HomeMy WebLinkAbout0031 HARTFORD AVENUE - Health 7
V
TOWN OF BARNSTABLE
LOCATION 3 I (PVT 4VA PW . SEWAGE #� -' `'
VILLAGE r"t �� `I S : ASSESSOR'S MAP & LOT CG> 04
3
INSTALLER'S NAME & PHONE NO.C(Xri�tw
SEPTIC TANK.CAPACITY 1000
LEACHING FACILITY:(type) 6 ; (size)
NO. OF BEDROOMS 3 PRIVATE WELL OR PUBS A'T'ER
BUILDER OR OWNERCU[X!T I C"
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
_ 3 ,
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TOWN OF BARNSTABLE ---
LOCATIO? 4 OI''� ,��- SEWAGE ,�_
VILL.AGEf +0 � ASSESSOR'S MAP & LOT
NOW49—2-c NAME & PHONE NO. ----
SEPTIC TANK CAPACITY_ __ ¢_.
1 og
FACHING F1�C1_LIT-Y:.(typ�e' ? _ (size)
NO. OF BEDR OMS _PRIV � LL OR. BLIC WATE
%b C 3�
BUILDER OR OWNED A? �
DATE, PERMIT
DATE COMPL.IANt."FS ISSUED_
VARI.fi,NCE' (,RAN ED: Yes_ No
0
Hauser ��aPl.
(O
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OFHEALTF-
APPROVED
arnstable Conservation Department
TOWN OF BARNSTABLE
Appliration for Diripuuul Hlodw Totwtrur rrmtt Date
Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal
System at:
......&,-tL.0 ............. ................. .......j?� Z 4::t.........................
ocation- \d ire, or Lot No.,`f� -Q
..._... _ r - --- --`-/'•--- ---- -------------- ._.._- ----`SJ....... 1-- --..._._:_.=1.........
_.`..........._._..._..__-
« cr ` dress
k.S
( — Installer Address
dType of Building Size Lot............................Sq. feet
U Dwelling No. of Bedrooms______________________________ __ -Expansion Attic Garbage Grinder
aOther—Type of Buildiig ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures __________________________________
W
Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
tx 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........................................
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........................
-----------------------------------•-----•-----------------------•-•----•--..........._......__-•-----......._....._:.......•--...._•--••---•-•--------_--•-.
0 Description of Soil_________________ ___ '
'�--...: ________________•--••----_____-__.-------------------------------•-------------------------•----•---•-•-•--••----
U 'e e �'-•`---------- --•••-•� � �t----•--------___-•-----_____•_-•-•-•--•----------------------•-----•--•-•--__•-----•---_...._..._._.__......--•---.
W ............... .••---------............._._...._...-----•----...----•-......------....___...__.._-•---........------...........-----.._...._._..__..---...------._._._..--•-•-••-----•-•-------•---••-.
UU Nature of Repairs or Alterations—Answer when a licabl _.- ..
P PP � �, -------------- ._._..........._..
-•----------------•-•-------•--------------------•-----•------------------- 1--� .- ------------------------------. --•--...••---...•----•-•••---•----
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Env' mental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Co 'pli ctsbeen issuedby he boar of health.
Signe - 2-I.2 2Z
...................
Date
Application Approved B 22^�2
PP PP y ............. ........................ .....................................
Date
Application Disapproved for the following rearons: ................................... . ............................. ...............................
........................................................... . ............................. . ...................................................--. ----.................... .1. ... : :_��'2
Date
Permit No. .........'2.`.......r ✓�.................. . Issued ............ ." .. .2
................
Date
3�..[:V a..'+�tic:,' ---✓-•.v_,",v--.-,,;,�.� ,w_.ia,.j....__��K��..y.-._�,�`�r.;�Y:-v._y,-;�. ._._.;ta'�' w.lr,_ � N .- -� :.. _ __1_�__..;_—�[� o �—_ ___r
No..2 _- 3 l Fas. :..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE ,,,
Aliptiration for Di�ipngul Nnrk,s Toni trnr#tun unfit
Application is hereby made for a Permit to Construct ( ) or 'Repair � an Individual Sewage Disposal
System at:
............... .T......1..:.^:.--. _ �.a ....✓...'.S>^. /t[`,ocation '�""d'�d,r c•s�s
................... .......................Ij ' ).;4-------- I-• •--=-A-{+-H
f!
----•---••---...-------
r �o
. owner ..............
dressC ��... r ..
Installer Address
d Type of Building Size Lot............................Sq. feet
U Dwelling No. of Bedrooms................................ _Expansion Attic Garbage Grinder
p-, Other—Type of Building............................. No. of persons............................ Showers ( ) — Cafeteria ( )
Q, Other fixtures ..............................
w Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons.
1:4 Septic Tank—Liquid capacity............gallons Length................ Width-------_........ Diameter................ Depth................
Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
a Percolation Test Results Performed by.......................................................................
Date....------------........................
,.� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
f14 Test Pit No. 2................minutes per inch Depth of Test Pit.-.__-___...__-_---- Depth to ground water........................
P4 --•-•-••-•-•-•---- -----•----------•••--•••-•--•---•-•••---••-•---------------------•--••-•---.....-•----•••----••---•......._----.............------........
DDescription of Soil_......... � -•..... `---•--••-•-------------------•----------------------......--------..................•...-••••--•••--••------.......••-
�� : w�
v ................V . ...---� ------------..............-........ ....--------------------------------------------------------------------....._..---------------...-----.....------.
w
UNature of Repairs or Alterations—Answer when applicabl ___ ._ .. 1 1----------------- ....................
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 Compl vc has been issued by he board of health.
/ ' �` _
Signed_ ""`- ...... ..< �j.......... ......... 21.s-.2-7 2
Application Approved By ............................ . .. ..... ... . ......;......................... . -- ....... . .............. ........... -
Da[e ...
Application Disapproved for the following reason.r: .................................................................................................................
...... ..................... ..1.. . -•2 2^...�-
. .... .....
Dare
Permit No. "' ------------ Issued ............ 2-..............
Dale
- .. _ _ ��-•„yam.-_^-'
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certtftrate of Tomplianre
THIS IS T• CERTIFY,(;. at the Indiv`dual Sewage Disposal System constructed ( ) or Repairedby Q�
--- �....-d ..... .................... - _.... ...__.............
I"[u�
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. y .... dated .:..... .- ��
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE----- .............. _9�- _......_...... Inspector ... ...... N....:.......`•..:. .�.............................................
rl
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�i / TOWN OF BARNSTABLE
No/.. . ? �� FEE.. ....................
Din;rn 4 nrk dun trn\r#inn Vamit
Permission is hereby granted--------- .-----•--,_--.......�` ......... ..............................................
to Construct ( ) or Repair �n Indivit ual Sewage Disposal System r t S
atNo............... ...---•----•- ,_.rrt'e .x `I��S-_<-- ----- - ----.................................
Stre
as shown on the application for Disposal Works Construction Dated......�.. .....
nn n a v` Board of Health /
DATEd�.�. .....................-•-•-••--••--•-•--•-------
FORM 36508 HOBBS h WARREN.INC.,PUBLISHERS