HomeMy WebLinkAbout0153 THISTLE DRIVE - Health ��� �►���l � � -� �,
I e b , e ���� ��,
� ��i- � ��
��
_ �
TOWN OF BARNSTABLE
LOCATION SEWAGE # 2, za 6
VII,1,AGE ASSESSOR'S MAP & LOT . 30.
INSTALLER'S NAME&PHONE NO. XZ^-% ,r
SEPTIC TANK CAPACITY 006 q
0
LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS 3
BUILDER OR OWNER - 6'4
PERMTTDATE: COMPLIANCE DATE: 'S
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
/�
N
C� �
t
�n
.L,yaJ�
�'
/Iff
-g4
LOCATION SE AGE PERMIT NO.
rs` y zxe _
VILLAGE
I N S T A LLERIS AME i ADDRESS
BUILDER OR OWNER os
w
DATE PERMIT ISSUED F-d
DATE COMPLIANCE ISSUED
r
:x g
Olt
i
o
N � . ��~��..............
. THE COMMONWEALTH oFmAssAcxussrrs
��V~��� ����
~ -- --' -. .~~
-----�� �x��"� 9f HEALTH
--���F--'`��� --�------_-------..
' ' '- - ~ � .
fo
r �
������m� °� �����aK Workg Tonstrurtion 1hrmit
Application is hereby made for u Permit to Construct ( ) or Repair ( \ an Individual Sewage Disposal
System at:
-_.-- '
____----__-__'-'_---'----'------------'_'--'_--
~~ ^�="� � Address,
Type of ' Size
Dwelling—Nu of -Expansion Attic ( ) Garbage Grinder 6)
Other—Type of Building ............................ No. of persons............................ Showers ( ) -- Cafeteria ( )
04
O^"c --_-_.----_--'_____.________________________�_________
U�� �dloo per person per day. Total daily
Septic Tank--Liquid Length................ Width................ Diameter---------------- Depth................ '
D� Trench--No.-.-----'-- \�il8� ---' Iot� I-coBt6--- ��--Tot� �uchingure�._--___�g |f�
' Seepage Pit I�o..--k-__- Diameter-'1&.S�^.`.- Depth below io�L^�.��6-'^-' Total leaching area. 2.a.a-ml. ft.
Z Other Distribution box ( ) Dosing
~~ PercolationTestResults Performed hv-. ------- Z)�c--����'�L'`���/�--_-
Test Pit No. }-']Lj.--'noinuteayerinch Drn16 of Test Irit.' Depth to ground water-.^m*�u�w�°'
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth toground water........................
u4-^~ ...........................................................= Description ofSoil...................... j.'...
..........................................................�'-r','L-........ -''------------------------------------
Z --..-----_------.---.---.---.-..--'-.-------------.--_------.--------------------------_-_.
U Nature of Repairs or Alterations--Answer when applicable--------------------- ........................................................ ................
......................................................................................................................................................................................................... � |
Agreement: �
The undersigned agrees to install the ufore6escribed Individual Sewage Disposal System inaccordance with
the provisions ofIZTI U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee issu by the b r of ealth.
ate
J* Date
� --------_---'--------------...---'----'-_----'--_.-'----_---------------------_---'---_-..-------'------
~ � Date
Permit Y�o--------------------------'_ Io»oe�--��-�^-'-�x^��-----------'-
. ~~^ � |
No......... �....... Fss. ..........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F• HEALTH
f
�........OF....... 44-n......------------------------------------------------
XOPAtrta#ion for Ui,> pm al Works Tnnntrnrtinn 1hrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at• �,,,
............... .. _ :.:.
W a . ......................
l. .......__...----...�... _�=.�- - -- ---t
•-••-•-_-. A
_........-____.....__.
JI]
oca Adds0411-W No.
.... ..............
------••-•--. ----- ...*. .... ... -----.. ........ . � Address
............... . ... .. .... .--.............._............. --.....-.-.----------..._.................................. ........ _.....................
Installer - Address
Q Type of Building.: Size Lot___ Li_ 1 .....Sq. feet
U
,., Dwelling—No. of Bedrooms____ __3________________________________Expansion Attic ( ) Garbage Grinder
Other—Type T e of Building _______________ No. of ersons-_________._________._______ Showers — Cafeteria
0.1 yP g P ( ) ( )
Other' fi
W Design Flow...................... .............
___gallons per person per day. Total daily flow............._ . . ____.____.._._____gallons.
WSeptic Tank—Liquid capacity_10_1.gallons Length................ Width................ Diameter------------_--- Depth................
x Disposal Trench—No_____________________ Width_t---t_R__________ Total Length________r _..r;_ Total leaching area....................sq. ft.
0.
Seepage Pit No........I........... Diameter_._.. ._6.._.__ Depth below inlet___.......'___._. Total leaching area_._ f.t_.0__sq. ft.
