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HomeMy WebLinkAbout0426 MISTIC DRIVE - Health yaC� l')'I��fic (�ri�� ��rs�-is f']'I rf'l S opt- oat ,� F BARNSTABLE of 6IC6CATION o ISk 4G �c 00 SEWAGE # VILLAGE M&(& Jokij W1,l�s ASSESSOR'S MAP & LOTdI��.a0s`�,,, INSTALLER'S NAME PHONE NO. ��• OQ�Scb� '� Sati �7I- IOWD SEPTIC TANK CAPACITY I16k3 LEACHING FACILITY:(type) t&cL (size) I, Obd 5-1 ((A41 NO. OF BEDROOMS PRIVATE WELL O PUBLIC AW TER BUILDER OR OWNER 601y5 ki" Co, 77I-Og�y DATE PERMIT ISSUED: 1 _Z o- gq DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �, �6` `±'�y 5 r l�, '�a t � �7' �/ � .3� �2 e' i ,�..� 4 r_ �G i vew� ' C-v"f � y ��cN� ,. � _ ` . . , r _ P THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE } ,� lirtttiutt-fur Diupuuttl VorkB Tonutrnr#iun Errant �x c7, Application is. hereby made for a-Permit to Construct (Io S or Repair ( ) an Individual Sewage Disposal System at: ---------------- --•-------------- -----------------•-- -----..------------------•---- L anon-Add 3 l, ..or �No. . --- --------•.......................•------- nOwner Address f.._.._..__ ............................... _...._7!V?`=--•-•-•--- ........................................... Installer Address UType of Building L, Size Lot_.Y-Jl-,�..& ......Sq. feet Dwelling— No. of Bedrooms... .....7_--------------------------------Expansion Attic Wo Garbage Grinder (N®) Other—Type of BuildiugW f' No. of persons............................ Showers (v ) — Cafeteria ( ) W Design Flow.Other- fixtures "_'_:_gallons per eri per day. Total daily flow.................. ..............:F-........................gallons. WSeptic Tank—Liquid capacity/.DWgalIons Length---_---__.____ Width................ Diameter....------------ Depth................ x 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 (✓) Dosin tank ( �J Percolation Test Results Performed by.� -----w�-------•------ T ------------------- Date.....11....��...� ---- ------ aTest Pit No. I_A�..__..minutes per inch Depth of Test Pit------ 3.._..... Depth to ground water........................ (% Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ PG ------ ------- ---- ---------- - -- ----- 0 Description of Soil..... x U --••----------------------------------•-•-•----•--...------------------------------------------------------------------------------------.......---------------------------------•-•------------------. w ,--------------- Uature 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 undersigne u er agrees not to place the system in operation until a Certificate o fiance has be by the bo ealth. © f Signed .............. . .. /................ Dace Application Approved By ......... .. ,e,e.�n.,. ........ ...... ......1.0'. �.r.C? ------------------------ ------------------------------- Application Disapproved for the following reasons- ------------------ ------------------------------------------------------------------------------------------------------------------ .......... .......... ............................ . .......... ............................. . ............. . ................... .... ..................... ................................... q Dare PermitNo. -------- v---------;L& .................. Issued .....------------------------------- ..----------------- Dace ze- t No:. �• _._._ ? Fps......, :r%......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ,� �rltrtt#flan.for Uivjipnittl Work,i Tomitrnr#ion Prntit ` /lit ..I ram' Application is hereby made fora Permit to Construct (V) or Repair ( ) an Individual Sewage Disposal System at: .t° � . .. f� L �tioi�i dcc• s5 /� v or_Lot No. Owner ?? ....................... .. .Address ��'j ✓l f Installer Address d Type of Building Size Lot.. -S .XOQ.......Sq. feet Dwelling—No. of Bedrooms.____._.____________________________.._Expansion Attic (,✓d) Garbage Grinder (,vv) `P6464 Other—Type of Buildiu W No. of persons____________________________ Showers — Cafeteria 114 d Other fixtures -------------------------------- ------- ------------------------- ---------------------------- W Design Flow................. ........... ......gallons pererson per day. Total daily flow................. .................gallons. WSeptic Tank—Liquid capa6ty/5�galIons Length---------------- Width---------------- Diameter................ Depth................ x Disposal Trench—No.................... Width-------------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-----�POOQ)Diameter____________________ Depth below inlet.................... Total leachingarea..................sq. ft. z Other Distribution box (✓) Dosing tank ( ) �/, ,, f Percolation Test Results Performed by... �../' _... r ... Date..... .......................... a a Test Pit No. 1_r� •-------minutes per inch Depth of Test Pit------ _3__..._... Depth to ground water........................ G% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ,r� -- ------ -------•---------------------- ....................... ...•--------- --- •-------------------- •--------------.................. Description of Soil t�r,a4�/1_il. �� 1r�----------------------------------------------- V -------------------------------------- ----------- •------- •----------------------------------------------------------------------------------------------------------------------------W 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 ust- er agrees not to place the system in operation until a Certificate o m lance has be n i su d by the bo health. Signed ......................... .. -.s ...................................................... --------------------------------- Application ✓ Da[e Approved By ------------- �' �<...:........................ ........................................ ... "�e '_�.g..<� Application Disapproved for the following reasons: ............................ . ..................... ...... .. . ...........------................... .......... . .......................... ..... . ..}............. ... .. ....................... -...........---------------------------- Permit No. l....��!... -f-------------------- (�'_.7 ._ Issued .................----Dat- --------'-----`---------Date---... Date ____-----_--------————-- ---_— THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C�EICtifirate of V-omplian e O THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( V or Repaired ( ) by ..... 1 �Z-/5--.0�L---------------- -------- --.------------------------ --------.-----.-------------------------.----------------------------------------------------------------------- Installer at .... U % .3 �-- ---lY1 % T<C_.._ . ` ,.. �"h..,._Aki /L L �'..... ............ ...................._.........---------------------------................. has been installed in accordance with the provisions of TITLE 5 f The State Environmental Code as described in the application for Disposal Works Construction Permit No. ..... .-...... .... ...._........ dated ........._. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE :SYSTEM WILL FFU'NCTIO SATISFACTORY. DATE ,,=........ N" ... - Inspector`.^A'...�^'f....... �'� . '.. ------------------------- ------------------------------ ------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH c TOWN OF BARNSTABLE No.. .�:.24.... FEE... e,r--)......... �i��n�ttl nrk� �un��r�tr##i.ttn �rrmi� Permissionis,hereby granted...`'�` --.. �-•--•-••-•----•---....---••-•--••......................•-•-•-••--••----•••-................ to Construct ( �) or Repair ( ) an Individual Sewage Disposal System atNo..--?- -....-R!-----./n—/� . l C....7-)'t'y'_----------- �..:... Yr/LL-S------------------------------------------------------------------------------ Street as shown on the application for Disposal Works Construction Per it No. _ ._ .. _ ate +.......................�1... .._...... ,J I0 Board�of`�Iealth DATE.............. 1 ..... . / --------...... \. FORM 36508 HOBBS A WARREN.INC.,PUBLISHERS 519AZ FAMILY y $E�M40 E 2 do 6;AvaAC.E sePri c TAQY� t4go x 160% _ . 40F. 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