HomeMy WebLinkAbout0232 COMMERCE ROAD - Health era /ov,{
13 o
LOCATION SEWAGE PERMIT 140.
2— 69-1�r�./rc/ C�
V I L L A G E ASSESSORS MAP NO: 3125
PARCEL NO: o a y
IHSTA LLER S A E U ADDRESS
BUILDER OR WNER
DATE PERMT ISSUED
DATE COMPLIANCE ISSUED r -
< <�
y� �
S�°f _� ��' ,�
��
ram.
� �
, �®� _--
�,
I
.�� b. U TOWN OF BARNSTABLE Jf 0
LOCATION- G�(Y1�'�'t�c, SEWAGE # �V' `Q9
VILLAGE &(VSk-CJ31 CEASSESSOR'S MAP & LOT31
INSTALLER'S NAME f� PHONE NO: L ` a"a
SEPTIC TANK CAPACITY `��• �`p�C
LEACHING FACILITY:(type) (sue)
NO. OF BEDROOMS PRIVATE WELL OR UBL WATER
BUILDER OR OWNER \kys�; c.-V.-<-r
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
a
A}o cvSr,'Q� �®
ko
k3-ko s� \
3 a
No-1/1............ Fes$... ............
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
i
....................................:......OF...........................................................---•-----•-------•--...........
App iratilau for 0iipuiia1 Works Towitru ion Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
.. .. .... . .. .tl�.°.._12d --- --------- -------------- --------......3.2 .... ..---... ....... ---•-•-•------•- .........
Locate -Address ��/' or Lot No.
.. ... Q_e--------------------•--•-•----•------•---- Y__ ..._...I............................................
Owner f Address
.§�
Installer Address
Type of Building^ Size Lot__ _ .......Sq. feet
Dwelling�No. of Bedrooms_.....................................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.
fx Septic Tank—Liquid capacity............gallons Length................ Width......:--------- Diameter----------------- Depth................
W Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area.........._.........sq. ft.
x+ 0
Seepage Pit No.. - Diameter----------- ------- Depth below inlet__6- 1......... 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.-___---____:-_--__-:--.
i, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-----------'............
R+ ........
oDescription of Soil... d ---------------------------------------------------------
x
W
UNature of Re i or Alteral'o s—An er when applicable_ ,!/ _'._0�..0 _ ................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT?:,. 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 e lth.
" 1
y Signed.-• .. . .... . ..... ._-
II • Date
N Application Approved BY _. : -�-
N ---•-----•----•------------------•----•-------------------------- 4c4'.
7r
..Date
Application Disapproved for following reasons:.........................................................................................................................
-----------------•-------------------------------•---------------------•-----••---•-•--•-•-----•-------•-•-----------•---•---••--------•-----•...••--------_-------
Date
Permit No..............��.3..................................... Issued.-
.
Date
No.-I�L---------- FRs..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF....................................................•-••----------..............--.......
Appliratiun for Disposal Works Tonstrnrtiun Vrrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
............................................... ....................... ---------...........-- -----•----------------------------•-------....
Locate -Address or Lot No.
.. C. •• . ......_.....
Owner �(, 1 Address
a Installer Address
Q Type of Buildi g Size Lot__ . _......Sq. feet
Dwelling No. of Bedrooms. .....................................Expansion Attic ( ) Garbage Grinder ( )
'_lPL4 Other—T e 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.
Seepage Pit No.. ............ Diameter _%._1_..... Depth below inlet..._�6............ Total leaching area..................sq. ft:
z Other Distribution box ( ) Dosing tank.(. )
Percolation Test Results Performed by.......................................................................... Date........................................
aTest Pit No. 1................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........................
Description of So -•----------------------------------------------------------------•-----....-•--------------------•---••••-•--....----
il =
x
W ----••-------• ---------------------------•------------•-••------------•-- - .......-•--
UNature of Re or Altera4 An er when ap livable _ �� �� .............
-•--• .
Agreement:*
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of T IT LE 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 th
p
Signed ........: ... -�? ..
Date
Application Approved By........... 1�......----•-•------•-•--• ...< 7,
Date
Application Disapproved forte following reasons:.........
••••-•----•-••........--••-...---•---•••-••-•---------------••-•--•-••------•-----•-------••--•-------....-•----•........................=..............................................................
Date
PermitNo.........-��/3--'------------------------------•--- Issued........................................................- Date
THE COMMONWEALTH OF MASSACHUSETTS "
BOARD OF HEALTH G LFA Gt orb,
. l ...............OF......� T ;��G........................................
.......:.:::..:............ ......
T r$if iratr of ToutpliFanrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (X)
by................ G' =-----•..... •-•---•------•-•--•-•--......••••------•---•••-••-••-•----•.........--•------ I...............................
Installer
-------------------•----
at ' G1j9 �rGt � C id6clE'H��+L --- "_
xq a3a� a
has been installed in accordance with the provisions of TI T LE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit Nb--. ... ........................... dated ' _`_ ___.___.__._........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED-AS A GUARANTEE THAT THE
SYSTEM WILL UNCTION SATISFACTORY.
DATE.-••• •.... .` :'..............••........ Inspector•
THE COMMONWEALTHM;ASSACHUSETTS
a� +k.
BOARD OF HEALTH .
OF....... :..............................
No.......... , . FEE........712
..
i u l .5onstr ion rrutii
Permission is hereby granted.....�...._..�........ ............ .��..� �`..._ _
to Construct ( ) or Repair ( )xan)ndivi ual Sepg%W?�c sal System '
at No.--- Ga --------••-
. -••-- •-•- ..... -••- •--•- -- ------ ---
Street
as shown on the application for Disposl Works Constructioner:>rut No........ .1... Dated.... x�
• • .
' and of Heal
DATE..............
°+� x>
FORM 1255 HoeaS & WARREN. INC ,"N.UBLISHERS K °*• «� ?�}
ii r