HomeMy WebLinkAbout0079 HILLTOP DRIVE - Health 79 Hilltop Dr.
Marston's Mills
A.= 077 016
TOWN OF BARNSTABLE
LOCATION Ap- SEWAGE #
VILLAGE t044 b' WllC-KS ASSESSOR'S MAP & LOT 077- alto
INSTALLER'S NAME & PHONE NO. �CYr� C7 C�O�y _�o
SEPTIC TANK CAPACITY /elbo awol
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS PRIVATE WELL OK-PUBLIC WATER'
BUILDER OR OWNER S�'�tJ� ®ICI_g4 VDO _
DATE PERMIT ISSUED: _
DATE COMPLIANCE ISSUED.
VARIANCE GRANTED: Yes No
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No .............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
-------------OF............. ------------------------••--------
Appliratinn for Di"aa al Workii Tomitrurtinn lirrutit
Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal
System at:
T.._.... lG ..._£? !.� ... � j ------------------------------------------------------------- ---------------
Locat' Address or Lot No.
L.�JlVS2... r7�---•-----. _�- /JP � �k /L[S
Owner Address
Installer Address
Type of Building Size Lo�Z400.4--------Sq. feet
V Dwelling—No. of Bedrooms...................�..,?_....................Expansion Attic ( ) Garbage Grinder ( )
pa, Other—Type of Building .10.SS Ognrc g... No. of persons....................... Showers ( ) — Cafeteria ( )
Other fixtures ---------------------•---------------------------- ---
W Design Flow................... .............gallons per person per da . Total daily flow__-____-.----� �3_.............._._..gallon.
< N
WSeptic Tank—Liquid capacity/0d(._gallons Length.___..&. Width..._ . Diameter------4 `� Depth.�'F_--
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No----------. ------- Diameter.....la---------- 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__.---_____-____---_-__-
P4 •----•-••------••-------------•-••••••••••..__...............................................................................................................
O Description of Soil-- P ���-�---- �
�------0--�-1-----•---•- --- ---� ,�---���'®/t.-------- -�-----------��----------��---�--C`+���.�-----
U •----------•---•-••--. - �-.. ......-•••--•-•-••-•-•------ ------------------------ ----••--•------
-- -----------------------
U Nature of Repairs or Alterations—Answer whenlicable.___-__- _-___-_. �.___ ,-----*.?
�r------- --------ZZ"0 ------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of T.IT LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b;enjjmued by the oa
Signed--- -•--•....... -•---••••-- ••-••----••••• t
Application Approved By. 1 4
ate
Application Disapproved for the following reasons:.................................................... ...........................................................
.......••-••••-•--•-•••----•-•-•--•---•-• ----------•---•-----------------------------•------•------------•---------••--•------•-•---------------------
1 ......----•...............•Date
Permit No.--- ----•-�--•"-•-` ---------------•--. Issued_----------•---- ........
Date
0
Vol '-•--J-•3_�
FEs v......A
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OFF HEALTH
t ............-OF............. ...._....... `.:. ..................................
Appliration for Uiq#niittl Works Tonstrnrtion Pumit
Application is hereby made for a Permit to Construct ( ) or Repair ��) an Individual Sewage Disposal
System at
-72 �. �ovP �� ucr �d 1�
...............•-- .�i...... . ......------...-----------...�... .........---------------------•------------ --•-_---------------...--------------------
Location
• • 1.. - i,�G r Lot
---- ------------•-..._•------------
owner
WW C/oe 0777
-------------•'
_ Sq. feet
Installer Address �.i
Type of Building Size Lo}=_-_11:9'�5'__
-
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No. of persons.........:_____________ Showers ( ) — Cafeteria ( )
d Other fixtures .._.._...
W Design Flow....................5�...............gallons per person per da Total dail flow............. 33�?___._.._._._________ lons.
04 W Septic Tank—Liquid capacity Z 4C gallons Length....... _WWidth___. ._ Diameter._.___ _�_ Depth__ _��__'.
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_________-___________--.
Lr. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...................
Ix --••--••--•-•-----------------------•--------------•••--•----•-••••-------•---------•...--•-._..._...._.__...--•---•----------------•-•--------•---------
Description of
�1 ' ............. ..........�,. =�----=-.-�--` -�-�.----------�-/--�----f -------- �`-'�� cry<5
---•-
U .......................-------=---
W
-•-----••-•-----------------••-•----------•----------------•-----------•-•--•--------•--•-•---•--•-----------•-•-----------•----__-_---•-----------•-•------------ ;�_-:-----
x 244�C 'c;CG � ' . ,
U Nature of Repairs or Alterations—Answer when applicable._----
_._%'___=_-___ _ _ ......._____________ ______________-
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
f Ithe provisions oT-TIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the oaf
Signed....4 ........ ------•----- ....... •---•--.._�_1. =tr/'
Application Approved By... --• . r�"
---------------- ------- -- ----- � -
Date
Application Disapproved for the following reasons----------------•--------------------•--------------•--•------------------------------------------.-•---•-......
-----•-•--•----------------•------•-----...--------------•-------•---. -----------___---•-----------__•-------------••-------------------------------------------------------------------------------
Q Date
Permit No. ........ ........•- -••------- Issued... ......
D,&te
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF ' HEALTH
••%......•(;�..'(�.............OF............ -r_ ..............._............_..
Trrtifiratp of Tontplianrr
THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired
b
_-,<x,.76 Cv7'T� C::6:�us�j� L E-77,yv
y ----•-•-•-•--••--•---•-••••----••-•--------------------------•--...-----•-
at �� t i%GG `7Z), = Installer lev'-'cJ 7e 1-V's es
--------------------------•-------- ---------------•--•---- ------ --------------•-------
has been installed in accordance with the provisions of TITIE 5 of The State Sanitary 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 THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..................... ..-.L..'�� .................................. Inspector.......................i- _'D.....................................
THE COMMONWEALTH OF MASSACHUSETTS
3'�,.. _ BOARD OF............�l�7ir...... .....OF--------------...............................................�`�G �.EALTHH
_..._..._.._..._....._..
No................ ... �_o
FEE........................
Disposal Workii Tonstrudion amit
row✓1.(Jz .rrv5
Permissionis hereby granted...............v-...........................................................................................................................
to Construct or Repair (<) an Individual Sewage Di s osal S stem
atNo. ----......................................................... ✓//C•.. '--•--.'6l4
...................
Street ,
as shown on the ap lication for Disposal Works Constructio ' it No.-,_:___._______. ated_______________________________r-_______
DATE_ _______________________••__^___........ Boa d of Health
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS