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HomeMy WebLinkAbout0375 MISTIC DRIVE - Health 375 MISTIC DRIVE Marstons Mills 4C 50?'/ TOWN OF BARNSTABLE LOCATION Zo-r v� /�- Sf, ,Olr,'y� SEWAGE # �'�"v� 00 VILLAGE ASSESSOR'S MAP & LOTOt6-0 40 INSTALLER'S NAME & PHONE NO. JO-A^ A. n a' < "o SEPTIC TANK CAPACITY �7f7 LEACHING FACILITY:(type) (size) 3,?X/O NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WA BUILDER OR OWNER DATE PERMIT ISSUED: "'# DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �/' 4:7, 5.00 < S ON " C. �a i )L !Sr NO-A Mum THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........I - -OW-4............OF.........rs.. ............................ vpfirat.ion for Disposal Marks Tonstrurtion Urrmit Application I is hereby made for a Permit to Construct ( Vror Repair ) an Individual Sewage Disposal Sys, a, .......... ......Dzu ........M.!4..............7............................................................................... Jocation-.Addressor Lot , .......... A!Iry.... !4s .................. .........W--7.1.140 ......................9,6 Owner i­', Address ....................... ------------------------------ -------------------------------------------------------------------------------------------------- ---1141", Installer Address Type of Building Size Lot-A44.67.0.0.3q. feet U Dwelling—No. of Bedrooms.................------------------------Expansion Attic Garbage Grinder ( ) 4 114 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria ( ) 04 Other fixtures ................................. .. ................................................................................. t� gallons. W Design Flow................ ,_gallons per person per day. Total daily flow.._......___.............._ 1:4 Septic Tank—Liquid capacity.K0.gallons Length................ Width....... ....... Diameter._-_____.._..... Depth................ Disposal Trench—No.-------I........... Width......Id....... Total Length....... Total leaching area........4Q.4.sq. ft. Seepage Pit No_____________________ 24ameter.................... Depth below inlet_._..........._..... Total leaching area..................sq. ft. Z Other Distribution box Dosin&tank ( ).. 7 - 'SLA ...... Percolation Test Results Performed by. .fLAJ! ...!�TZV......14 ..... Date.............7.//0 .. it Test Pit No. I........Z—�__ inutes per inch Depth of Test Pit-------)_.1........ Depth to ground water...... Test Pit No. 2................minutes per inch Depth of Test Pit__.___.......___.... Depth to ground water........._..........___. -----------------------i.......... ...... ......... ---------- ------- -- 0 Description of Soil............. ------------------------------------------------------------------------------- ...... 14215.01 .......................................................... 40��. ........ .......... ............................................................................................I..i i7t ----------------------- M ----------S--A, f ........................................................................................................................................................................................................ 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 Code—The undersigned further agrees not to place the system in operation until a Certificate of CoZmpl2iana been issued by the board of health. Signed ......... . ....._...... --------e4llz�_- ---------—---------------------------------------------------- ------------------------------------- Date ApplicationApproved By �.............. ..................................................................... ..........Z--- 42 I ---- ------- 2&,,-1 Application Disapproved for the following reasons: ------------------------------------------------------................................................................................ Y ........................................................7.........................................................................................---------­-----....................................... ...................................... Permit No. 47----3 y------------------------------- Issued ........................ ...........................Da........ 'ILI— -100 FEic 41................ THE COMMONWEALTH OF MASSACHUSETTS G. -7 BOARD OF HEALTH ........... ............OF......... 3 .6........................... Appliration for Disposal Works Tonstrurtion Permit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: 6 AA ,AA �0-t­ ­X5- Mr5rir , '�tiv ................................................. .........VC ......................... . ................................................ ....................... oca n-Addrs!,,, or Lot N 0 ........................................ ......... _-�T.. M. .........-- Owner Address .......... ......... Installer Address T.-,rpe of Building Size Lot.A� �j._.O..Sq. feet U Dwelling—No. of Bedrooms...............4---------------------- Expansion Attic Garbage Grinder ( Other—Type of Building ............................ No. of persons............................ Showers Cafeteria ( 04 Other fixtures -----_---------_.................................................................................................... <11 �Is ----------- Design Flow................... ........ . .__..gallons per person per day. Total daily flow.......................... .T_ . ......gallons. W I I, 04 Septic Tank—Liquid capacity.1.Z)fUgallons Length................ Width.. Diameter____.__......... Depth.............._. W Disposal Trench No........I........... Width.......112........ Total Length__......._..... Total leaching area.,_.._�X- *74?..sq. ft. Seepage Pit No_____________________ Aameter.................... Depth below inlet....._.............. Total leaching area..................sq. f t. C-ther Distribution box Dosing)to k U t 1!5 tA 1q..... Performed by ....................... i) .Percolation Test Results ----------- ... ... ................... Date......... Test Pit No. I......:7 3ninutes per inch Depth of Test Pit.......1.1........ Depth to ground water...... Test Pit No. 2................minutes per inch Depth of Test Pit..._................ Depth to ground water_.__._...............__. ........................ . ...........f.�----- .........4.................................................................................. 0 Description of Soil..............C-2 ......... .........su!*_� )L ........................................................ ....................................................................................................................... ------------- U Z ....................................................................................................................................................................................................... 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 Code—The undersigned further agrees not to place the system in operation until a Certificate of Complian e as been issued d by the board of health. Signed ._-------------------------- ........................................................... ------------------------------------ Date Application Approved By ........ ------ -------- �./....2...... u, -----------Application Disapproved for the following reasons: .............................................................................................--------------------------I--------------- ........................................................ --­-------------------......................................................................­................................................... ----- --------------------------- Date Permit No. ----------x 7 3 V-------------------.......... Issued ................................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............�.J)W.4........... OF ........ ...Z.............................. (fiertifirate of Cantyliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------_------------------------------------------ i Installer at ..................1'.-Or. ............................... ----5TIC ...... .................... has been installed in accordance with the provisions of TITLE 5 ofjhe State Environmental Code as described in the application for Disposal Works Construction Permit No. ..........7.1.....-3...V------------ dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..........:4....... -- ----'r-111--- ---------................ Inspectorl�. .......................... ............................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......OF..... A 12 VA C'JA I ................................ FEE....................... Disposal Works Tonstrurtion "prrmit Permissionis hereby granted.....................................................................I........................................................................ to Construct or Repair an Individual Sewage Disposal System ........... ZS "o. - �-, i V a, No..... ...............al Street qq as shown on the application for Disposal Works Construction Permit No.._. Dated.......................................... .......................................... ................................................... DATE................................................................................ LB6ard of Health FORM 1255 HOBBS & WARREN, INC., PUBLISHERS i 11 1 V I I I I eA,TC B45 t•1; E,p, �_ T L .• lI IN Ile I -1 • �� •T.� z car. �t � 7/ Ab B e-:>�Dom S qd �l L✓ FLovl t( X 1 I tj = � G•PD- � �O u� L� lac.• ��� \ I 4 24-0 AA Flo Tsc, 'Dar�►� Ltd a L-G'iG }i' {li f'. �P=G .� s,_,;w- B_..aw' ..i r _ •<... j-jjL(�h Gr` A2(��11 `'" y�t/ifif¢1�1 4E I /J G7 so 7�,t�'j� i't�J�-EMI bl.�r'L_ �..�,'ti� `�:7:`�.�.1�..`/c i�.... C�• I � j 50 o Q�Jv�EoV� Akfj UI�SUP*dl3i M�,Tr✓2lQL Ip (! ALL- A2o7r�� fEMr- Q, > rze?LA a wIrg u�� Grr��vLa� C�:r� ; �5;.t a'25 Svc I�G MAT7EQ4 A L_ Tyr coo ��of V1 t- I 33 r T r` INJ wv, IrJd. lil✓ 14 48, 157 14V t�:'Y iN� 4 4X8 �cou��+FFJ55C¢5 c," i 1 SULLIVAN I - . v _ No. 29i33 �'f Ili r < f ail I, i ,.. � t �,.�...,..••. <.,,. .. .::`� .,:T Alt I , III { O �... � r �J c 1 ,' II OF�I II - II I T24',A�� '�=; I 1.�'� 5 3 1 tJ tQ .a LA 10� 2 _ -—i- I III I I ii Ii I