HomeMy WebLinkAbout0094 MEADOW LANE - Health 94 Meadow Line
A= 133-023,.
W. Barnstable
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TOWN OF BARNSTABLE
�u• � � ` w _ A � ��:ATION ' l� � 'L�CJU� i�E�1'�, SEWAGE # G
VILLAGES uy,c \S66 ASSESSOR'S MAP & LOTlyg 62-s
INSTALLER'S NAME & PHONE NO. < M `'-c��n�., :2f
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) ()L,)0k&eVS (size) (�
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratiuit fur Diupuml Workii Tomitrurtiuu Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at:
Location-Address or Lot No.
ern. << -------5 - -......
Owner As
a «_ __ `.. --------•------------------------------------- atL__PL __ J ��(dres 7--•-•--,�y us....-•--
Address
Installer
UType of Building Size Lot............................Sq. feet
Dwelling— No. of Bedrooms.---_�__--------------------------------Expansion Attic ( ) Garbage Grinder (�g
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_A-S'6%alIons 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 ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit-.__-_-_________-___ Depth to ground water........................
L% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
9 --...----•-----------------------------•••---------•----••-•---------•---•-•----•----•-•-•••--------.........................................................
0 Description of Soil........................................................................................................................................................................
4V ........................................................------------------•--------------------------•-•---------------•-•-•----•---------•------•-------------•-•---•-••------•-----••-•-•-•-•---•--•--
W --•-------------------------------------------------------------------------------------------------------------
U Nature of Repairs or Alterations—Answer when applicable._ L _. . .__« +u_ c` .. car' ___
---------- - - -
1 15 -- (r�,\..---.'r_.-V.-----�._. �x `� �Iuo..D��� v �"�-----
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 Comp - nce has been iss the board of health.
Signed ........
- P1 �
' to
Application.Approved B evf- `......... --- ". ...: ---- ------ v .
Date
Application Disapproved for the following reafonf- -------------- --------------------- ........................ --- ............ ..............
....................... -- ........................................... ........................... ... .................... ............. ................
l� Date
Permit No. ----------- Issued ........:/..""��6--�......
Date
1 M
No..2
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF . HEALTH _
TOWN OF BARNSTABLE
Appliration for Diopooal Work,6 Tom6tritrtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( V an Individual Sewage Disposal
System at:
..... ......
Location-Address or Lot No.
....................... ------------------------------------------ -----------� -------......------------------------.....--------...............--owner Acjdress
---•--..... -----------------•----•-•-•---•---------... �L .. U, t.' ...?....... -------.
Installer Address
UType of Building Size Lot............................Sq. feet
�. Dwelling— No. of Bed Garbage Attic ( ) Garbage Grinder
pa, Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria
a' Other fixtures _______________________________ _ _
W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons.
WSeptic Tank—Liquid capacity.-�-S.V(�alIons 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 ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P6 --------------------------- -------------------------------•-...-------------------------•--•---...................--••---••••-----------......._....__....--
0 Description of Soil............................................................................... ------ .................................................................................
+;V I.......................................:...............................................................................................................................................•--------•-•----
W --•-•------•-------------- -------------------------------------------------------------------------------------------------------------------------- ---
GU _Nature of Repairs or Alterations—Answer when applicable ...��«--�h._ � __ _U ___s..__._..._.
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 Comp nce has been iss y the board of health.
Signed ................ ------ - - ............. ... '-' .....-" ..
Dace _
Application.Approved B -------------------'--------_--------------------------------✓ ... ........ - --------------------------------------'
Dace
Application Disapproved for the following rea.ronf: ---------------------------------------L------------. ----------------..............................................................
-----`------------------------------------------------------------- .....------------
-------.....'---'.........................................'-------------"-"/-y�.r�.....------------------- - -----------------------
Dace
Permit No. - ..-_..... ........................... Issued ........1...�i�.......5 ...4..
Dace `
>:ti....,�.�..�..,..-�.�,.sew.�,.���>eti,�..���.n�.�.��.�.�,�-�tti®.�»�,m���-.�,00.�o�e..�.�.�.�n-��».�®�.,..,e�>«,�,.n�a.�•�_._�a � .- r1
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
C�Pr#tfirate of Tomplia re
THIS IS TO CERTIFY, Th t the Individual Sewage Disposal System constructed ( ) or Repaired
by ........... ----" - - ......._----------------" --------------- -------
at at .......--.-C%\ ..-...M- C l�.�.l.Z .0 ...... ; 'f ✓ - :' - .................... -' - ......
----' '
has been installed in accordance with the provisions of TITI. of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. - -.._,� ~.-...-- dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE AS A GUARANTEE THAT T E
SYSTEM WILL FUNCTION SATISFACTORY.
DATE ..... �� ..... ----. � ---...---- Inspe
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
No `... j FEE.. . . ... .
�i��oott1 ork� C�on�tr�rtion �rrutit
Permission is hereby granted.---SCI� M`f ^ ���-•------------------------------•------------------•---------------••---...---.......
to Construct ) or Repair, ( an Individual Sewage Disposal System
----------...M. f�r��;' `�� ------ ---------------------------------------------------------------•-------------.--
at No... .\�t Street �
as shown on the application for Disposal Works Construction Permit NVo���"-_---�hlated__. _�_ '�
"I DATE.---• ,r"� -- Board of Health
;�----------•-�d`
FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS