HomeMy WebLinkAbout4698 FALMOUTH ROAD/RTE 28 - SEPTIC 4698 Falmouth I3®ad/Rolit, 28, s�+i I
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TOWN OF na P.NSTABLE
LOCATION G' `ll Ll� , SEWAGE # 6
VILLAGE V/f ASSESSOR'S MAP & LOT 0440`C"7
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INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type)
,.NO: OF BEDROOMS PRIVATE. WELL OR PUBLIC WAT R .
.. BUILDER OR OWNER
DATE PERMIT ISSUED:
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DATE COMPLIANCE ISSUED/A
VARIANCE GRANTED: Yes No G!
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THE COMMONWEALTH OF MASSACHUSETTS ^
BOAR® OF HEALTH
TOWN OF BARNSTABLE
Appliratiou for Bi-tipasal 3Vark,6 Towitrurtion ramit
Application is hereby made for a Permit to Construct or Repair a� n Individual Sewage
pp y ) p ( � Disposal
System a �?
y ��D
...............................
....... d ----•-•-•--. --•-• 6t "'--------- ----- -------
Locat' n-_ dress or Lot No.
-- --- . ............................ ..............a......•.. --•-•-....---------•--..............................
Owner Address
Installer Address
d Type of Building Size Lot............................Sq. feet
0-4 U Dwelling—No. of Bedroomst __________________________________Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
a' Other 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.
3 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. I----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................
(% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a ---------------------------------------------------------------------------------------------------•-••------------------------------
•------•-•---•---------.
0 Description of Soil........................................................................................ -------------------•--•----------------------------------------................
x
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 Compliance has bee beea issued by th oard of health.
Signed ............. _ 9
Application,Approved By ............ ----- -----....._..------------------------------- .................. ....
Application Disapproved for the following reasons: -----------------------------------------------------............------------------------------------------f---------:---------
---------------------------------- -------------------------------------- ----------------------------------------------------------------------------------------------------------------------------
Dare
Permit No. ...... lJr_'" --------------------- Issued ............. -..9..`.1�5._.....................
Dare
TOWN OF BARNSTABLE
'LOCATION `!J a SEWAGE
VILLAGE Ld !J/ ASSESSOR'S MAP Sr LOT OHO
INSTALLER'S NAME 6s PHONE NO.
SEPTIC TANK CAPACITY
:LEACHING FACILITY:(type)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WA R
BUILDER OR OWNER 2 Jc
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED
VARIANCE GRANTED: Yes NO !/
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THE COMMONWEALTH ,OF MASSACHUSETTS l/
BOARD OF HEALTH
TOWN OF BARNSTABLE
Apphratilan for Diti-Vinittl Worlw C omitrnrtintt 11amit
Application is hereby made for a Permit to Construct ( ) or Repair ( 4�an Individual Sewage Disposal
System at.
� .- = rr ----- •-••......• �''
r -•-•-'•-_.Location �� n _or Lot No.
Owner
� - Address
W ^� Ic alter , - L�.:/� .....Address-•---•----••
a ✓ '
Q Type of Building � Size Lot............................S q. feet
U Dwelling— No. of Bedrooms'------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
QOther 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........................
a ....•-•--•••----------------••-••••••••••-•••••-••-•...•----------••--••--------•----------••---•---.........................................................
0 Description of Soil...........................................................'-•••-••••••--•-•---••----------------------••----•-••-------••-•-•-•••----•-••......--•-------••......-•-•--.
x
U ........................................................-------------•----------...-•••••-••••----•-•-••••-------------------------•---------------•---•••••...........................................
W •---••-------- ----------------------------------- --------------------------------------------------- ----- - _----- --
U Nature of Repairs or Alterations—Answer when applicable.__ �� � « .411 !� .......
-----------------------------------------------------------•-......-----------------------------------------� -� ' -�� --
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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 Compliance has been issued by theboard of health.
. - /, -
Signed ... .. i ....... ..s ' '.� �
Dare
Application,Approved B ��- - �`' -- - -------..-------------------------------_---------------------- ------flSa.e.-.9-- ....
PP PP y ----- ---U
Application Disapproved for the following,reasons: ...... ..... ....__.................. ...... ....
r j a ;
........................—..........:.`-------------..._._............:....:-------------------------------------------------------------------------------_-----------
Date
Permit No. -----.-�. a.. :�f..0 L S-------- -
-------------------- Issued ..........--- �>..'..1
Dare
THE COMMONWEALTH OF MASSACHUSETTS t
BOARD OF HEALTH
TOWN OF BARNSTABLE
CETPrtifira e of CTomyliance
THIS
�I/StTO CERTIFY, That the Individual Sewa e Disposal
Sy�Js�[-ern constructed or Repaired
y ...� L f F! _....? .. .. .:� ��•!:? _ �ri der 1i'1 -.. .. E� ...
at .......... .........y "2
------ --- -------- ------------ _..... --- -----------
has been installed-in accor✓ncec.withr the provisionso TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. .-. .... dated ------ ...-._l_._4f;�j.�.....
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE �` �__._1.,.._:..+�� - Inspector --- -.-, -........------------------------------------------ --------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
c� TOWN OF BARNSTABLE
No..... FEE.._1_._..
Uifipnpttl Wore nitrurtiun "amit
Permission is hereby granted.- ' ''� f9.' - =rf '.. F
to Construct ( ) or Repair ( an Individual Sewage Disposal System `P
at No. ` +�? �' --------------•--- � _ - _i��...............
___- - ��- ....-----------------••-'--.......
_.- • ---y /. te"t""r`o-s Street-,-•� - - 's- .� QQ
as shown on the application for Disposal Works Construction Permit No.__.S_�_ '-__ Dated..... ...............
................................... N- ..................................................
C
Board of Health
DATE..................... --= Z--•-
FORM 36508 HOBBS&WARREN.INC..PUBLISHERS