HomeMy WebLinkAbout0881 OAK STREET (CENT./W.BARN) - Health 881 OAK STREET, W.BARNSTABLE
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- TOrW/N_OF BARNSTABLE
LOCATION 1 �� J�"��" �/+� �1 �1 SEWAGE #
VIL',AGE �pw-osO(Alz ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY 5 2
LEACHING FACILITY: (type) i 5 4- L. (size) ?0 i K)y,L r
NO.OF BEDROOMS,,
UILDER
ERMITDATE: 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
.___E_d_ge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet 91f leaching facility) - Feet
Furnished by X
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LOCATION SEWaC;E_ PERMIT UO.
VILLAGE
--WSTQ - LER 5 IJWE . .ADDRESS
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BUILDER 5 Al TIE ADDRESS
D/�TE PERKA T 155UED
D ATE CONAPLI W ACE ISSUED :
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Apphration -fox Bi-qVviiat lVerkii Towi#rurtilon Prrutit
Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal
System at:
Lo atio dress or.Lot .
Owner Address
Installer Address �`p
U Type of Building Size Lot.._7ej 6``--77 Sq. feet
Dwelling—No. of Bedrooms........... ..............................Expansion Attic ( ) Garbage Grinder ( )
per, Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Otherfi res -----------------------------------------------------
W Design Flow-------------- .....................gallons per person per day. Total daily flow____......_..YOO_________.__------
WSeptic Tank—Liquid capacitv_4' allons Length---------------- Width---------------- Diameter_-._-_..-__._- Depth....------.-_..
x Disposal Trench—No- -------------------- Width....___-,.._..______ Total Length_---_____-_---..---- Total leaching area--------------------sq. ft.
Seepage Pit No......'_�.......... Diameter.....1�4_00--- Depth below Ainlet ..�..�../��.�..._.. Total leaching area_____ ____________sq. ft.
z Other Distribution box ( Dosing tank ( ) �u— R;' �"'
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_-._..__-__-------..----
------------------------------•--- •---•-------------------------------------•--------------- ----••--.......----------------
Description of Soil-----------------3..;tel--•-•- fv-- ------ ��--------.---------------- -= --- -- --
W ----------------------------------------- ------------------------ ji l L � .........
x =
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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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been iss d by t e bo rd of 1 c
Signed...... /� / ------ !� _�...*
r Date
Application Approved By----------�_.
A...----------------------------------------.....---------- ----------------- .- --------------. ---- Da.......Application Disapproved for th.e folowing reasons:................................................................................... ..................
--•-•--------•--•-------••-------••-----•--•-----------------------------------------------------------•-------..--- ---.....--------.-----
�/ Date
Permit No..-----`6 ...................................... Issued....... ----------7 -••------
------------- ---------- - -- - - - - ---- -- - - - --�- ------- - -- A11L ----------------------
No.........
...V.C).......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
'of I
........... - ---------- OF......... dt-----------I.............................
Appliratio"n -for _Uiiivoiial Works Toniiitrurfion -ermit
't-1 ic'ation is hereby made for a Permit to Construct (X) or Repair an Individual 'S`.e'W' a!g'e` Disposal
System at:
.....a4k_-IM........ ................. --------------------------------------------7---------------------------
s L _7�!,............. .....of
..........
0 n r Address
#
--------------- .........
Installer Address
Type of Building Size Lot..._/7/W1?/__4/77.Sq. feet
U
Dwelling—No. of Bedrooms----------Y------------------------------Expansion Attic Garbage Grinder
Other—Type of Building ------_--------_--------- No. of persons............................ Showers Cafeteria
Other fi=res ............................................................................I---------------
--------------21--------------------------------------
Design Flow.............. ...............--- g allons per person per day. Total daily flow--_-__--------- __-____---.-_-----gallons.
P4 Septic Tank—Liquid capacity_�'':"gallons Length________________ Width-.__-.____.-.- Diameter.__.-_--.._-__ Depth......__..._..
Disposal Trench—No_--------------------- Width............._.__._. Total Length____._..__.......... Total leaching area--------------------sq. f t.
Seepage Pit No._____---Q------------ Diameter..... Depth below inlet.................... Total leaching area------------------sq. f t.
Other Distribution box ( Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date-------------------------- -------
Test Pit No. I-------_------minutesperinch Depth of Test Pit_-._____________-_-- Depth to ground water..-..-------.--.--.--__.
fA Test Pit No. 2................minutes per inch Depth of Test Pit.__..._._....._..... Depth to ground water_-.-_._.___.___-___-....
Ix ----------------------------------------------------..................................... ...................................................
0 Description of Soil--------------------)__W........
ft 4.........I-(,-- V 047
---------------------------------------------------------------------
--------------------------------------------------------------------- ------51--l-
U ;, , . .................
W ------------- ------/... ......../01-1........J7-
Z , --------------------------- 1P-----------------------------------t-------------------------------------------------------------
U Nature of Repairs or Alterations—Answer when applicable---------------------------------------------------------------------------------------------_.,
.............................................................................................................................................----------------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
k
the provisions of Article XI.of the-State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Cer'tificate'dJ[:":'C--ompliaifte has been 1�s j I by tjj >fdf
s 0
.... ......... ---------------------
Date
ApplicationApproved By---------- A-------------------------------------------------------------- --------- ------------------------ ---------------
Date
Application Disapproved for the following reasons:................................................................................................................
.........................................................................................................................................................................................................
Date
PermitNo------- ...................................... Issued---------------------------------------------7..........
Date
..THE.COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
. ..........................................OF............ ........... .....................................
Tutifiratr of Tompliaurr
THIS IS TO CERTIFY, That the Individual Swage, Disposal System constructed or Repaired
i 1le
by.............. /----ix�
--------------------
01 -- - -----------------------------------------------------------------------------------*--------------------
Installer
at............. ........... r)f-4-4. .........................................................................................
has been installed in accordance with the provisions of Article X1 of The State Sanitary Code as described in the
e7
application for Disposal Work�s-'.Cotfsfruction PeRMtN6.-_.�,_YW
--- ----------- ----------- 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
_47 4L
N 0........... FEE... -------------
Permission is hereby granted........... ---- - ------- ------------------
to Construct or Repair an Individual Se age Disposal System
I.....h; /14 Ay1'*41d_
at No......... .............W...... ---------------- .........................................................................................
Street
as shown on the application for spo§al Works Construction,T 6Firnt"N ..... ated........----------------------------
... .. .. .............
Board of Heal
DATE.. ----------------- ..................... .................
FORM 1255 HOBBS,& WAR-Ritti.-'I*NC."'PUBLISHERS
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