HomeMy WebLinkAbout0365 WILLOW STREET - Health 365 Willow Street
West Barnstable
/ A= 131-018
7
- s
om K
1,10
i !eoo �Ary
�eSt p't
-To i' Soli
stl 0,0
VmM
hoopOw�
Colkyse
. a
131
TOWN OF BARNSTABLE
LOCATION ,3
VILLAGE AZ/ Ag ASSESSOR'S MAP
IK Q �
INSTALLER'S NAME & PHONE NO. 575 °,'j,!,lLo'gV STPZELT
WEST BARNISTABLE, MASS. 02
SEPTIC TANK CAPACITY. UO .1 'IA,2- 00
_LEA,"'HING FACILITY:(type) (size)
NO. OF BEDROOMS 3 PRIVATE WEL O I R
BUILDER OR OWNER r
DATE PERMIT ISSUED:
DATE .COMPLIANCE ISSUED
VARIANCE GRANTED: Yes No V
a °
- o
Jos
3
l 1n`
ASSESSORS MAP NO:
��.-.�1 PARCEL N0:
No...
_ . Fizia2., ...'...'
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH 7 -�
r0
.............
........OF....... --------•----•-----------------------------
Appliration for Diopoial Works Tonotrnrtion Vamit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
..................�".._Gl� . -- �-.------. ..........-----------....---.....----------- ----........---------------.•-----....----
Locat' Address or Lot No.
O n ddress
ar1J �lct 1 Gl�
......&-"0 ..
Instalier Address
UTy -e f Building Size Lot............................Sq. feet
�-, Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( }
Other—Type T e of Building No. of persons............................ Showers
� YP g ---------------------------- P ( )--- Cafeteria ( )
dOther fixtures ---------------'•-'--------•-------------------------•.--...------------------------•-------..........------...---... ------
w Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............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 tank ( )
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.---....................
R+' -•----••-• ¢I
Description of Soil....... •----- �!QL - ------------------------'---•-------...-------------...............---.
x
w
UNature of Repairs or Alterations—Answer when applicable.............-..--........-----......-.--......-.-.----.--------.--- ...........................
•-•-----•--- -------------•----------•-------------'-•-........-••-•••••-•--••--•------''•---•••----•-•-•--•--••-•--•----'-•••---••-•-•-•-••-------------....1--•-----------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TT T LE p 5 of the State Sanitary Code—The undersigned furtl er agrees not to place the system in
operation until a Certificate of Compliance has bee issued ly the and f!dalth.
Signed.. •• ............ !a-............. �7
at
Application Approved By---••......--- --- . ---- .... \ ......................
Da te
Application Disapproved for the following reasons:------•-------••---------------•----------------.............................................................
--•-•-•-----------•"••-------"' ..................
Date
PermitNo.... .), •. 1 ---------•-•---------. Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�
| ---'/"-------'-' -'~--
Appliration �.~4�r U �� as�K� Workii Tonstrurtion
/ prrmi
Application is berx6v made for u Permit to Construct ( \ or Repair ( ) an Individual Sewage Disposal
System at: /
Loca�ihn Add-ess or Lot No
ssJt-
Installer Address
Other fixtures
Design per person per day. Total daily
Septic Tank—Liquid ............gallons Length................ Width................ Diameter-.---- Depth................
Disposal Trench--No...................... Width.................... Total Length.................... Total leaching area-----------sq. bc.
Seepage Pit No--------------------- Diameter.................... Z>oo16 below inlet.................... Total leaching area..................sq. b.
Z Other Distribution box / \ Dosing tank ( )
~~ Percolation Test Results Performed bv.......................................................................... Date........................................
� Test Pit No. l................minutes per inch Depth of Test Pit.................... Depth to ground water---------..............
f:!� Test Pb No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
.....
[} .................................-----'-'-----------'------
ofSoil....... _1 _.-'---_-__'_--'-_--------_-'-_'-____.'
........................................................................................................................................................................................................
----_----_----_--'----------.----_'_--'------------..._--'--_----'----------.---'---_
U Nature of Repairs orAlteratioms--z\uawerwbcouoolicuble................................
-------'-----'-------'---'----'----'----'----'----'-------'-'-'---'--------'------
'�g -_-_-.
The undersigned agrees to install the zforedeucri6ed Individual Sewage Disposal System in accordance with
the provisions o��I��� .5 oi the State Sanitary Code-- The undersigned further agrees not to place the system in
operationJ a Certificate f Compliance has been issued
_____ ...../^......!2_._�?
� Date
Application Approved By.............. � ______. ���.�_!�_~7
- 5 � v"=
Application Disapproved for the following reasons:............................................................................................................-
.........................................................................................................................................................................................................
Dat,--
PermitNo.-' ......................... Issued.......................................................
Date
THE ooMwomvvsALTH OF MASSACHussTrS
BOARD OF HEALTH
94-
--- ~---'OF-.dw
�
wntifiratp of Toutpliattre �
� THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired'�e)
at................... xa �
has been ioorJ)cd iouoorduoc: with the '�ouo of T 5 S � Code as described in the
application for Disposal Works Construction Permit No....��'���....
....... dated------.---.--_----_
THE ISSUANCE OF THUS CERTIFICATE SHALL NOT BE CONSTRUED ASAGUARANTEE THAT YHE
SYSTEM WILL FUNCTION SATISFACTORY. ^ ,
DATE............................................................................... __-__________________________________________ -
THE COMMONWEALTH or mASsAo*ussrrs
BOARD OF HEALTH
----��F--_�� ____________
-- - --��'
� Dispoiial Workii
Permission - hereby granted
Street '.
as shown on the application for Disposal Works Construction Permit NZZ al_,). Dated...... 2 .......
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
to Construct or Repair-�.' �'ividual'Sewage Disposal System
f
AsBuilt Page 1 of 1
1VWLY UV 3aAttlVJlA13LC ,
LOCATION SEWAGE # e13
VILLAGE — �iG,�j! y/ ( ASSESSOR'S MAP �, t
INSTALLER'S NAME fiz PHONE NO. "�, i�l.=''�' ST�A T
SEPTIC TANK CAPACITYLQQ 1TO, ^t2__3o05
LEACHING FACILITY:(type) akL ji (size) 2
NO. OF BEDROOMS 3 PRIVATE WEL O
BUILDER OR.OWNER
DATE PERMIT ISSUED:
DATE .COMPLIANCE ISSUED 4-z-d
VARIANCE GRANTED: Yes No V
1
a � o
o
1019
q�
a o
3
you°
l oL
http://issgl2/intranet/propdata/prebuilt.aspx?mappar=131018&seq=1 3/28/2012