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HomeMy WebLinkAbout0544 ROUTE 149 - Health 5 r� t 4 i 9 Lk _.c�'au. 1,�5_ FLLN ��� OCg�RD _,� _ NSSAB E� A- ,..,�, �, �. d K, �} 5 V f . — �, f� � �: i h E r✓ TOWN OF BARNSTABLE LOCATION Lot �-3,`✓ Ste`/��� �1�/ SEWAGE # 9Y- 9 VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. v�� SEPTIC TANK CAPACITY law \ LEACHING FACILITY:(type) j0 i ¢ (size) �A( NO. OF BEDRO MS ,� PRIVATE WELL O PUBLIC WATE BUILDER O DATE PERMIT ISSUED: 14, DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No e a / i 0 � a o , s No.. .... ..........q . t� AMOM THE COMMONWEALTH OF MASSACHUSETTS SarnstaWe Coneortizda ngr4 BOARD OF HEALTH .......... ........................OF...... Apptirafiffft for Disposal Works Tonstrurtion rantic Application is hereby made for a Permit to Construct Repair ( ) an Individual Sewage Disposal System P A525- _ AfW;;' 1M_6-7 ----------------- --------- or o. ........................ ........Abc ' ............................. .................................................................................................. Address ................ ............... _htz� .................................................................................................. PQ aIn�stall�er... 10.2:2 Address d Type of Building Size U Dwelling—No. of Bedrooms------------- -------------------___--__Expansion Attic (416 Garbage Grinder (A/� �_l PL4 Other—Type of Building ............................ No. of persons__........_._........._____. Showers Cafeteria PL4 Other fixtures -------------------------------- ---------------------------------------------------------------------------------------------------------------------- Design Flow...............5.5... gallons per person Xer day. Total daily flow-_._.__.....3-SO..................olops. Liquid capaci L .11b Septic, Tank At; gallons Length--- Width. ./ - Diameter______________ Depth.y.'6 capacity.4-lo. --------- Disposal Trench—No..................... Width.................... Total Length....___............. Total leaching area....................sq. ft. Seepage Pit No------I------------ Diameter.....W- ....... Depth below inlet.....Ll.......... Total leaching area---U�Z...sq. ft. Z Other Distribution box (v*r Dosing tank ( ) \1 Percolation Test Results Performed byA124R7iW.A46_,4!A-1.............��Date.......677/ Test Pit No. I.......Z......minutesperinch Depth of Test Pit----1-2-/....... Depth to ground water..M&V Test Pit No. 2................minutes per inch Depth of Test Pit............_.._.... Depth to ground water....._..._.........._... aj .............i---- ......... 0 L6----------*------ ­�...........*"*........**---------*---------------"------------------------ Description of Soil...... ..............20�w.t.. //.................................................................................. ..................5".5...... ....... - ----------- - -------------- q-7.j ------ . ... -----------------�Vb......WA .......................................... .............. Z I .......................... .... ... —Answer when applicable------------------------ M ..... U Nature of Repairs or Alterations --- .......................m...... U ........................................................................................................................................................ ............................................ 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 h been ..sued the board f health. Signed ............ . ......... .........a--------------------_---7-- ---- ---a......................... ......4.6-- Application Approved By --- -------- ...... .... .. ..... ........ ...... ... ...... ... ----------------­-- ..... Application Disapproved for the following reaso . __---------------------------------------------------- ....................._-------------------------------- -------------------------------------- ...................................------------------------------------- .. ................. ......./...... -----------------6;.................... _1 0- ---- - --------------_--_- Permit 0. ........ ............................ Bsued ..... ----- ----------7 --- -- ..i N ------ . .. .... ... . 4 is F + No........................ . a Fzs........................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OE HEALTH ......................Gl OF..... 1 (r ,s.. ApplirFatiun for Diaps al Works Tonutrnr#iun ramit Application is hereby made for a Permit to Construct (�r Repair ( ) an Individual Sewage Disposal system t: ,�- /` � .� L c�,�/n d'��s� or Lot No.•--------------------......... -` .... ��� ..----• ..... ...---•................................•--•-•- ••----................. --•-• a ���...C©A�l..1 Address . .. Installer Address z. d Type of Building Size Lot. ./,../....................-�-•'feet U Dwelling—No. of Bedrooms-------------- _-__-Expansion Attic 0,1) Garbage Grinder (•/4'D 04 Other—TYPe of Building ------------------=--------• No. of persons............................ Showers Cafeteria a Other fixtures ••-•-•--•-•-•---•---•--••-•-•-•---•--•--••••-• . •.----••••----••••------••••-•-•------------•------••-••..... -- (-----)- W Design Flow............... re_...............gallons per person�pey day. Total daily-__ow............3 ...................gallons.s. WSeptic Tank—Liquid ca acitY/� gallons Length-- Width..Y../©fl. Diameter________________ Depth __`��_'. .x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit NO------I------------- Diameter.....!©____.___. Depth below inlet..... _.......... Total leaching area._.Z P7_...sq. ft. z Other Distribution box ( t,< Dosing tank.( ) j a Percolation Test Results Performed by f :...._.... `r_ t ?��..". r ' `'��'. �`ID Date....................................... Test Pit No. I..... -..._._minutes per inch Depth of Test Pit...j._�_. ..__... Depth to ground water. `&�4.:_.__. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----------------------------------------•-------.....---------•---•----. •---------•-•---•---........................................................ D Description of Soil...... at�l.... ..%' f ......... U -..�. -----------------.......---------------------......-•-•-----.....--=...-•-----------.1._l......................................................... -------------------------------------------------------------•-----------------------------••---•-•------•------- 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 ...............5 ----- . .........A....... --' ---------------------- � ApplicationApproved By ...... .......... .. .... ............................... . .......!... . -- ............................ --- Application Disapproved for the following reasons: ........ ...... .................................... .. .......... . .............. .. ................... ....... ---- Dare Permit No. Issued .10 . .... .................... . ............................... Dace THE COMMONWEALTH OF MASSACHUSETTS /)(/ �/� BOAR/POFHEAL /T I ----------- L/.9�t1.'u ---- OF -- ....................... Clertifirate of C autpliance TH S I- TO )CERTIFY, That the , dividual Sewage Disposal System constructed ( Y) or Repaired ( ) b c°T_A at ..�..... p.'.' ------J� /.// .......� ... ----------�4.�- t . .. ----........�� --------�P / -- ler---------................................................-------......------------------------------------------- has been installed inaccordanc w(th the provisions of TITLE 5 of T e State Environmental Code as described in the application for Disposal Works Construction Permit No. ---. r- dated .. ------------------ ---- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE C NSTRI-�D AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-------€ ` ".... .. Inspector 'e" - ........ THE COMMONWEALTH OF MASSACHUSETTS - ... ..BOARD ®FWET..4 ..... No..�.. •-•------ iu�ruu�tl A. 0 . ............. FEE. . .............. urku Tun tr r r it Permission ' hereby $r,anted.---------- . -•-_.. ... ................................. to Construct or .pat n liv,�4ua g p at No...... ...........7 /........ - - -- -- OXY ....... 1 Street as shown on the application for Disposal Works Construction Permit No.. ... ......... .. Dated.......... ......................................... ... --------••----••••----•-••-..................... oar d of Health � -.A _DATE--- . . FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS --75.5 70 I 77 o 5 � 3 s X z-s �yo :.'Az 79 _ �! :.. / . �._.� ' _� ��. .. � I .Ire !_ ._T. i7�-•. CO �¢3, > ,�.<;,..�. - -i- - ij -7070 , .. I j 1 ' f S. i I i ! i I i I I • _ rh-v /"'�� 4 , Mc,�n� �L J, a-✓�/n/� -/j 7� -,77 i �✓'� / \�,/� \\�-�+Tr� J. (1 1. .t 1..y ,; F i ( f.,..f �.k ..'. i -J _:1-- .j � I * �.L.I t..,..4LID�t , � _t �. , _, -'r d T. 27 o �. "78 77 1- I c--k>a\/LL t i r t f 77 . OV j 1 . ! 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