HomeMy WebLinkAbout0036 VIOLA LANE - Health 36 Viola Lane
A = 043 —006—8
Marstons Mills
TOWN OF BARNSTABLE
LOCATION �fy� �� SEWAGE #
VILLAGE5 - ASSESSOR'S MAP Cz LOT(5 O 'a�6
INSTALLER'S NAME & PHONE NO. /� � �tv%/gain}
SEPTIC TANK CAPACITY
LEACHING FACILITYAtype) eo�--rl (size) , cod
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER__],,,f f
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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THE COMMON EALTH OF MASSACHUSETTS
BOAR® OF HEALTH
ta
Appliratiuu for Uiupuua1 Works Tuuitrurtiun ramit
Application is hereby made for a Permit to Construct ()() or Repair ( ) an Individual Sewage Disposal
System at:
_ Location-Address or Lot No.
m
.....................- `!ui! t�:__. �x tlla
_.. ...............................................................
Owner Address
W ..........................
................... -- �g� f ... .............................---•-•------
a ..-----•-- .
Installer Address
QType of Building Size Lot...lej-&zQ......Sq. fe t
14 Dwelling—No. of Bedrooms...!_rt �_r-. )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Ga Other fixtures -------------------------------- -
W Design Flow.................................-9r _._gallons per person per day. Total daily flow........................ :4.......gallons.
WSeptic Tank—Liquid capacitygallons Length S.-......_.. Width.. .-tf.4 .._ Diameter. - Depth_o!�&..
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.___�e.&u -------- Diameter.....Ll)......... Depth below inlet.....(Pt........_.. Total leaching area...Z .7_....sq. ft.
(7C) g ( )
Other Distribution box Dosing tan
Percolation
Pit
Results m Performed
rfor ledr inch Depth of T Test Pit_____-_--�--_-_- -• Date_.
a p p �___-_-__-- Depth to groun water..
(i, Test Pit No. 2............:...minutes per inch Depth of Test Pit.................... Depth to ground wat ..... -
O --•---••--•-•--•••-----------••.....................................•-•-••-•••-•......-••---•--.....---..........._..------... .4T-Ef'I4E-N••-Description of Soil.......0 2°------rnesce4...L-'� (PZ_CA ........................................................................... ...._ALLYN..... tea
(xj ---------Z ..•..._.�ccQ�u�----� WILSON ...
No.30216
x --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- � ----------
U Nature of Repairs or Alterations—Answer when applicable.....................................................................
At ---a
Agreement: cCaow-
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with eA/'a-f
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 een issued by the board of healtlL
AZ544— Signed ----------------- -----...� �-� -��
..----- - '- --------------------------- ---------------------
Dare
Application Approved By ...............
-! . --------------------------...----------------------------..-------------------- -------�1= �
Date
Application Disapproved for the following reasons- ----------------------------------------------------------------- ------...................-
---------------------------------------
Date
Permit No. ........S.1-121-"-G�` z Issued -----------------------------------------------
Dam
No.. .t.:.z RmB............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..-----.....4...vw..ti ..............OF...... c�.F,t�� 4a. .......................................... .
ApplirFatiun for Disposal Works Tonstrnr#inn rrmit
Application is hereby made for a Permit to Construct (A) or Repair ( ) an Individual Sewage Disposal
System at:
.............................................................. ..................................................................................................
Location Address �1 or Lot No.
......................................................i. /•T'. ... r� ................. C//t7/c? �.avrt
Owner i� _'tD� ;l�� _.lrr Address
Installer Address
d Type of Building Size Lot....1.6 462-P......Sq.W10)
t
v i _Dwelling—No. of Bedrooms....._•f_!..�...........................Expansion Attic ( L) (garbage Grinder
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
P I Other fixtures ......•---•-.,...
d ..........I............ ............................................................
W Design Flow.................................-�- ___gallons per person per day. Total daily flow........................ .......gallons.
WSeptic Tank—Liquid capacity.l gallons Length 6#"n'... Width..4.-LO".. Diameter................ Depth_.�A*.
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..... ____ Diameter.....jC?......... Depth below inlet..... ........... Total leaching area.... 9�7_...sq. ft.
Z Other Distribution box (7C) Dosing tank ( )
Percolation Test Results Performed by..... 1:__- i ........................................... Date__/ ....•..........
aTest Pit No. 1......... ------minutes per inch Depth of Test Pit___-__-�!._....__.. Depth to ground wa Fty
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground
Description of Soil.......__ 9..... ...E..=.,atr.;.c>Z_I �^
.._...-----•--..___.____•^.-......-• ,----' ........Nilc X. !u2a ..................................................................... . iLSONI......
' No 30216
-
W ----•---•---------------------•-•---•-•---•---•--------------------•-----•--•-•----•-•-----•-•-----••---•------------......-•-----------•--••---••--•-------- �� =----------
UNature of Repairs or Alterations—Answer when applicable_________________________________•_•_.________-________-_-.-- 9q _61537 `
..............-----------------------------------------•------------•--------------•------------•-----------------------------------------------------------•--•---•-• Q
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with i�.�.8►9
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�aseen issued by the,board of healtSigned ................. w..----..:="�Q-- --, '� ..... .......:........'---...... .-.....-......--Daze--
Application Approved By .... "" - ... ......... - _.... .... �/-= - - '...
Date
Application Disapproved for the following reasons- ----------------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------- -- ---------------- ---------------------------------------------- -................................................ --------------------a--------------------
" D
PermitNo. - �I _------_--------------- Issued ------.... ---......-------- -------- -------..........re..----.
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
- . OFF ��'. s�`G C---------------
�Q�t�i.C�i�P D� V�IIxYC�1�t�iYf.CE ��
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( )
by47 77 ..... ..................... ............... . ......----
Installer
at �.�-- .. .e..
has been installed in accordance with the provisions of TITLE 5 o, 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
No....51.1 2-6a`I/I ...........................................................
FEE. _._>5..............
Disposal Works Tuns inn rrmit
Permission > eby granted....•--- ----- - -=---- �=----==-•--..._�.-- -.....-----•--...__.._..------••------••---:.._......._..............._._..
to Construct ) or Re air ( ) Individual Sewage Dis osal ystem at y� --
- -----.... -----._......... -•-.---••-.-----...------
-
--.- -=------------••--•-------•---------------•-.......•
Street re
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as shown on the application for Disposal Works Construction Permit No.$ Dated.........r_____________:...................
................................. ----- --- - ..................................................
17
�/�j Board of Health
DATE_------------- _7:I................................................
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
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