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HomeMy WebLinkAbout0061 SUNDELIN WAY - Health C� 3uni-e- � C6 � , r ape' ASSESSORS MAP NO: 6 PARCEL NO: No.,._..:_..--•--......��J � Fps.. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliratiun for Diriputiul Wurks Towitrurtiun Frrutit Application is hereby made for a Permit to Construct (Ce or Repair ( ) an Individual Sewage Disposal System at: ..........., ...�1�....S ` ,Y ---------------------------------- ... ortylt�e\d1.a5 bgoo or Lot4o. Owner Address a b w•��. i 4900 � S' I �� �� ....�....�... �..d`'1....- -------------------- -w.. Installer Address U Type of Building Size Lot... .0-?2...Sq. feet ., Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) a Other—Type of Building ..._: p (4) — Cafeteria ( ) �t .............. No. of persons _______......__.___. Showers dOther fixtures .....1-0-6--------------------------------------- ------------------------------....-------------------------•--------....----.......-•------- W Design Flow........... .........gallons per person per day. Total daily flow..-_-.3.®........................gallons. WSeptic Tank—Liquid capacity_Ift..gallons Length..... -....... Width._._S__....._ Diameter---------------- Depth...J. x Disposal Trench--No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No...... Diameter........( --------- Depth below inlet..._'9............. Total leaching area..: . .'.r_ ..sq. ft. Z Other Distribution box (x) Dosing tank ( ) 394,,3 `"' Percolation Test Results Performed b ............. Date........... ,�� g.(6.1.. Test Pit No. I...... ------minutes per inch Depth of Test Pit---1.617- Depth to ground water....,t1.4.._.4/.4T e (s, Test Pit No. 2.......4>........minutes per inch Depth of Test Pit.... Depth to ground water.._.4/C..�-0�?_G, 0 Description of Soil-------�A��t.....7-¢-- k.�P..:....5.!%. 1------- -------------------•--•-••--•----------.------..-•---.....-.--..-----.---..-..---.---. x U ..................... --•--••........_....-•••---•---------•--..........••-------•-•••-•--••---•-----••-•----•--•-----•-•---••---•---•---•--•-•-•••••---••-----••-•--•-••........----•---•--............. w --------------------------------------------------••-----------------------------------------...---------------------------------------------------...-•----------...._.........-•••--•-•-•---....--... U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ----•-•-•-•---••--•••-------------•------•-•-•---•••-•••-•...----••......----•----••---•-••--.......--•----•-•-----•....---••-•----•-••---•••--•------•----•--•-•---•••-•-•-........................... Agreement: The undersigned agrees to install the aforedescribee1ndivi 1 wage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental undersigned further agrees noc to place the system in operation until a Certificate of Compliance h by the board of health. Signed ........... .......... .... ................................................. ...A lication A roved B '.... ..... !/._...: -� PP PP Y ........ ...f...:...g ..., �`� Application Disapproved for the following reasons: .......:............................................ ........................................ -- .......................... .... . .......:. . ... .......................................................... Permit No. ......�f ............ Issued ........ Z ...... Dace Q02.o 00 3 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratintt for Diripninl Works Cfnttlitrttr#inn lirrutit Application is hereby made for a Permit to Construct (Cl"or Repair ( ) an Individual Sewage Disposal System at: ........... 7-................Uw....... w .; .............. --••-••-••--•--••--••--•-------------------------•--...._._..-------•-----•-----•--............... II�� I ocati -Address or Lot o. Y� w ............. /V A/ � � � S .. '�................................................ Installer Address ``/! U Type of Building Size Lot.._r-��c1 2 Sq. feet .............. a Dwelling—No. of Bedrooms-----------------------------------------.--Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building _-_�t od-____-.._--__ No. of persons------ ---------------_- Showers (�) — Cafeteria ( ) P4Other fixtures .. ----------_---- ------------------------------------------------- ---------------------....................................... W Design Flow.......... ---------gallons per person per day. Total daily flow....... J..�—..........................gallons. WSeptic Tank—Liquid capacity-_/...gallons Length----4-------- Width....a.------- Diameter................ Depth... x Disposal Trench-- No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No ---_-----.-... Diameter--------6----..... Depth below inlet.__2............. Total leaching area- sq. ft. Z Other Distribution box Dosing tank ( ) 334.3 ~'' t Percolation Test Results Performed by.......................................................................... Date..._.._..S /8 G a T -------------•-- N Test Pit o. I................minutes per inch Depth of Test Pit---h(.F...... Depth to ground water..../v_-a...l.