HomeMy WebLinkAbout0091 INDIAN TRAIL - Health qt fnd�an ra;L
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TOWN OF BARNSTABLE
LOCATION iul- -41LL 9k� SEWAGE # ?_
VILLAGE- Cb ASSESSOR'S MAP & LOT 03Y- ./ o
INSTALLER'S NAME PHONE NO. " ' l
SEPTIC TANK CAPACITY 0: 0 $ e- 4
LEACHING FACILITY:(type) Lp (size) '
NO. OF BEDROOMS ' PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER t'ao
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED:' Yes `s :_. No
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ASSESSORS MAP NO ® '
-- PARCEL NO:
THE COMMONWEALTH OF MASSACHUSETTS
SOAR® OF HEALTH
`.. - ..............OF..........
Appliratiou for Dhipniial 18orkii Tome rurtiun rumit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Systenj'at;
Location A ess or Lot No.
..... ..._:y ....................................... -•----...-------- _�_.__:=.....:-------------....--•---...._.._....----------------•
Installer Address
Type of Building Size Lot............................Sq. feet
C��Dwelling—No. of Bedrooms.,_ _ !. .__._Expansion Attic ( ) Garbage Grinder ( )
__._.. No. of ersons____________________________ Showers —
a Other—Type of Building ____________________ p � ( ) Cafeteria ( )
POther fixtures -----------•-------------------•---------•------•-•---•---------•----•---••••••••••--------•...•----•-----•••-•----•••-•-_._•---------•--••--•---•••-
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity------------gallons Length................ Width................ Diameter________________ Depth................
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__..----•-------------------•-_.._..-----_._...
O Description of Soil--------� �-- •......... �®�y1--------------sue ��- -
x
U
x - A--�-•-•---_ L... -•-----•----------•--•--------•--•----•------•-••---•••-••--•-•-•••-----------------
U Nature of Repairs or Alterations—Answer when applicable___ �-__: _ ..... a---` ,4 L_.__X.f�___.
� �'-------------•-------------------------...---------------------------------------..........------
Agreement:
�_
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Ti T p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has beeU issued by the boa d of health.
Date
Application Approved By-•----- .............9,--n_- k,57
Date
Application Disapproved for the following reasons-----------------------------------------------•--------•-------------------..................................
........................................•------•-•--------------•--------------....----•-----•--------...-----------------------------------------------------------------------------------------------
Date
Permit No........57..7.__-_&Zl---------•------ Issued_.......................................................
Date
- 3/�
C /`'j
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
d /'✓.................OF........ 1 LL- '
Applirotion for Disposal Works Tonstrurtion thrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Syst
.............j/GZi `. ' '...................... .................__. ` �!1 ry /d•�--l/�-----..., ..... y .
Locat:on-A ress x or Lot No.
51
Owner '
....
_15-
Insta!1er Address
Type of Building — Size Lot............................Sq. feet
Dwelling—No. of Bedrooms.� f.................... .....Expansion Attic ( ) Garbage Grinder ( )
04 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' 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.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................
rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
•�...... ••-•-••••... _t-s.....• .....----------=--=---•-•------------•• -----_.. • ._.._.. _-•--
Description of Soil - ..e/fA'� 112114'�'/ a.t ?li' ii.-..-- "I...........
---� / .e / �
_ ------ : = �: _
U Nature of Repairs or Alterations—Answer when a placable._. tiQ-___ :_ 1..__._1_,1_._!l _. '11L.....5..1`:.....
----------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TI-11 j 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 bo4rd of health.
Z—f'Z4l s GLo3 r �.,,j f, (. Sign- �/1--ti -- --- ---
! + Date
Application Approved By........
'.� � -----------`7
Date
Application Disapproved for the following reasons-------------•-•-----------------•-----------------------------•------------------------•--------•-••••......---
---------------------••---------•----•--••---•-•••---•••-------•-••--•-••--------..._........•----.....---------------------------------------•-•-----•-•-••••--•--------------••--•--•------••---•-•---
Date
PermitNo...... `_ .................. Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
�..-� BOARD OF HEA TH
� j
X2�.4. ...............OF..... ���1..��/.............--------..........-_....
Currtifirab of Tomplianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (.
by....................................................................................................................................................................................................
Install
has been installed in accordance with the provisions of T i T E j of The State Sanitary Code as described in the
application for Disposal Works Construction Permit NTo...... �_� �_...... dated_._._.._-----------------------------________
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT VNE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE C�...-:. �............. Inspector................
-----
V 3 THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...........oF.........2 /Q11:.�CCJ I.. ?...c �..........................
No.a '.6_2+,s.._,I ` FEE... ...
Disposal Aorks Tonstrudion rrutit
I� Permission is hereby granted.............?� ------- --------------------.....-----......------------.........--------...--•---•--•--••-------
N to Construct ( ) or Repair,,, ) an Individual Sewa a Disposal System
Street
as shown on the application for Disposal Works Construction Permit o _ t fl_.__ Dated..........................................
Board of Health
DATE....................... ° 5........
-r. .........................
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS