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HomeMy WebLinkAbout0012 MOUNTWOOD ROAD - Health PF 12 MOUNTWOOD ROAD MARSTONS MILLS A = 150 - 076 r TOWN OF BARNSTABLE LOCATION ,yICJJy7, ,t0od/ �26 SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO.s.�laC«)7 e_VNSi SEPTIC TANK CAPACITY /G?60X LEACHING FACILITY:(type) Z?-v7—�S �f (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATeR BUILDER OR OWNER 14-1 DATE PERMIT ISSUED: �y 9 DATE COMPLIANCE ISSUED: : 2 VARIANCE GRANTED: Yes v�� � � �� 1 ^� s c� / c% � ' .���' �� � � �� �� No.../. ? Fps ................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH A p p R p y E p TOWN OF BARNST Bart. Conservatsou Commissi Appliratiou for Uigpniial urk� sign s rruu on Application is hereby made for a Permit to Construct ( ) or Repair an Individual �&y'vea sposal System at ........ .. ' ._ .... Location-Address t No. ...... O wn,er T ........AdAdre�s Installer Address Type of Building Size Lour f_f _Sq. feet Other—Typeg of Building .................��._ No. of ersons__---_--_-__-__--_--(_____)Showers b g Cafeteria ( ) a Dwelling o. of Bedrooms......................... p Expansion Attic Cafeteria a e Grinder ( ) dOther fixtures --------------- •-•----------•----------------------.----------------------------._.._..----------------...-•----------.....---•--•----•---•---•--_. W Design Flow.............. ....................gallons per person per day. Total daily flow____ .....................gallons. WSeptic Tank—Liquid capacityl&-6gallons 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 ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date----------------....------•---•'---•---- Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ r, Test Pit No. 2................minutes per inch Depth of.Test Pit...:................ Depth to ground water........................ �+ ---------------------------------------------------•-------------------......--------------'--•-------------------------------------------------•---- 0 Description of Soil--- -------Q ''-�----•- ---— -------c,-�" � e............ x � --•-----------------------------------------------------------------------------------•--•--•-------•...-- W UNature of Re irs or Alterations—Answer when applicable_.__ ,��____...� i0 G 9.... .i _.. ------......- °V --------- --------- ..........i;------.�.5"Cs ------- Agreeme t: 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 Compliance abn issued b �ardofhealth. Signed --------- ....._-------- --- --- -------- Date Application Approved By ..... . .....-.. .... ------- ....... ------ Date Application Disapproved for the following reasons- ---------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------=----------------------------------------------------------------------------------------------------- ------- -- ------- --- ---------------------------------------- Date Permit No. 1...' 7 �. Issued .��� �------------------ ate �---••- THE COMMONWEALTH OF,MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Applirttiilan for Uhipviittl Workii CanuitrUffou� rrntit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewag,Disposal System at: �Dc1M' ........ ..... I-00M .................................. --•-..........._/J..../GAS-------........-----------.......-•---............_.._. 1 Location1- ddress or— t No. r --------------•� --•----------- .......... J�'-7..c10�....�_�_�•�-.......... ........t ----- Owner Address �� s ------•7b�' .! ...................... Installer Address Type of Building Size Lot�../��!� -Sq. feet Dwelling—No. of Bedrooms............................................- Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ___..------•--...-------•---------•----------------------------------•--------------._.__._...-----------.._...----•-----------•••-•----............. W Design Flow________________�_��__.__._.....____.gallons per person per day. Total daily flow........ ....................gallons. WSeptic Tank—Liquid capacityZt4�6.gallons Length................ Width................ 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........................ (s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W .-••••---••••--•••. ......................................................................................................................................... 0 Description of Soil------...--- ....... r�1� •`S4�SQ-L am.------``�-=---=e' _� `-5 '` ....... U -- - '5--•-•-•�-.5 --------------------••••. •- W V Nature of Re airs or Alterations—Answer when applicable..... _ �> -------- � ` ---------`•S�?¢V ----•---------� �-------• /`ST%! -------Ti -- -• - -T ....... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in y 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 Compliance has b7n issued by the,boa�rd of health. Signed ..... . �/. / ApplicationApproved By ....................( ...... 1 ,C-�-= a v`_ --.: ......................---------------...---- Date Application Disapproved for the following reasons- ....................................-------------------- -I..------------------------------------------............--------------- ------------------- ------------------------------ -------------------- ---- ---- ---- -----------............................................... - r-....--! - ------------- ----------.....--- - ---------------------------- Permit No. .......... � - �__ Issued 0`-•..............cam._ c-..------...-____-. --._.--- Date.._.. Date� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Tompli xttce THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( � ) by----...........................-------................... 2]'ZG 0717 .......�J ? ---------------------- • Installer at .............................................................. ✓ve"UAT-/_ee)4 l.. ✓L1/LDS. 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. ........q;/..- .--.,3_:7-1........ dated ........------................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCT/,ION SATISFACTORY. DATE.......................... ---------'�---/�---1-------------------------------------- Inspector ...---------���_. ---------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH p TOWN OF BARNSTABLE ............'_ Disputial Worko Tonstrnrtinn Orrntit Permission is hereby granted_______________________ .G©.................................................................................. to Construct ( ) or Repair (K) an Individual Sewage Disposal System at No...............................,/�.-.•.--......�-v l�645 ��L� ��L1, Street as shown on the application for Disposal Works Construction Permit No.5gXn�I7_!__ Dated................. /--'1•_-A----.____ ----------------•------•---•----------!�N A (� _ ) _ �f U-Board of Health DATE---------------------1;5-------/--•---------;_.-------------------•--•--------._.. FORM 36508 HOBBS&WARREN,INC.,PUBLISHERS