HomeMy WebLinkAbout0139 RIVER RIDGE DRIVE - Health 66at- 06-1--012
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TOWN OF BARNSTABLE
LOCATION �'lt- (2 -AVER �iW= �j SEWAGE
VILLAGE ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO. irkk 3r
SEPTIC TANK CAPACITY , 0 0
LEACHING FACILITY:(type) �� (size) 1 004D
NO. OF BEDROOMS 7D PRIVATE WEL OR�UBL�ICWA�TER�.
CBU:I:LaDE . R OWNER 4 C-LA t, I
a
DATE PERMIT ISSUED: g
DATE COMPLIANCE ISSUED: y/
VARIANCE GRANTED: Yes No
391
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No...... -1 Ar F�s......� ..
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
TOWN OF BARNSTABLE
Appliratiou for Uispnattl Work's Tomitrurtiutt Frratit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
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Sys......Ptrl_...t :.....1� `:.. 1� � - ......................................................2 ` ` .•.......................................
at* n•Addre r Lot No.
L
lJ ... ....... ------------------------------------------- •----_------------------
er ,J —i/ .Address
a -------------------•--- t._ G a.._.._.
Installer Address
d Type of Building Size Lot...
._ �...Sq. feet
Dwelling—No. of Bedrooms---- ;--------------------------------Expansion Attic 010) Garbage Grinder (//cJ
Other—Type e of Building C�4��lJl No. of persons............................ Showers p., yp g ---•-•-•-• p ( ) — Cafeteria ( )
a' Other fixtures --__-.---__-•------••-------------
-------------------------•- ----------------.-..--•---
Design Flow•.............•- • g P P p-- ---y - --- -y gal
W �1�__________________gallons per per day. Total daily flow__._.__.....�__.-�._�__.____________._.___ Ions.
WSeptic Tank—Liquid capacityMM.gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No. .................... Vidth.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing nk ( )
Percolation Test Results Performed by...... - -y .. 7..................................... Date......�`•-�`-AX
�•� .......
Test Pit No. 1___�a___minutes per inch Depth of Test Pit.................... Depth to ground water..��:__ .......
L� Test Pit No. 2................minutes per inch Depth of.Test Pit---:................ Depth to ground water........................
Description of Soil...... _. 1.2-04
__ i
x
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 -----• -e - -= - qlrj.c�x-------
Application Approved By --------------0\4'.w1---- 'c- --=� ..._/..:�,.--C.-7.----Q-i�-
11 --'------....-...--.....----'------..-...---...--".................---- Date
Application Disapproved for the following reasons: --...--"...........................................'--"-------- ........------........--'---....------....---'-'.'-------------
/ Date
PermitNo. � (Qf6........ ................" Issued ---------------------'- ' ................................
Date
No... . ..�. -A, � T _ Fx$....... ......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratiou for Dispuiti1 Work6Tomitrartions ami#
Application is hereby made for a Permit to Construct (1/) or Repair ( ) an Individual Sewage Disposal
System at:
..I ....... -•- . ..._..__.-:�-••-_-.. -•-�-- ---------•..................................................
Lo,t' n-Addres ) or Lot No.
(I n 0_1 er ,p Address
Installer Address
Type of Building Size Lot.....................lo ..Sq. feet
Dwelling—No. of Bedrooms........`3_____________________...........Expansion Attic V/p) Garbage Grinder
91.4 a Other—Type of Building �( �_ No. of ersons............................ Showers
g P ( ) — Cafeteria04 ( )
Other fixtures 5�-;- 3
W Design Flow.................1_-.._-..................gallons per per on per day. Total daily flow...........-�--_J....................gallons.
WSeptic Tank—Liquid capacity)jM.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 /, �1..--_y_! Date-----_�o l._Yc._°�
Test Pit No: 1_.._�a...minutes per inch Depth of Test Pit_________________ Depth to ground water___1
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a
x . Description of Soil-------I�C,Q T/ ...... 1�.....................----------•-----------------------------------------------•--------------------•-------------•-----
U ----•---------------•--------------•-----------•.....----------------------•---------------•...------....---------------•---------------•-------•--..............._....................................
W ----------------------------------------------------------------------------------------------•-----------•--•-------------------------------------------------------------------------
U Nature of Repairs or Alterations—Answer when applica.ble...............................................................................................
----------------------------•-----------------------------------------------------------.....•-•------------------------------------•-----------------------...----- -------------_..........
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 .......... Ems` Cyr ` - �DDa-�g
A lication Approved B --- -------------------------------------- ---------------
PP pP Y ................. � - ----1..'.-. -a
.� Date
t°3 Application Disapproved for the following reasons- - -------------- --- -----......................................................................................................
....................................... ---------------- ----------------------------- -------------------------------------------------------------------------------------------------------------- ----------------------------------------
Date
Permit No. .-.........�� f-16-------------- Issued 1..�..-..� 7....-.c ..
Dale
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
T&Miftctt#e of Complinure
T,-IS,IS TO CERTIFY. the Individual Sewage Disposal System constructed ( V ) or Repaired ( )
by �J .= ....... ............. ..r... .........
Installer
at ......c -'f ��= `-� � � ................................ ..-...----------------------...----------------...------------------------------------------------------
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. .........ZI-----e..M.......... dated ................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE............. ....... 1_.. ...... ---------------------------------------- Inspector............. -..---,--d .>------.......--------------.... ----------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Disposa kii Tonotrur#' n ern�it
Permission is hereby granted......��-_4 _-- --•- -_-_.-.--
y --------------------------
to Construct . vl�or Repair ( ) an Individual Sewage Disposal System
t� --------••---------•------------------------•--•............
Street ec3�
as shown on the application for Disposal Works Construction PeP No.._.l l _ Dated. .......................................
1 � ._�. -
r .C�•f' �' Board of Health /
DATE......... ----- ---'�-/-----'-•-�/--•,. -------•--•-••-----------------
FORM 3650E HOBBS&WARREN.INC.,PUBLISHERS
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