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HomeMy WebLinkAbout0351 WAKEBY ROAD - Health (2) D43 00E- ©c;;Z, I)gC( rs 7 ` I 4/ 90.:3 O. (J`Z p Fms.. .......... ............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for Disposal Works unstrurtiun Virutit Application is hereby made for a Permit to Construct ( or Repair,( ) an Individual Sewage Disposal System at. 2 / � Ai ,t-�l �l I /`�i vt7 Gl/ .............. Q. .............. ......._.. _._..........._ ..-.- ----------- --•-'�------------------ ---- r ......................... - .. �/ .. /t ......--- 'J-. .....- . ..................................... ff .........l.t Y''...C:_'..-Y._. ...Addr Q/� Fes/�N ?Ar t -0/ Own l Address ............................ ......---- ....................................................... Installer Address �./ dType of Building Size Lot.�l_1__.�/.......Sq. feet U Dwelling—No. of Bedrooms___--C -_---------_----------------Expansion Attic Garbage Grinder (� Other—Type a of Building � -________________ No. of persons......�------------------ Showers ( ) — Cafeteria ( ) Otherfixtures ------------------------•------•-•--------------------. ------------------------------------------------------------------------.....--••--•....---•• W Design Flow..................... ..............gallons per person per �0 day. Total daily flow-------- Septic Tank—Liquid*capacity gallons Length-------9._. Width...,6....... Diameter................ Depth........... Disposal Trench—No._.. ----------- Width.................... Total Length__.____._ll_..___._._ Total leaching area............ ft. Seepage Pit No...... .......... Diameter..6�.__._..... Depth below inlet..__b.. Total leaching area.-/ �..sq. ft. Z Other Distribution box ( ) Dosing tot.. pp •� '~ Percolation Test Results Performed by f1 ....r .. Date........................... o Test Pit No. 1....... . minutes per inch Depth of Test Pit____________________ Dept to ground water-___--_-_...____--____ . LL, Test Pit No. 2..._'_pa-_-_minutes per inch Depth of Test Pit.................... Depth to ground water........................ R'+ ----•-------------------•-------------------------••----••-•--------.................._..•--•------....•----------.....--------........-•••--••--••----.----- O Description of Soil................. � ....... .. ......../2..'/`T ---- ...................................................................................... UNature 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 Co `ante has been issued by the boardp of health. ,� 1 Signed ----------�------.... 1�. .a . ...... '_". ----- `.J C � l d Date Application Approved By ------------- -.... - - --------- ..... -.Z.a:7.- g'L.. Date Application Disapproved for the following reasons- -----------------------------------------------------------------------------------------------------. .. ---------------- .......................................... --- .-- -- -- -- --- -------- -------------.........----------.......-----------------------------.................-------- c� [e PermitNo. ........... 0--- 3-....5` 7-�(----------------- Issued ..-.....................................................Da - a-------- Date t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Application for Disposal Works nnotrnrtiun amit Application is hereby made for a Permit to Construct ( V or Repair ( ) an Individual Sewage Disposal System at .. �/..._GlJ1Y7/l�� 1 111 C-\ PRatSo Addr C.�C� / -J� 3v Fes/i�^ ( ' " t ..........��C/l.� .............. -------!. ............ ................ •--•--..................... ........------.._.......--------...............__............. -- ........... �-�1 �D� ..............................................� ............ ���t fir/ eategs Q / ......------ --•------•--- Size Lot_•�.lt_"_�l__.--_-_S feet wn Installer ' Type of Building q, U Dwelling—No. of Bedrooms•-•-- --------------•--•.Expansion Attic Garbage Grinder -----__---- 'k Other—Type of Building - _---- No. of ersons......4----------------- Showers � YP g -•---�-------•-- P � ( ) — Cafeteria-(----). dOther fixtures -------••----------------------------------•-•------------•-•-----•--•••-••--•----••-- W Design Flow..................... .._....._...._.gallons per person per day. Total daily flow..........2r*Z_?,�)_.....................gallons. WSeptic Tank—Liquid capacity / gallons Length........��.__.. Width._..,6...... Diameter................ Depth........-_.I_.. x Disposal Trench—No.__.._;-.4.......... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------!'_---------- Diameter.__A........... Depth below inlet___._1K.. Total leaching area., .��-,�_sq. -t• f Z, Other Distribution box ( ) Dosing tank,( � `-' Percolation Test Results Performed by ..---•... .....e!J fl!v � Date..................... 7J Test Pit No. 1_:'".�_.__minut7 per inctihgDepth of Test Pit.................... Depth to ground water____................__.. 44 Test Pit No. 2-------�_-_minute's per inch Depth of Test Pit.................... Depth to ground water........................ 94 -••--•--------------•••••-••-•-=----•---------•-•-••-•-••-----......•------••••---...-•-••-------•--......................................................... 0 Description of Soil--------------- --------------------... � �L. x x ----•------------------••--•-------••-•-•--------••-•-------------......•••••-----------------•----------••---•--••••••--••••---•••-•---•--•--•----------•-••--------•-•--••-•---••--•----------------•- 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. Y P .p Signed -.... -----�.---------- ....., _�. Application Approved BY --------------(��--.. .... ....---e .. .. ......---'-'-'---............................................................ .Dare Application Disapproved for the following reasons- .........--------------------------------_----------------------------......................__................................... ---------------------------------- PermitNo- ------------ -----(. ...'.- .--------...---- Issued ........................................................Dare Da.....--- / Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cgelrtifira a of (faraylittnee THIS IS TO C RTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by <..�---------------J ... <� =--------------.............---------- at .............. 7 "y�� � Installer ....------------------------------------------------------------------------------------ has been installed in accordance with the provisions of TI E 5 o`The State Environmental Code3 as described in the application for Disposal Works Construction Permit No. ....:............ ...... . .... dated ......../I........................---.-.-.- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BEXONSTRU 6A54CG A A RATEE THAT THE SYSTEM WILL,FUNCTION SATISFACTORY. DATE /.-�I�.��.rl. lJ---------------------------------------------------------------- Inspector .............................. .. ! THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 3g� TOWN OF BARNSTABLE No...��............. FEE...loo...... Disposal Works Tonstrurtion Permit Permission is hereby granted.............. r.: A........1�............................................................................... to Construct ( L,4r Repair f4,2V an Individual t.wagre Disposal System -------------------------------------------------------------- JStreet ey as shown on the application for Disposal Works Construction Permit No.�%: ......7.r— Dated........ ................................. �. ........................� - Board of Health DATE......... I......'_� .`.... ' FORM 36508 HOBBS&WARREN,INC.,PUBLISHERS TOWN OF BARNSTABLE LOCATION 3,s/ 1 xLkpLj SEWAGE # '�O_ VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME& PHONE NO. �t i SEPTIC TANK CAPACITY O000 BLEACHING FACILITY:(type) (size ) boo QNO. OF BEDROOMS_ PRIVATE WELL O PUBICWATL ER. BUILDER OR OWNERr DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No / '�j(�,!��'� 'l'' ��"b .�a,, ! � �' i ,' .,.: 0 ,� � � � ��� �,� ►,.lo GArz$.o�� �r�l�ro� �d►t_`f FLOW = 11b >c 3 t b G•P'D. �E�ric Tl�ti`1lC = 33o.r (S0 % ' 4-95 6.Po. �ISPOS,dt PIT - USE lOoo C,ZL-. }T �, �ti//AL --,TX-WALL ty t. Ic� SF ac � - SIV-TTONA SO 1505'. X I .o TOTAL- �ESIGI.1 = d25 G.QD. roTA L_ t C7- dGC >L&T10Q 2&TE ( tt� 2 �SrtitJ 02 LESS. ALL SULLIYAN - ,GIs 1 ;;` n No. 2"S733 �A} C TOP 1-N D luv„1-7 INV. ' r �X fU•Ce SEQriC Io ��. ` TiarlK IOOQ ?� INV. tM/. Mc� PIT SA u w I rN e Wire! 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