HomeMy WebLinkAbout0228 TREE TOP CIRCLE - Health ��� ��.,.c�.�--}gyp �i'r;�..�,
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TOWN OF BARNSTABLE r Y
LOCATION FOR LklrC, , SEWAGE #
VILLAGE ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO �Mrb JtU�
SEPTIC TANK CAPACITY � 't $�`6 ticc, ( 6TL> c,�,
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS PRIVATE WELL l l,� UBLIC WATE CO
BUILDER OR OWNERQ
DATE PERMIT ISSUED: •� L/
DATE COMPLIANCE ISSUED: 1'. - 2 / 71
VARIANCE GRANTED: Yes No �/
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF, HEALTH
TOWN OF BARNSTABLE
.�- Appliratiun for Diupuua1 Workii Toustrnrtiun Vantit
Application is hereby made for a Permit to Construct ( ) or Repair ("-�an Individual Sewage Disposal
System at:
...• -== 2........ .................. ..............................................
Location-Address or Lot No.
..............
�... ..$. .o .jJ61. k. ...._.. � ............................................................
VaL) ................. ................ ......Y..
Owner A�dre�s p c •s (,,
-fe1. ... �.. ............... R.O.-__..-. '�..__°--.8 �_. ......IYIV"s ` `U .....
Installer Address
Q feet Type of Building Size Lot___________________________S q.
U Dwelling No. of Bedrooms.........__ _..__Ex Expansion Attic a g— ----------------------- p ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures ------------------------------------------------------••-----••••••---••-•---------•--...--------••-•--•--...••---•••••-•..................•••..•••...
W Design Flow.......... ......................gallons per person per day. Total daily flow-______.." ................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area._..................sq. ft.
� Seepage Pit No......_. __-- Diameter.__... ..pag �__._.._. 1 L7_._._ Depth below inlet.....(01......... 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........................
44 Test Pit No. 2................minutes per inch Depth of.Test Pit---:................ Depth to ground water............._..........
P4 •-•-•-•••••---------••----•--•••••••-••--•-•••--••••----•••••••••-••........................•...._...........................................................
0 Description of Soil--------------------------------------------------------------------------------------------..........-...............................................................
"W
V .._......-•-----••---•-••--••••-•-•••-••••-••-----•-•....------••--•--•-•--•••••-•••--•-•.......••-----•-••••-•-•••-•-•-----•----•••••••••-••••--•-•••••-•••---•....-•..................•--•....••.......
W
U Nature of R pair`s or Alterations—Answer when applicable.......�_�_l�______o.&�--_.....!G� :�Q ..�.............
------. . . . .....c - f _ �i'�.,L }. T1�^�......C,-0-- ......................................................
Agreement: f
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 bee issue b t e board f health.
Signed .. .)...------
Due
Application Approved By ........ .. ............ �- 7 /qy
.......................................................... ... ......Dare--...../
Application Disapproved for the following reasons: ............................... ---------------------------------------------------------------------------------------------------
.......... ............ . ..... ...................... ................................................................................ ...................... ....................................... ..................... ........
Da[e
PermitNo. -------9./. A...6�z....................... Issued .........................................................-----......
Date
�W
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Disposal Works Toes rnr#inn Frrnti#
Application is hereby made for a Permit to Construct ( ) or Repair (`• an Individual Sewage Disposal
System at:
-. Location-Address or Lot No.
-•-•--........ <�I s5.. - c - ti"�- ------------------------ ---------------- -1!��i '............................................. ..j�..._.
�J
Owner Add
VV
a .............. _......._..__.....................-......_.._.._.._.._._..'---.. '-----....--------....._..._._..._..-_-....-.-_-._.._......__.M.K�.._. __........------..
Installer Address
d Type of Building Size Lot............................Sq. feet
aDwelling—No. of Bedrooms......... �.............................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures ----------------•---------------------......----------.....---------------------------------------.......------------.....------....------•......._...
W Design Flow..........!:". ..:".'�.....__..__•---_--•-.-._gallons per person per day. Total daily flow........ _ _ ---------------gallons.
WSeptic Tank—Liquid ca.pacity............gallons Length................ Width---------------- Diameter..-.•_-..-_•:--• Depth•••---------._-.
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...................sq. ft.
Seepage Pit No........._._....... Diameter......1..477__.... Depth below inlet----.mod......_.. Total leaching area------------------sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
HI Percolation Test Results Performed by------------------•----------............................................. Date----------------------------------------
1.4
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
(z, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water-..---__.•--•------.-..-
a •-••---•••-•-•••••••••-•--•••---•---......---•-•--•-••••......................•-------------•-----------------••-••---------•--•-•-••-----•-•--••-------•--
0 Description of Soil...........................................................................................................................................................................
x
U ---------
-----------------------------------
-------------------•-•--.--------------------------------•--------------------------------------------------------.--------------------•---------------
110 ....................................................................0.........................................I--_----------------I--------------------------------------------------------------------
Nature of Repairs or Alterations—Answer when applicable........ ..0 011 ...... ._.:.___ :t T.............
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 �✓/ ............°
v --- ----- ---- ---- �l ------
_- `
te
Application Approved By s �7 --------------
Application
------------------------------------------------------- r `
------------------
.Disapproved for the following reasons- --------------------------------------------------------------------------------------=---------------------------------------------
------------------------------.................- ---------------------------------------------- ------------------------------------- ------------------------------------------------------- f
.� Dale
Permit No. .......... /- ;, 5 ------- ............. Issued ----....... --------------------- - ate
Date
.r
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Cex#ifica#e of C ontlatia cce
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( L_L_ ,,
by...................--------------=-------- r4 !�' 't 1� --------------------------------------------------
-------------------------------------------------
Installer "
at _77— `-0-0.....c--1-src...V�------------------------
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. -......... /...c--°L,t..4...... 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
No.... TOWN OF BARNSTABLE
.-�_�-=��
Disposal Works Tnnstrudion Pgrntit
Permission is hereby granted....----�....! -_�.f ..l__...f _�e __t _.._ -_+f _ ..
r--f.�.,- �.- �.
to Construct ( ) or Repair ( ),an- Individual Sewage Disposal System ?
at No............................•--••-••--•-•-•' a� - "' to��...-'�`�?,� /_1_�/�_�� - �'t: t/�r°1 I{
- -. •_.• -------------
Street � ��/
as shown on the application for Disposal Works Construction Permit o.,%,/l______.____;� Dated..........................................
°.•^�_ ----------------------------------------•---------------
DATE................................................................................ V Board of Health
FORM 36508 HOBBS&WARREN,INC..PUBLISHERS