�/p.Try (_, Test Pit No. 2......4.......minutes per inch Depth of Test Pit---- G-.69...... Depth to ground water---./b6o..w T"-L, a ..................................--p..-----._.�w ......-----••...... ......................................................... DDescription of Soil.......� �-......1� �6'' ....... -•-----Q-------•------------------------------------•-----------------------------------................ x U ..........••••••••--•----••-••••...............•--•--•--••------.........._..•---•-•••---------------•----•-•••-••---•-•-•-•••--•--•••----•-•-•••-•••.......•••--••--.._........-------•••--.....---•--•• 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 Coder e undersigned further agrees not to place the system in operation until a Certificate of Compliance has'b I tied by the board of health. Signed ............ ........................ ---------------- X�Da �r3 re . ......... .� . ... . ..1/...._ ... 4 .................... ...APPlication Approved BY ! j Application Disapproved for the following reasonf: ....................................._............................V(...... ................................... .......... ....................... . ............................... .................................................... .......................... ...... . ...... ........................................ Permit No. .......,...:...� . ..._. ..� ...� Issued ......... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (ETPrtiftctt#P of Compliance THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( � ) or Repaired ( ) by .._...---------- -------__.....a..._......._.................. .. - _ � naa iet at ......_ a..'.... .dl..... �i/�/ . ...; '... ,i�J ....... ! .................c.............. . .. _ has been installed in accordance with the provisions of TITLE of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ... ..-.`1 .._ou, j7_ -.- dated .._/ �"'. ..,,�� THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............ - .-.._.1... .._........_..._.............__... Inspector ........ . ..................................................._........_..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No........:+�.........� fi FEE.��.�..F�.��..G'z'� �in�n �t1 nrkn �na��tr�tinn �rrtitit n. Permission is hereby granted.....,...06.......................�.._...... to Construct (V) or Repair ( ) an Individual Sewage Dispos System at No.../�l. ... .e.....I�`G/_ S�✓.✓ c'.�/!t/--k.�9�..... = g k/: /� : Street P y as shown on the application for Disposal Works Construction Permit N'o'S. ._./A�_..._ _ Y ..................... � ----------- - f --� ------ ---- ,• �/ � / '` � � --•-•----••-•----••---• r• DATE----•--•------------•---•---•-----•-----�.;:- ...............1............ Board of Health FORM 36508 HOBBS&WARREN.INC..PUBLISHERS � �•e TOWN OF-BARNSTABLE Of 1132 0/ LOCATION 41 Soidip'llu Y SEWAGE 1 VILLAGE A�Rt%�2 a ASSESSOR'S. MAP LOT, INSTALLER'S NAME PHONE NORIj(It,J t9licIid f SEPTIC TANK CAPACITY 160)9ftL TN K_ LEACHING FACILITY:(type) 't'IN- `DO 3 (size) /60(j NO. OF BEDROOMS PRIVATE LL OR PUBLIC WATER lv BUILDER OR OWNER j,�),0,.jjkA, DATE PERMIT ISSUED: // / /9-:s DATE COMPLIANCE ISSUED:_ VARIANCE GRANTED: Yes No Qr°� C- 35.. y —' ' , COMPLIANCE. , )WN -e BARNS`�A'B L E k CLASS: 4', Marine,Gas Ste P, > ers satisfactory 3. Auto Sho s BOARD' OF HEALTH r p .[gunsatisfactory- 4. Manufacturers IMPANy , =' { (see"Orders") S. Retail Stores 6. Fuel Suppliers DURESS �-"ti %� n y Class: 7. Miscellaneous t -. ,t--� J. 3 QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors) JOR MATERIALS Case lots Drums ' AboveTanks Undetgtound Tanks IN OUT I 16-gellons Age ( ? Fuels: w Gasoline, Jet Fuel (A) �Diesel,' Kerosene, 12 (B) heavy Oils.: 7 waste motor oil (C) new motor.',oil (C) transmission/hydraulic ;ynthetic ,Organics: degreasers ran � S iscellaneous: s POSAL REC IATION REW,RKS t) . Sanitary Sewage. 2. Water Supply t_ I �. I"`,- if '� / ,Y"7" . OSown Sewer Public `'- On-site Q Priv.0 .� Indoor Floor Drains: YES NO Q Holding tank: MDC 'Catch basin/Dry well _ On-site system UR EiMi�""__- -• - -._...._._.... .... �__. �— Outdoor Surface drains:YES NC , - 1 Q HoldinL• tank: MDC 0 Catch basin/Dry well - OOn-site system Waste Transporter Licensed? -Nama of Hauler_ nesti nat i nn Waste 'Pr,kA6*_ 2. ei Person(s) lnt.erviewed . Inspector Date i-,.,s. s.�r. .,'»�+- .-. C '..r 2; ,y''s ..h i-�Y±ti_ r r.s` sq r.,,. y. _ r,.: •5e.,4., ..e..i 'i. r .,r'• ::._. 'tF', x,,,.., .t., ,Xia+k.. - A a r ; ','rr tea... �,. ,.F w. Q­e now .itii 'Y t: ..... ,.T t': t"•_ y} S,. is 7.nr a � , ' a ... �. icy, .,. d _ .:. ,. n.... ... .... .. MIT! J .. y ...a p, ,.., y+ AN 1 , H w 01 TrA 101 it, . 3 , .. .. .. 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