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HomeMy WebLinkAbout0057 WALNUT STREET (M.MILLS) - Health 5 7 WALNUT )^ A=149-003grS f I (20 No.... . — Fps.............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE App iratiuu for Diupa!3al Work,5 Tomitrttrtiun Urrutit Application is hereby made for a Permit to Construct ( ) or Repair ( �n Individual Sewage Disposal System at: .................... .............................. .s./ -•---�------------L-L------/-ti•--p-.•.--t------s---------•-••---•----..3......�..,..t.--i--�--9--;•-/i -�---(•-----.------ ation�:\ddrss oror L 7 ------------------------------- -•---•-•---•-----------••------•--•-••-----••-•----•-•-----------•---•.-•-•-•----••------......... a � ' Address 7 ..h ��/JD1, « � It., ` � -------------------------------- .............................................. .. .. ......--..........-- Installer Address pq VType of Building >� Size Lot...... �__ 41....Sq. feet Dwelling— No. of Bedrooms...........?' ----------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons--------------.-.----------. Showers ( ) — Cafeteria ( ) Q' Other fixtures ------------------------------ - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity.-..........gallons Length---------------- Width..........-----. Diameter................ Depth................ W Disposal Trench—No. .................... Width-------------------- Total Length..-----------_---- Total leaching area....................sq. ft. x 3 Seepage Pit No--------- ---------- Diameter--.-.--.------------ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ 1.4 Test Pit No. I................minutes per inch Depth of Test Pit........--------- .. Depth to ground water........................ (i Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water....--.................. a --------------------------------------------------------------------------------•--------------------------------------------------------- *.... ......... ..... 0 Description of Soil........................................................................................................................................................................ x U W •••------------ ------------•----...-------•---...........------------------------ --- --- UNature of Repairs or Alterations—Answer when applicable---- -----soU .. c Tom•-• _..__. ,.9 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 iss d by the board of he lth. Signed ---------------------------_. - --- 3—�.9—g. — G�/............ ..................----- Dace Application.Approved BY .............. .. ..-.... -`...-.......--- ......-........ .......�� Application Disapproved for the following rearons: ----------------_.......-------------------------------..............--------------..__.----------------------...........----------------------........_..------------ -------- -------_---- - ------ ---------- Dare p Permit No- --------------- --s...-...` 'o.i�-- --------- Issued ...........3..- Q..a-. ace f t, aG j) o No....2'._!....-...`1..0 Fxs....�'�.v. ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Apphration for Diti-pw3al Works Ta tuitrnr#ilan Permit Application is hereby made fora Permit to COrlStruct air Re or '� ( ) p ( an Individual Sewage Disposal System at: Ca -:\ddress ...............^"--- or Lo No. -'`y�'�" ar��► /-�h��vsvi ,S-7 l,�i./hH f ---- ------ ...... W �Oja rC),vn�r / v Address a ...............•-••-......................... = ' u .......................................l. f S�, /� 3� �y/�/ M Installer Address e. Type of Building Size Lot------- .• �L.-..Sq. feet 1-+ Dwelling— No. of Bedrooms------- -----------------------_-_..Expansion Attic ( ) Garbage Grinder ( ) `4 Other—Type of Buildiit 0., yp g ____________________________ No. of persons...._......_-.--_..._.--._.. Showers ( ) — Cafeteria ( ) Q' Other fixtures W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacitv--..--_--.gallons Length-_------------- Width---------------. Diameter---.------------ Depth................ x Disposal Trench--No. .................... Width-------------------- Total Length-------------------- Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.........----------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) W Percolation Test Results Performed by ---•--••--•-••-----•----•----••----..._-•--•• Date..... ,.a Test Pit No. 1----------------minutes per inch Depth of Test Pit..-_--.-.--------- Depth to ground water_--.-----------.--.--- ~ inch Depth of Test Pit-------------------- Depth to ground water....................-... O Test Pit No. 2 ••----.minutes.per..........--•--•---•.........................•---•---•----•-----.........---'-•-----••----•------•--•----......._........._....... Descriptionof Soil-----------------------•------------•-------•-------------•-•------•-••--------••---•---. x .............................. U ••--•••-••-••••------••-•--•�-••-•-----•---•--•-•-•---------•-•----•---•------•-•-•----------•...... --•---------••---•-•-----•-----••----•--•--•----•-----•--••-••..................................! U Nature of Repairs or Alterations—Answer when applicable----. .��� /S Uv �' �6i^ at OI ----•...-•-•. ..----•----------------------------------------•-•--------•-------------------------------------------------------•-------------------------------•............---. 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 ee issu d by thee board of health. Signed -------------------------- ..... .... G'� _` 3—� - - ------ ------- .................................y q� .._.... Date Application.Approved By .................... ... .. ... r.......... � ,.1`'• .......................................................................... ... Application Disapproved for the following reasons: ---..--_--------------- ............ .. Permit No. I G - 1 C)� Da1e ......_----------------------- Issued �, ,.. ,^ `..fL I ate THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Trr ifiratr of Tara liana THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by.... Re. ( �) R----... �-. �U h G III------------------------- ---------------------..........--------------------.............------.._......-------------------------•- Ins�r.J'ler at .......... ...> X4St�,< 4/--!.._.... . � --s-----------------------------------------------------------------------------... has been installed in accordance with the provisions of TITI.E 5 eof The State Environmental Code as described in the application for Disposal Works Construction Permit No. ------/-.S'..- -------- dated __. .. ...�f.4'..._ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................. - - _......__�>....._-----..1%1.....'.`�....---_...... Inspector ------------------.._----- . -J THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No...... `�—.-�0 F FEE........................ -. UispnoalWork-5 Tnn#r wa_ n "Vrrntif / /�, � Permissionis hereby granted................ b..-►-�----•------------- ----------- -----------------------------•-----...----------------------............... to Construct ( ) or Repair ( �an Individual Sewage DisP�osal System atNo. 7•l{/ �h /.rrs/a.. ....-- -'-----------------------------------------------------••--•--•••.... Street as shown on the application for Disposal Works Construction Permit No./7 --,_`t=,.11u-.. Dated---.. ............. n r� ? . ....... ------ DATE................... ----------.....-•---------- ... j Board of Health FORM 36508 HOBBS&WARREN-INC..PUBLISHERS TOWN OF BARNSTABLE V/ LOCATION r7 Wa/h w SEWAGE # q 5 — I ©Y VILLAGE /hays S MILL ASSESSOR'S MAP& LOT f YY_ �3 INSTALLER'S NAME&PHONE NO. Jb 4ti 1a,�7 /f E91�' S"9 S. SEPTIC TANK CAPACITY /S'0 y LEACHING FACILITY: (type) ���;�trte�.�S L 6� (size) 'W X 9' x '2'o>.;, NO.OF BEDROOMS Air jtn BUILDER OR OWNER lyf :fIt K h oil PERMTTDATE: COMPLIANCE DATE: 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 i S , 1 w 00 f3 : 7� o � ' s TOWN OF BARNSTABLE LOCATION S�7 lea�h a y �t SEWAGE # - 5 - 0 VILLAGE h1al,1645 /y1I1r ASSESSOR'S MAP & LOT `/ -�3 INSTALLER'S NAME&PHONE NO. fU 4H a It V17-5 r 9 r SEPTIC TANK CAPACITY LEACHING FACILITY: (type) try�l tva�.rS (� (size) �7' X 9' x -1 oD•�, NO.OF BEDROOMS BUILDER OR OWNER 4? Y'x Ka n ca! o PERMITDA COMPLIANCE DATE: 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 L /7 j o o a Z\ s