Z Other Distribution box ( ) Dosing nk )
7 Percolation Test Results Performed by.....:_ _. . ._:.__.. _ ✓" Date_...... .........
a Test Pit No. 1....'t_'1......minutes per inch Depth of Test Pit....I.Ak......... Depth to ground water_____
w .Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
w< ----•--- ••-----••-• -----------------------------•-----------•------•--•---•----•-
D Description of Soil...................... ---- -- .... .....
....................................... 1t ----•_ '�'-^ --------------------•--•----•-------•--------------------------.._..--•-----
-------------- --------------------------------------------------------------•----------------------------------------------....------------------------------------•.................................
UNature of Repairs or Alterations—Answer when applicable................................................................................................
_ •----._...-•----------------•----------•--...-•-•------------------------------------------•------•------•--•-----------------------•------•-----------•-------------------------------•----•-----••--•-
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
tl e provisions of TIT111, 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been"issu by the b of ealth.
Signer ---- ----- .......................... ............ ... ad
C/Date
Application Approved By............ -. --- - • --,-------•- Date
Application Disapproved for the following reasons___________________________________ ____________________________________________________________________________
•.............•--------------•---•-•-----------------------------------------•--------......_..----•--•-----------------•-------..-.-----------------------------------------------------...------------
// Date
Permit No.---------•----- ••• Issued-----`-��S-•- ..........................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF —HEALTH 4
..........:f� ..........OF'..: .... ...: ....................................
�rr�ifirtt#r ,af (�unt�li�nrr
THIS IS. O CE TIFY.That, he Individual Sewage Disposal System constructed (1") or Repaired ( )
% .. ........................................................
by................ fa! r....... Inst ;¢
.0
at..............-c4` --- ........-...........................:Ir ...... -f---------
has been installed,in accordance with the provisions of TITLti,,.., 5 of The State Sanitary Code as described in the
application for Disposal Works Cozstruction Permit No._ d!'__ x?_____________ dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE.CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNTIO,k4 SATISFACTORY.
y.
DATE......... ................................ ...-•--------•----=-•-•---- Inspector......... •-•-- ---- ---- •--- •----••--------••-------••-----••-------••--
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�..... .-4�_. a !. ......................................... d`
No.. ..... .............. FEE
Disposal n ii Tnnntrnr�ion unfit
Permission is ereby granted -•---------------••--------•-------•--.._._._........--------.............••-......
to Construct r Repair ( ) an Individu S wa e Disposal System
`at No. ._ �.4......_� _... :?-------- `:. .................................................
Street
as shown on the`-application for Disposal Works Construction o_____________________ Date ________._.____.__.__......._..._....._..
--•- --- '-• ------•-
Board of t
DATE..... / - ....
FORM 1255 HOBBS'& WARREN, INC., PUBLISHERS
�j1l.Lyl1� �n.MIL�t� - � �T✓i��CUGM / -- - 1
P.-LcDw i1b - 3 = 3-4D G.P•D.
�t.�>^tc T'�-i►� = 3�0,� ISo % = 49c,6.R�. � _
u
iSPO�At. PIT - use lOoo 6�.
� � a
o D. �V
TC>-rAL -tomESt6,Q = .42S G•PD. Rl
TOT'A L ID,&l Lam( F'Lov-/ 6.FD.
PE1ZCDLD.'t X0LJ t2%rE t"1�s 2-M i Q' orz L 6S. -Al
Ai� tfM'
of it
ro
Two
u 4n
T—E—
Tor FUD L 100.p
WCYL K :
..ar/nT. T i ../ire / '•Pi�� � ,r `�
.. vss 1►JV` ���/
4'p,Pp iw. 6AL.
udso v.. luv. -Boy, �(� ,� SEvr-�c
Gay. mot'}.-2..2
a LAN A
PIT . .
i W1 *w
G
W�S+•IED
I A9
Pczo�tL_ LOC,TtOt-i
ILLS
C G u-c t F`� T I-!A-(- �t-i t= �� 'D{►.1�•�..y 51-lo�c!►J Pt_A 1�! R i_^H=��L'E.ti.l C E..
w rrA TWA -SIDE LI"E-- �UT C.�•
AWr-> -SC'rV�ACIC Vc4uIQEM&-"Ty o>= �-Nt~
To W w Or- BI f 13 t.. �� �U !
TI-Al5 t7.:�lstit. I uo-r �,U;Cra p�.i osYl=ev1LLL v � ,�
It.lS��:J'✓<t=.1.t; .�,rvc_��i�.Y �� T4�`. c�F�:,r-T�, �►-I�wt..a ,��,cat_I <_tS.ti.�T �E,,t�t�t lit,,,,
u .,.0 i'> i e, l7 C:::M ►�1�: l_D"C` t_t t-1 �'> -