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HomeMy WebLinkAbout1650 OLD STAGE ROAD - Health '� 2 �� � ��� 1. u o 6 i f I r v t TOWN OF BARNSTABLE A = 15 2, 010 LOCATION � 5� �ADSIi� SEWAGE # w VILLAGE ja6l ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. & A� SEPTIC TANK CAPACITY dry LEACHING FACILITYAtype) -D(Le-C-09- P1% (size) NO. OF BEDROOMS ATE WEL R PUBLIC WATER BUILDER OR OWNER, ,1;� DATE PERMIT ISSUED: 'a- DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ✓� NJ 9v 1 v�o r (Is r 1 FEE THE COMMONWEALTH OF MASSACHUSETTS APPROVED BOARD OF H E A LT HOarnWb1*CW=fVaien m TOWN OF BARNSTABLE 9,/,& 9 Applirtation for Disposal Works Tnnstrnrt"rrntit � Application is hereby made for a Permit to Construct ( ) or Repair ( �an Individual Sewage Disposal System at: .............�& J .......0j0.. �... / v�`' I 1•�'• `421 ....................................................... Locat Address or Lot No. Ow Addres �.. s a .............................. `e...�' �.-•-�-��'.... ........... -----.... �_..o ` `e... `� ------..............-•---- Installer Address UType of Building Size Lot.................... .....Sq. feet Dwelling—No. of Bedrooms--.._3..................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building . No. of a YP g --------•------=--;-------- Persons---------------------------- Showers ( ) — Cafeteria ( ) g Other fixtures ................ .... . . . d --------------------•-----.•------•---••----•------•--••--------•-----•----------------.....•--•----......._..------------ W Design Flow................................. .... gallons per person per day. Total daily flow............................................. WSeptic Tank-L Liquid capacit} .gallons Length----- ..... Width........... Diameter-------------_- Depth................ Z. Disposal Trench—No. .................... Width-...._�._.......... Total Length......_............. Total leaching area....................sq. ft. Seepage Pit No........./--------- Diameter..../Q.._._-_- Depth below inlet....4�;a.�....... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water....................... f� Test Pit No. 2................minutes per inch . Depth of.Test Pit.................... Depth to ground water........................ ----------------------------------------------------------------------------------------•----................................................................ ODescription of Soil........................................................................................................................................................................ x U ---•----------------•--•--•----••------.....-------------------•-•-----•••---------••-------------------...-----------••---•--•----------------------•--------------------.....---------••-------------. W x -- ---•------------•------ U Nature of Repairs or Alterations—Answer when applicable._-_--�cA__�c4�.......(.CJ1R3..5.. `�................. -•---••-------------------------------•--•-------•-------------------•-----........----.........-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE S 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. Signed ....-��J ���`r'1�-- -.© ..................... -'--. -'Date-............-... ApplicationApproved By -- ----- ---- ----- ... ..-- . --- ------ .. ..--- ............................ ............ .................. Date Application Disapproved for the following reasons: ..................................................................................................................................... ----------.................. - . .` ...................... Issued ...................... Permit No. ........ Dale Date No /0 V/ a � � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Disposal Works Tonstrurfl�7vrrmit Application is hereby made for a Permit to Construct or Repair ( u7--an Individual Sewage Disposal System at: .............. Q.... ............ ........................... ..................................................K7............. .......... --------- /fAC Locati,:�� dress or Lot ........................... ..................... .Owner . ............................................................... C��r -1 Address ............................1 9 . .............................. ............. ................ ....... ...... ....... Installer Address Type of Building Size Lot___________________________Sq. feet U Dwelling—No. of Bedrooms-__... ..................................Expansion Attic Garbage Grinder 91.4 1 Other—Type of Building ............................ No. of persons_...................._______ Showers Cafeteria P41 Other fixtures ...................................................................................................................................................... C11 L Design Flow................................ .-gallons per person per day. Total daily flow............................................gallons. WSeptic Tank-�Liquid capacitx;CM.gallons Length._.._..... Width._...._..... Diameter................ Depth_....__......._. Disposal Trench—No..................... Width_.....(............ Total Length.................... Total leaching area....................sq. f t. Seepage Pit No........./--------- Diameter....40....... Depth below inlet.....d�e,.�....... 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........___._.__..._.._. 44 Test Pit No. 2................minutes per inch Depth of Test Pit..._.__............. Depth to ground water..__...............__... 9 ............................................................................................................................................................. 0 Description of Soil........................................................................................................................................................................ W U ......................................................................................................................................................................................................... W ....................................................... ................................................................................... �i . U Nature of Repairs or Alterations—Answer when applicable......__177 t4(-( r ......(.C 'i­L--------- ...................... ...... .......................................................... .................................... 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 Aiance has been d by the board of health. Signed ................ Zi.............. ...Gc........................... --------C7 ........................ Da e ......... Application Approved By ....... . ----- ... .................... ........................._ ........... '6;--------------------- Application Disapproved for the following reasons: ........................................................................................................................................ - --------------------------------............... DarPermit N ........ ­-------------------- Issued ......................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE V�ertffiratc of Compliance THIS IS TO CERTIFY, That the Individu4I Sewage Disposal System constructed ) or Repaired ( 4-1, by..................... n >-" V(NA(A�q�) S ...14: — _ C -------------------------------- ............................... ---- ------- ---------- ­­I.......................­.................................... ............................... Installer at ............................................ 0 0 C4� P-0- ..................................................................----------------.....................................................__........... ....... ---------- .......... has been installed in accordance with the provisions of TITLE of he 4 vironmen'alCode as described in the application for Disposal Works Construction Permit No. dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT B N A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......................................- y -- � . -------................................ Inspector THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE NFEE........................ Disposal Works Tlinstruction Vrrmit (��_ cA P� L-vA(-,Y9 Permissionis hereby granted............................................................................A................................................................ to Construct or Repair (—"_a Individual Sewage D 5�s gsal System, at No. .................................. —C K 0 67 - --------------------------------- ...... Street j as shown on the/a plication for Disposal Works Construction er it No.. . .......... ted ................... ............ ................. ......... Board of Aealth 17, .................. ........... ................. .................... DATE....... 3, ............................. FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS