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HomeMy WebLinkAbout0012 STALLION WAY - Health �o � - a --.,— --- -�f- I SMEAD a ' KEEPING.YOU ORGANIZED No,10334 2-153L MADE IN USA GET ORGANIZED AT SMEAD.COW LLL 5� tL TOWN OF BARNSTABLE LOCATION LA � 7 �7 ko w,- SEWAGE # VILLAGE ASSESSOR'S MAP 6z LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY (d00 1 a«aa f LEACHING FACILITY:(type) Lectc�. (size) 1,0-00 fft(tov,1 NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER '&artf;-4 %014�5 (0, 77!—dgq DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No let to 13? i 1 601 No.... :. ..L F�s........L©.d........ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE 00 Alip tratiun for Dispoli ai Works Tonstrurtiun tirrutit Application is hereby made for a Permit to Construct (1/) or Repair ( ) an Individual Sewage Disposal Syst at ...... .`�. ........................ y = - �. --- ..... ----........ oc on ddre �� No ..``w......... •.............. .......... . --- --- •-••- ----.------•---..--•--- er � ddress .. „ _2�a............... ...---.....------......................---- Installer Address Type of Building W(V(�j> f:211 nijr_ 3 Size Lot..... q. feet �-, Dwelling—No. of Bedrooms............................................Expansion Attic (t/d Garbage Grinder ( ) aOther—Type of Buildin No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures ..............•-•••--•------•----- W Design Flow...................f.l�_..._._.._..•.__gallons per per day. Total daily��flow___........ _..._................._gall gallons. WSeptic Tank—Liquid capacity/OOV.gallons Length__ __6.._.._ Width.` __..._._.__ Diameter________________ Depth........... x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area................-...sq. ft. Seepage Pit No-------l------------ Diameter.._.. -_- Depth below inlet...4P--.f-........... Total leaching area,:�,16 77...---sq. ft. Z Other Distribution box ( ) Dosing t nk ( ) Percolation Test Results Performed by...__.CAL'4. �.............................. Date....._.................................. Test Pit No. 1....4«L.minutes per inch Depth of Test Pit.... ........ Depth to ground water..WL641,....... 44 Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ 0 Description of Soil.....C_.__ --- ---- - -------------------•---------•--------------------------------------------------------------------- ... 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 Complia has issu by the board of health. Signed ..--- -- - --- ---------- --- -------+....................------ --........-----..-. Date Application Approved By -...--.-- 7... Date Application Disapproved for the following reasons- ............................................................................................................ --------------------- ........................................... ------------- -- -- - --------------------------------- --------------------------- ---------------------------------------- - -- ----------- .................------------------ Date PermitNo. ......7 ........... S.-rf,--------------- Issued ....................... ............................ Date .� lv 7� a No....1s _: .5.1 Fic$........Z �........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Elispos al Works Tnntitrnrtion rantit Application is hereby made for a,Permit to Construct (V) or -Repair ( ) an Individual Sewage Disposal ----------- -------- ----- - -------- /� Address -,�— br Lot No � . / � -��;----- ............I------------------------ --------- P-_e'�� ..___-------- .._...__-..--------------------- ;� w,er Address -- •---------------------•---........----_...._ Installer Address / q d Type of Building L�OOD �2 INS - Size Lot____________________________S feet Dwelling—No. of Bedrooms____........................................Ex ansion Attic 4) Ga ba e Gri der _ P ( U) g ( ) aOther—Type of BuildingaJ_1°i-l :_. No. of persons....______4-______________ Showers ( ) — Cafeteria ( ) Other fixtures ................... ' ------------------------------------------•-------------------------------------•--------------•---------- W Design Flow...................//"0.______________gallons per person per day. Total daily flow............. - 0......................gallons. WSeptic Tank—Liquid capacity-�0Q.gallons Length._._(1_____ Width_`?(_1 ..___ Diameter________________ Depth_,5.__...._____ x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------/------------ Diameter...../Q......... Depth below inlet...6............... Total leaching area_—Xn2......sq. ft. Z Other Distribution box ( ) Dosing tank ( ) W Percolation Test Results Performed by........ ..!..: �:?�______�______________________ Date.................................... Test Pit No. 1_._.'�_�_minutes per inch Depth of Test Pit....�.y__....... Depth to ground water_.M�_____- 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ............ - -•----•-••••--•--•-•--••••----••••------•-•--•-------------------•---------•----•----•--••---....••-•-•-•--......----•----•----_- 0 Description of Soil..... Q___`,?_,4, - '1-------------------------------------------------------------------------------------------------------------------------- x U --------•---------------------•---••-----•------------------------•---------------------------------------------------------------------•-------•---------...-•- W --------•---------- ------------------------------------------------------------------------•--••-------•-•-••-----------•-•------•----•--•-----------••-•------•-----•----•-••-•---------•--•-_------ V 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 Complianee has b e issu by the board of health. Signed ..---- ... _ --------------------------------------------- ------------------_----------------- Date Application Approved By .......... Date Application Disapproved for the following reasons- ----------------------- --- ----------- -------..............................................................-------------------- - - ------------------------------------ .........................------------ qDate Permit No. 1 3---`------a te ��--.....----- Issued ...........................................................--------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Clertifira#e of C omplinure THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( t// ) or Repaired ( ) by------ T ,/ 0 -/SC:O�L------------------------------------------------------------------------------------------------------------ ----........-- --------------.-.-......-...------------------------ Installer 1 at .-.. - T---..../ �-''7 ��.'7"rgLLI DOA-/ .GC/.,1'�-------1'Y�. /Y1-/LL 5-------------- - ---- 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. --..-.-�. .--..- - ��- 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 G� C, TOWN OF BARNSTABLE No...%3_�_�✓.�."l FEE..... ..�....... Rapasal Works Trnns#rndion antic Permission is hereby granted......17' 2 SC 4 LC --------- ----------- ---- --------- -•-••-••-- to Construct ( V) or Repair ( ) an Individual Se"m,age Disposal System at No......4-a-T-.....1-3.-2---••---`' -C L.l _N_._..W-4-V................ = Street (�� �� as shown on the application for Disposal Works Construction Permit No._s%.,__ _.:___�_>Dated__________________________________________ . DATE_ UBoard of Health �- --- --- -- ----- •�---••--••-•---- FORM 3650E HOBBS&WARREN.INC.,PUBLISHERS 716 PA 1 T i . .. i t t b � Y' 'rL�!' • o !?bA GE� ` DAILY FLOW r. � �S - S C.. 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