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HomeMy WebLinkAbout0956 RIVER ROAD - Health 956 RIVER ROAD T MARS'1'ONS MILLS A = 045-010-002 G TOWN OF BARNSTABLE q LOCATION 9& ��04er ,(� SEWAGE # VILLAGE%sS� 1�t \�j ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE.NO. �JW SEPTIC TANK CAPACITY 1�� �G�� x (I�C� Rt LEACHING FACILITY:(type) � � PC (size)( NO. OF BEDROOMS PRIVAT WELL OR PUBLIC WATER—Jprj BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: '"" VARIANCE GRANTED: Yes No �/ Sty s�� � � �� u p a s� �w �tl I� � -� l�� p t �[A —00 10 or;, �qy � � No.............1 'fi9VE@ I j FI;:s...................... HE COMMONWEALTH OF MASSACHUSETTS IVY OAeRD OF HEALTH TOWN OF BARNSTABLE App iratiun for i uu 1 urku Tomitrnrtiun Urrmit Application is hereby made for a Permit to Construct ( ) or Repair (/) an Individual Sewage Disposal Sy j ..................... .�. adt.................................... ................................................................................................. Location•Address or Lot No. ..sr�-0_'{� _._ s�o. ............................................... . ... ----•- ------......----------•---•-----------j-------......--- re, a S.JS.1.4.1 ` `Q O. /� C—s.( e W✓✓<J� .. 1 l ae�/t Ad .... f ......................... Installer Address d Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms----X...............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ------------------_---_--- No. of persons............................ Showers ( ) — Cafeteria ( ) 04 W Design Flow•Other fixtures // -a -_gallons per person per day. Total daily flow-----------------------------------------gallons. 9 Septic Tank—Llquid capacity(..aD.....gallons Length---------------- Width................ Diameter..._._--.__--- Depth................ W Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. x 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. 1----------------minutes per inch Depth of Test Pit--------__-_----_._. Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ a -••-•-•--•••----------------•••••-•----•------•----••-••-•-•••-•-••-•-•-••-•-•-•---•----------------........................................................ 0 Description of Soil......................................................................................................................................................................... x t., W --------------------------------------------•-•------------•_.-.------,----------..---------------•----••---- " Y _.._ ....__ _ V Nature of Rep or Alterations=Answer when ap�licable..__. f/. ....... ......A... ........ T. __. a• ......... ^'L---------------------------------------------------------------•-•--•----. 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 Compliant as been issued by th oar o ea t Signed ....11` .. .................... Dace Application Approved B ..... ... ``. � / ....................... Date.....-....------ r Application Disapproved for the following reasons: ...................................... ---------- ---------------------------------------- Permit /y No. ... ....... `.. ✓ ----- Issued ........ .v'0....... .....Date...... Dare No........... ........... FEB... ........1.....F! THE COMMONWEALTH OF MASSACHUSETTS yBOARD OF HEALTH j TOWN OF BARNSTABLE �J Alili ration for Dtriputial rlt�" n t �r r#tnn� eruct# Application is hereby made for a Permit to Construct ( ) or YZepair (V) an Individual Sewage Disposal S .� s�..... . ..................................... ----------•--------•-----••-••------------•--------- ---...---••-------------....-----.......-- Location-Address 'l or Lot No. =---------------------------•-•--•-•--- ...................... S.0 ------•---..-----....-----...----..._........----................. o1 le,- p� Address --.5�_�� ---- ----------------------- ----c ---......-- �-�n CZc�_..._.� .�c.n .� ---------------- Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.---_, _r__ -------------------------Expansion Attic ( ) Garbage Grinder ( ) `4 Other—Type T e of Building No. of persons............................ Showers — Cafeteria Gar YP g ---------------------------- P ( ) ( ) alOther fixtures ------------------------------------------------------.............-................. W Design Flow.................................ff.....__--gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacityf.00--_--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 t N I suits Performed n Test pi o. ch Depth of Test Pit-------------------- Depth to ground water........................ (% Test Pit No. 2................minutes per inch Depth of Test Pit-------- ........... Depth to ground water.-.--_----_-.__.__--_--. 1:4 ------------------------------........................................................................................................................ ..... 0 Description of Soil-----------------------••-----------.-------------------------------•--------•-----.....-----------•------------------------------------------------------------------ x 10 U .----------------------------=------------------------------------•-------------------------...----------------------------------•------------...--------•--------------•-•----------•-----....--•--•.... W ............................. ------------------------------------------------------------------------------- 7 ------------ . U Nature of Repairs or-Alterations—Answer when ap licable.-.- .fJ_ ......_I......A. �� !_ n.5..(---__--.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 Compliant has been issued by th oar of-l—iealth. Signed .......... Law �- Dare B Application Approved ...... .. ��� -.... ...... - ...� 7-�" 5;; Dare Application Disapproved for the following rVasonr: ........i--------- .......... . ... . ... . .......................... ------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------- Dare Permit No. .... .... --- - ✓�.--------------- Issued --------� '`� ...................... Date ---------------------------- -------------j--------------------_---------- THE COMMONWEALTH OF MASSACHUSETTS i BOARD OF HEALTH TOWN OF BARNSTABLE f Cer#ifi ate of TomyIiance THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired ( ✓) by ....... C=c>�...\�`-t/` ---- ------ ------------------------------------------------------------------- t� ('� Insr.Jler ,�> ......... .�..u�� ._....... ! C�------------------- ------ -------------------------------------------------------------------------.--------------------------------------at ........ 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. _' .,5;/�--_ datedFAN�T�E .�.....le THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE ONSTRUE AS A GUAHAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE ............. '''.........._.....--------- Inspect .._:....... - ! .--.•-.. . .._.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH , -T- TOWN OF BARNSTABLE �, No._...�....--••-• FEE........................ Riip l Nork.5 Towitrudiott f rrutit Permissionis hereby granted----- = Z` ---------------------------------------------------------------------------------------- to Construct ( or Repair (IL/) anindividual Sewage Disposal System atNo.-•---- � .s P .......(Z-G1.................................................................................................................................. 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