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HomeMy WebLinkAbout0206 BREED'S HILL ROAD - Health w dap TOWN OF BARNSTABLE LOCATION' 0'/ )q -5r Ntli p-d SEWAGE R VILLAGE ` ' ASSESSOR'S MAP &. LOT INSTALLER'S NAME & PHONE NO. Lsh' SEPTIC TANK CAPACITY�� _ i u •+ LEACHING FACILITY:(tyge) u (size)— NO. OF BEDROOMS -PRIVATE WELL OR PUBLIC WATEIt BUILDER OR OWNER A4,4SS D DATE PERMIT ISSUED: DATE COLIPLIANCE ISSUED: VARIANCE GRANTED: Yes No ti, n } �J �y31� . i i i No.._ .1._......... �// 111 �-� Fps..... . 0...... THE COMMONWEALTH OF MASSACHUSETTS BOARD QF HEALTH *7 �1...........OF. ..... ... . .. . ................ Appliration for Diupuuttl Works Tomitrudiun Permit Application is hereby made for a Permit to Construct ( or Repair ( ) .an Individual Sewage Disposal System at: r V ` a i� Loc tion Address or Lot No. w Or Address --" ...-• ................................. ••-•-•----•-.......•-----•-----_......----•----•--..........•--•--•......................... ''CJ M Installer Address Q7i Type of Building Size Lo ......Z. U Dwelling No. of Bedrooms............................................Ex Expansion Attic a g— p ( ) Garbage Grinder ( ) p� Other—Type of Building N Qaffidiwms ails..:2.7SZ?...5,r—Showers ( ) — Cafeteria ( ) QOther fixtures ------------------------•--------- Design Flow...................:.-7..5..__._. gallons per per pej day. Total dailf fl w--------.-. -�2...................gallpnst, WWW P q P Y�e g gt Q.. ... Width:.._._. Diameter:-...- Septic Tank—Li uid'ca acit allons Len h.. L� Depth_. ._. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No...........I........ Diameter.......LO..... Depth below inlet......(,....._... Total leaching area.:&...7...sq. ft. Z Other Distribution box Dosing tank tg�..te-Depth /�Percolation Test Results Performed by......IL..r....... d�1 :./.19d.... Date....5w1Y ...07.... . Test Pit No. 1___. minutes per inch Depth of Test Pit.. to ground water.. Lz, Test Pit No. 2... _minutes per inch Depth of Test Pit....... Depth to ground water.. ... . . __ ..- R+ -----------•-------•..................•--.........-----..._......•-•--...--••-•-•--.......................................................... 0 Description of So' ... ce -------*----- ------------ xaw"--... .. --- ....a------....-----...._................. x .. ....... ._ .�Gc,u,:- ...................................................••••------•... lab V Nature of Repai or Alterations—Answer when applicable................................................................................................ ------------------------------------------------•-•-----•--•---•---..........------------•--........-..........---------------------••-•---•-------------•--------•----------••----......._............. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of LITA U 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. Signed.... . .... .. Dae . ......... Application Disapproved for the following re o s:...........................................••---------••-•---•-------------•••-•--..._......................».. -•----•..................................... ............................... ...----•---.........--•-•---...............----•--•-------•--•-----•...........-•----- ._ ......----..... ..: Permit No....... ..... ..................... Issued-.-.... --• •I �......-»Dau No.. ..... 1 Fas............/ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH h �J.. /.U............OF............. Appliration for Ui,ivnottl Works Tnnitrudiun Permit Application is hereby made for a Permit to Construct ( `or Repair ( ) an Individual Sewage Disposal System at: , - P. ....... . . ��: 3I 1-f �i2 W ._ Location-Address or Lot No. -....................... .�... ................................ .._........------..... .. `....... .... W A e— —� L! �er.. .. Address- »............. ,-a (-- . .... ... = -----•-------------------------- -------------------------------------------------------------------------------•---........ "Instaper Address } Type of Building Size Lot.-.Z!.Cf_ ....Sq�feet �-. Dwelling—No, of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building +� a yp g ._...�-----------------=--- No:Wofspersons._7_�.:��..�?:F Showers ( ) — Cafeteria ( ) Otherfixtures ta►2 �.-----------------------------------------------•---••-----------------------------.-------•---. Q �'' W Design Flow-_1...............'�1_. .............gallons per person per day. Total daily flow__.._-_:7 �2...................gall'ons., WSeptic Tank-'Liquic capacityl. ..gallons Length... ..!1_.. Width:._.?*.X:.. Diameter................ Depth.. ..4?.. x Disposal Trench—No. .................... Width.................... Total Length.................. Total leaching area....................sq, ft. 3 Seepage Pit No...........t _._... Diameter......1.0...... Depth below inlet.....rl�.._...... Total leaching area. ..sq. ft. Z Other Distribution box ( Dosing tank ( ) t Percolation Test Results Performed by......!(,. :.. Test Pit No. 1..�- ...minutes per inch Depth of Test Pit..... ��.. Depth to ground water.� ..1,/? ...� . 44 Test Pit No. 2..A=..L.minutes per inch Depth of Test Pit........�� ._. Depth to ground water.I.Vf j� _ P+' .. .. .......... .......................................................................... O Description of Soil..... __ `� � 7......................... t( is - -- . AD V ...........e"f ............................... W .....--•................` . f-1 (1 ...fU_ !:�,.. ........ .. -...� � 9, m� y v .j 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-TITL 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. Signed....eA--•-•-...4......................•----.A.....................•.......... a • rDaZe - -,,kApplication Approved Byr; o w ....-.--�-----•-_.... ...!__ •�. (- c`f J....... ' rr r '•r Date Application Disapproved for the following re s s:-----•.....................'-="-`=....-------------------------•--------•-----•-••----•-•••--•...._........ .. n jPermit N �. ,� Date o...... ./ • ( --------••--•••-_. �F Issued..---- .............. Date Y _ THE COMMONWEALTH OF MASSACHUSETTS' / /�f' B'OARD�F HEAH,- �' L� /..t,�..l1V �.0F......._ .......r. ............... ......... (Irdifiratr of f ompliatta THIS IS TO at the Individual Sewage Disposal System constructed ( ) or Repaired ( ) a ....�: .. .•-�:.. .>.�� ....... ----•-.•...............................� -..............-- ................by..........r.�� ��} d /;.. at..1, d....._ �......__. ' `�!�.rt --- tall .................. . P V,1� % / # _.. .... ............... has been installed in accordance with the provisions of TITIE 5 of T- e., State Sanitary d/as descr'bed in the application for Disposal Works Construction Permit No-----�'_�.~..:_�t��_=�. dated__.. . ,�..�����................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUA ANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ......................................... Inspector_ / !(-mot` T'01P.++M9,0-0.@tpYf t.b9lYq•y♦v F�MTwrP^n..T+nw•v�rwsr _ w�rtAM^TB40'NOVe9.90M'rib611Fb0@+'?.rtF±v Lnmin T.s e�..o e•ab _TT.!.. _----------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD /� OF HEAL H.- ll. .....OF.....p. - M C �'/--.� .l�►'�--..... No.. ............._ ► r FEE........... .. �is�n�ttl,,//� urk��y��un�#r�r#iun �rrbti� Permission is hereby granted------ ------------•-------•............................................... .. to Construct ( ) or Repair f�( )ran Individual,SewageA Disposal System . at No.... � l�Jj '•' � _. 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