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
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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
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