HomeMy WebLinkAbout0046 MORGAN WAY - Health ns/off
Vol",
TOWN OF BARNSTABLE V
LOCATION x026* SEWAGE #94 -2,4¢
VILLAGE Id• 3 ,2�►7s°fA, d-- ASSESSOR'S MAP & LOT`,r- 0,4,9
INSTALLER'S NAME & PHONE NO.
,141SEPTIC TANK CAPACITY. IDOL &AL
LEACHING FACILITY:(type) Gd;q pd (size) /000 GAL
NO. OF BEDROOMS PRIVATE WELL O PUBLI WATER;
BUILDER OR OWNER 17i0l�diNB L'rrE21//CC(i
DATE PERMIT ISSUED: 9-li 9A_
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
, pphration for Mitipw3Ml Wor1w Tonotrnrtion remit
Application eby made for a Permit to Construct 04 or Repair ( ) an Individual Sewage Disposal
Syst at ,
...................... ...............
ocation- dd ess r I of No.
::�---—------- -—---------.... ........
Owner Address
Installer Address
Y_
� S� Type of Building Size Lot________..1______ _k5._ q. feet
Dwelling—No. of Bedrooms..�.``_,.,�->> . ___---_-.-Expansion Attic (116) Garbage Grinder (NO
���K_ o. of persons............................ Showers — Cafeteria per., Other—Type of Building ..________ p ( ) ( )
a' Other fixtures ------------------------------- - -
� ,-�---gg
w Design Flow....................I`�................gallons per pit per day. Total daily flow._........33d......................gallons.
WSeptic Tank—Liquid capacity.MP_gallons 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 ta�}k ( A) ///2 v /,F,7
aPercolation Test Results Performed by...... ..._ ...... �'.A Date.
a Test Pit No. I.....Z�...minutes per inch Depth of Test Pit.................... Depth to ground water_._4t!Vo._._ .
(q Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
9
0 Description of Soil... ' --..
- -•----•---------------------------------------•------------------------------------------•--------------------------------.--------------
x --
w
UNature 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 Cod_e—The undersigned further agrees not to place the
system in operation until a Certificate of Com lance has iss d by the b r f health.
Signed . ................. ... ... .. ..................................................... .........Dare...........:......
Application Approved By ---�... / . . ... . ... . .................D"/r -." . /ace
Application Disapproved for the following reasons: ...................................... . . ... ........ . . -- . .................-- ---.. .
.......... . ............................................................... . . ...... . .... -- ................................. -- --. . ................ ........................................
Permit No. ....?.........'....... .Y...� ...... Issued ............�',�,.- ---
Dare
��
No. ........ _ Fi$... �-. �
THE COMMONWEALTH OF MASSACHUSETTS 1
BOARD OF HEALTH
TOWN OF BARNSTABLE
, ppliration for Divi-Vuutt1 Worbi Cnunitrurtiun Frrmit
Application is,hereby made for a Permit to Construct (1,14 or Repair ( ) an Individual Sewage Disposal
System at,.:
.... ---•---•-��...............�.�•-.•-•-•----.....--�'--•-••.-•.____.. ._-• �--�/---------.- :-•.---...:...----•------...-----.........-------•
Location;6kddfess (J�,, C / _,,/ r Lot No.
----•- - - ••--•-----•-__--- • ------- ------------------------------ --------. .... -----_... •-
Owner Address
Installer Address
Type of Building Size Lot.__.�. ....... � Sq. feet
.. Dwelling— No. of Bedrooms......._____________________________________Expansion Attic (x,6) Garbage Grinder (A/U)
aOther—Type of Building IV No. of persons............................ Showers ( ) — Cafeteria ( )
QOther fixtures --------•--------------------------•---�� -------------------------------------.......__....---------------------------------•-----••--••-_-•---•
W Design Flow....................�1_&................gallons per person per day. Total daily flow...__....__.�_-�___.....................gallons.
W Septic Tank—Liquid capacity./dv0._galIons 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...----, � .._`/ �Q----------------•---•------- Date._._��
a ..... . ...........
Test Pit No. I.....;Rt_ -...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........................
a' •---------------------=----•---•--------------•----..._•--•--........------._._....•-••--_..............................................................
Descriptionof Soil._./!O•rQ.p.... (Q --y'--------••-•----------------------•----_....---------._...-------..._..--------•-••--•--•-•-•----•-----------.....--•-----•
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 further agrees not to place the
system in operation until a Certificate of Corn liance has n issued by the b rdoof health.
Signed ......................:. ..... .. - ............................... �f
_Date
t
Application Approved By ...G.^..:.....�. t 2 ....��'`�. fin- ---......... ........................... .... ............................:....
Dare
Application Disapproved for the following reasons: ........................................................................................................................................
.................. ................................................................................................................. .............. . . ........
�_ Date
Permit No. ....,........ .. .. ....... Issued �' 'r...: � .-..�4!. .'
.......................•Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
C�e>rtif ra a of C11omplia ><ee
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( )
by ... ......LjtSCQ . ............................... . .........................
- Inxmller
at ....G1'-`�........!.�iZ ... •�'l/� .C/%rl ._r,/ 1, ,..../r� ✓t •o .................................................................
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. 1...........~ s
T'... dated /7 .. .
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED-AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.........r f'1 ....*'...'..... ..`..Y............................ ; Inspector:. ................. -
t - f
-------------------------------------------------- ------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
No.................... FEE.....................
Biupuoal Vorkii Tunutrurtiun Wrmit
Permission is hereby granted.... . �'2 { .
to Construct ( or Re air ( ) an Individual Sewage Disposal System
61
---------------------------------------•---•--...._.........
d Street
as shown on the application for Disposal Works Construction Per,.it'1Vo..................... ated ._j._....__..._._.__._..__j....
Board of Health
DATE ......................- .....-------------
FORM 36508 HOBBS Q WARREN,INC.,PUBLISHERS
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