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Home My WebLink About0780 MAIN ST./RTE 6A(W.BARN.) - Health TOWN OF BARNS TABLE LOCATION S �b41 ILI-W Y7 SEWAGE # - --_5 VILLAGE V1.1 ASSESSOR'S MAP & LOT 1.56 INSTALLER'S_ NAME & PHONE NO. 1G \� ✓� SEPTIC TANK CAPACITY 1 UZ L LEACHING FACILITY:(type) -FL 1DI f u5561zi-(size)- NO. OF BEDROOMS RIVATE WELL OR PUBLIC WATER BUILDER OR OWNER Lk-,-\\\N c• gv%_ 0, A ' ssy� DATE PERMIT ISSUED: DATE .COZIPLIANCE ISSUED: VARIANCE GRANTED: Yes No �C (C-TIftwxl-i r. 1 00 4 V, T x !O.W--. Fps....................... _ • l5� � THE COMMONWEALTH OF M'ASSACHUSETTS - BOARD OF HEALTH �TO W.............O F o.sr.0 t� . Appliratiun for Uisipuattl arks Tonstrur#tun rrrutit Application is hereby made for a Permit to Construct ( ) or Repair ( (�aa- Individual Sewage Disposal System at ............... - ..tca_-60-11 .�..... .............T -----•------ .,.�g1�1*�5�� -Addres or Lot No. Ow er Address ..........-��......`��-....� �`...---------------•-----...---.......--------- .............. �5.------••---....---....---------...--------.......----•---- Installer Type of Building Address g Size Lot.............................Sq. feet ►-� Dwelling—No. of Bedrooms..._q--------------------------------- .Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of ersons............................ Showers 04 P ( ) — Cafeteria ( ) Q Other fixtures ........ W Design Flow........... . ...................gallons per person Pier day. Total daily flow......a4-A-0......................gallons. WSeptic Tank—Liquid ca.pacityl��.gallons Length---l dam.... Width....C7_......... Diameter................ Depth.........-- . x Disposal Trench—No..../.............. Width.....R.......... Total Length...a.C._�_... Total leaching area....................sq. ft. Seepage Pit No...................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed by.......................................................................... Date.......•.................. ............. Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ C4 --------------------------------- •...... ••------ ------ •---............------------------------------ ----•.................=•.......... O Description of Soil.......----- •-•---•--•-------•-••-•--------•--------------------------------•--------......--------•--------------•---------.......------......-------•---............. w •----- •---••----- ---------------•-------•---•---••-•----••-•--•----••-•----- •.... ----••.....pp ....--••------ -------------•---••--•-----•--•-----••-•----•-••---....--•-••-•--•----•---•-----•-•_..... v Nature of Repairs or Alterations—Answer when applicable .....1.' .Q-�.. S - C— "�� ?�? Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of IITI LF, 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 bo of Si - ��..................... -•- . .... .. _ Date ApplicationApproved By.................. ..-•-----••------•---------------------•........ ............. --3>5 ate Application Disapproved for the following reasons:................................................................................................................. ...............................................•---------•----•-....-•----....---....----...--------•---•-•-•------•••---•-••-----••-•-•----•••------••--••------••-----...--••-•...-----•-•----•••----- Date Permit No.... -.. Date....................... Issued_....................................................... L C ]v '��-�-•- � ! _ / FEs............._.. _ i THE) COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAILTH . t Applikttt' pan;for,Uhiposal Works Toustrnr#inn Permit Application is hereby made for Permit to Construct ( ) or Repair ( L).-an-.Individual Sewage Disposal System at: •............... s._i_'?.� - rt..tl� - .f._ --.........- - ....................... ... -- I:ocation-Addressj/ or Lot No. ..........._yd._ ...._ ct r��f, G' i/✓.............. ........ ... .._._.............. �1 Owner k Address a ............................._..- 4..+_..:...1-------------------•-•---•-----------------. -------------•-•-•--•------.----------------. Installer Address Type of Building Size Lot............................Sq. feet 1-4 U Dwelling—No. of Bedrooms.... ...................................Ex•ansion Attic 4 ;p ( ) Garbage Grinder ( ) pal4 Other—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures d -• ------------------------••----------------.._..--•--....._....--_..... W Design Flow......... _ ....................gallons per person per day. Total daily flow..._._.�4.�A.L7.._..........__......gallons. WSeptic Tank—Liquid capacity lF1-T)gallons , Length` :1�-` .:_: Width....(s��..f_. lDiametter................ 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. Other Distribution box i Q' z ( ) Dosing tank ( ) ` ''" a Percolation Test Results Performed by.......................................................................... Date......................................... Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water.... f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Oa ••••••••-•••--••••••-•------••-•--•....•-••-••---••-••••...•.-•...•••••..................................................................................... Description of Soil......................................................................................................................................................................... (,) ........ W v Nature of Repairs or/Alterations—Answer when applicable--------t t..-_n L -s i r :c::•C•'�gel?k r_f- , .T•1l1 jo' .) ___ ?:___ • •-•••-_` ', .......... � ..G. r.p......: ............. ........ ...... = .... Z Agreement: f The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLF, 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 board-of health. .- c -- f Date Application Approved By................... ............................ `= �``' Date` Application Disapproved for the following reasons:.............................................................................................................. ........----•-------•---•---•------------------------•---•-----•---------.....---•-------...--------..........-------------------•-------------•---•-------------------•--------......------•----•---•-•- Permit No...... -�� Issued. • Date...... Date �--._--w—�.,.__.. -4.-..�..— —._..-M�...r�.....-:era.----.�...,....y...... �,..-,.r.._��«.......,....._..«.�.............,..._a.+.�.-.�Y- - �,.�...�.�e—��. � THE COMMONWEALTH OF MASSACHUSETTS t! �i t BOARD OF HEALTH ....... Trr#ifiratle of Tomplittnrr THIS IS TO CERTIFY,That the Individual Sewage Disposal System constructed ( ) or Repaired by..................•-•-•...." - .1c ,� r` ................................................................................................................. Installer - (_ - L . V&,::a sc,at......__... .. .......................... ---•--•-•••-•-•-•-•••-•••••i.�.�...........••••••---•-..........••-•••......------------ has ....... been installed in accordance with the provisions of TITI 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._ ............ da.ted........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........... ..1�j� ��? .. ........`•-._�..... ------------- Inspector...................................................•................................ r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ... ��C .rJ ......O F.............�'`^ tr y ...... No..•-•............ .::.-. FEE'-.--�-��........ T Bisposalr ork,o Tanotrnr#ion Permit Permission is hereby granted................... ._ ............. _ -----------•-----------------------•---...•......••............---_.... to Construct ( ) or Repair (� ) an Individual Sewage Disposal System -------------- _ �................................................... street /^ J as shown on the application for Disposal Works Construction Pe�nut_No��'>7.:_.2 D�1ted. i2..!.�!�........ ------------- � - y' / �, DATE. u,>ard of IfCallh r'. �, y,