�� te�
........ P. 5tir •-•• ..........................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iI'A LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of he .
4SigZn . . .........
D e
Q D`ate
Application Approved By... ----••.......-•-•----•--...--••--•--•--.....---•--••••-•.---•- 8
Date
Application Disapproved for the following reasons:..............................................................................................................
...............•--------.....----------------------------.......----.....--•---------------•-----•-----......................--------------•-----------•-------------------------.......•--•---•••-•••---
g� Date
Permit No..61: 1$8............................._.-_ Issued................-•-..........................-•----...
Date
.r
_ � s
333 No.___LIJ --. Fas..... Q.
THE COMMONWEALTH OF MASSACHUSETTS '+
BOARD OF HEALTH
............ ....0F........ .. 1 . ................
Appitration for Disposal arks Tons rnr#inn jrrmi#
Application is hereby made for a Permit to Construct or R (') man Individual' Sewage Disposal
System at:
Location-Address - t No
_,..... G 1r�G 17Y�t� S�vt*.........................................._.....
Owner J
Address
a .......PY `,..A LC.t0-.=Y. -• .!:.................• .....w................. ....................... ...._............• �
Installer
T of Building c ?�: � naaress f.`- r ", , a
Type g Size Lot.............................Sq. feet
aDwelling—No. of Bedrooms.....��..................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No, of persons............................ Showers ( ) — Cafeteria ( )
QOther fixtures -----------------•-•----------------....-•----.............---------------••--------------------- ....
WDesign Flow.............a ..............gallons per person per day. Total daily flow_.....14_ C ....................gallons.
WSeptic Tank—Liquid capacity............gallons Length...:............ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No........I----------- Diameter......!.0t__..... Depth below inlet... xt........... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................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 - -
W ----------
-........
-----------------------
.------------------------------
--------
•-••----------
------
•---------------------------------------
••-------•-----•----. ---•--------------------
x -----------------------------------•------------•--------•--------...---•----- ..------•--------•-•-----•---------------------------------------•----........--- ........
U Nature of Repairs or Alterations—Answer when applicable......1 .._ ._2�_ ....... `�'T1.c,w.... ..-.. l �
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iI'PiS 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued��byhe board of heal
gn - - %`� ' - .............. ------- -----
Date
Application Approved By... 7A1&_tZ//W/, - '`^
v ..---••--•-----------------------------•--•-..----._
Date
Application Disapproved for the following reasons:--- --•-------------------------••-•--•----------------•---•-•---------------...-•-----•-------..............._
r
.....................•---•-•-•----•- •--•-••-•••-----------••------•••-----.........-•-...••••-----•---•-•--...---••-------•---------•-----......-----'----------........----............................................
Date
Permit No...Xel:'3 R.................................. Issued.........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTHY ,,
1 .V` ........OF........ ..)NYZ..VV.C. \. ...........................
(9rr#if iratr of Tompliam
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
r
by................................. 'A... :�-.Mtx�t ...... ....•` " .....•.........•................................................................_.........
Installer
at.............................. .....I.SZ-21 All.se tr_C- ....� a.z�--__-------------••------•------•-----•---.-------.---•-•----------------------•--------•-
has been installed in accordance with the provisdions of TITLE j of The State Sanitary Coe s described in the
application for Disposal Works Construction Permit No.....�f__�?lY............. dated..-.���/��►'�.___......................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. ,£
DATE................................................................................ Inspector.................... ..........................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
-2/�p 7Ta:��..OF.....��.. YZVt1 'C„ .�........................
/ �. FEE 2
Disposal Works Tons#rudion . rmit
Permission is hereby granted_.... .'.fl� �:"..1�.�..�.....
to Construct ( ) or Repair (V an Individual Sewage Disposal System
t ` IPrt `cam+\r-2�
at No.:•...................... . .. .-•--- ............,,.. .. .-�r`i - ....- .... --_----------- ' ..........
Street
as shown on the application for Disposal Works Construction Permits No.4�--.173- S&-__ Dated..�A/
/,,..n.,.._
................Z .....-- ...........................
Board of Health
y t/-
DATE..... ^F= c ----------------•-................................