HomeMy WebLinkAbout4046 MAIN ST./RTE 6A(BARN.) - Health �� �
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TOWN OF BARNSTABLE a
LOCATION SEWAGE # V
VILLAGE e L-,VK"!ZL.,f 6 ASSESSOR'S MAP & LOT J Y 7
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY ' I bQTD ��`yo►'�-�
LEACHING FACILITY:(type) 1'Q�'-��5� �` (size) - i'7cbf
NO. OF BEDROOMS/✓ PRIVATE WEL ;OR PUBLIC WATT f�
BUILDER OR OWNERji -
DATE PERMIT ISSUED: 23-
DATE 'COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No f_�-�
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No.. F�s.... _..... .....
&I 0=,3nMQntTHE COMMONWEALTH OF MASSACHUSETTS 4
BOAR® OF HEALTH
Signed pay--` TOWN OF BARNSTABLE
Appliration for Uispniial Works Tongtrnrtinn runfit
Application is hereby made for a Permit to Construct ( ) or Repair ( n Individual Sewage Disposal
System at:
........... �� --... . .f -.. -
(�•Location.•Address VtN
•-• �. - - f=��5.�.�:S .A--Q •-------•-- •--••-•----•-- c��2G ` -.......:.�• ..... --.... ...
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a ............. ........................
p � Gr�?�..... _.... 12�/
Installer Address
UType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms-----�............................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building .... ..... No. of persons............................ Showers
a YP g ------------------ P ( ) — Cafeteria .( )
Otherfixtures ------•----------------•---------•-•------------......-----•-•-•-•---------------------------•------------•-------...
w Design Flow......==�' -.................gallons per person per day. Total daily flow..... .---------------.-gallons.
WSeptic Tank-� Liquid capacity.1.6 allons Length... Width......._ Diameter-_-_-_.-____•-_- Depth................
x Disposal Trench—No..................... Width.........._......... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.... .............. Diameter../6/
________ 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........................
rs, Test Pit No. 2................minutes per inch Depth of.Test Pit---:................ Depth to ground water........................
9 ._...._•--------•---------•----------•------------•••--•-----------•--------------------------------.........................................................
0 Description of Soil...............................................................................-------------••----------•-----•--------------••--------•-......................--------
x
---------------------------------------------------------------------------------------------------------------------------------•-•-----------------------------------------------------------------
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UNature of,,Repairs or Alterations—Answer when
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 issu d by t�br.;I..-plhalt
Signed ------------- ------- -------- --- .
1
-- -- --- ...........
® Dare
Application Approved BY /l-,r.'�c ----�------.. a - ........................
v Date
Application Disapproved for the following reasons- ------------------------------------------------------ -- --- ------------------ -- ------------------------------- ----
Date
PermitNo. a..-..vim.. .l ......... Issued ----------------------- .........................................
Date
No. Fzz-
THE COMMONWEALTH OF MASSACHUSETTS
BOA RD OF H EALTH
TOWN OF BARNSTABLE
Appliratiuu for Disposal Works CnuustrurtuQn Vrrmit
Application is hereby made for a Permit to Construct ( ) or Repair (individual Sewage Disposal
System at:
._..._.-4! .__.». 2- :- - ------------------------------ ---------------------------------
Locatio -Address
».- or Lof No.
—t-..».»�...�4_ie..�Z: --- -^ -- ---------- C�l�d't�! G1..(�� �—
'--------- j drress
a -------------�.:� ---' �'L-_.- - - ----------P--o-- -
Installer Address
Type of Building Size Lot-----------_--_ -_Sq. feet
U Dwelling—No. of Bedrooms-----�____________________________Expansion Attic ( ) Garbage Grinder ( )
`-4a Other—Type of Building ____________________________ No. of persons---------------------------- Showers Cafeteria
( )
dOther fixtures ------------------------------------------------------------------------------------------------------------------------------------- --_-
w Design Flow........ '��_--------------------gallons per person per,day. Total daily flow------�-��-C�-----------------gallons.
WSeptic Tank-L Liquid'capacity.Z igalIons Length--- Width -------- Diameter---------------- Depth_------_______
x Disposal Trench—No--------------------- Width------------------- Total Length-------------------- Total leaching area-------------W_-sq. ft.
Seepage Pit No-----,�-------------- Diameter__/L?___-------- Depth below inlet___ - Total leaching area----------------sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
1 4 Percolation Test Results Performed by-------------------------------------------------------------------------- Date_--------_-----��-------�__---.
.a
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-_______-_--____----_--_
P4 ------------------------------------------------------------------------------------ ---- -- --- -- -- --- -
0 Description of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------
x
U "-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --- -----
w
U Nature off epairs or Alterations—Answer when applicable_,____ -_ C (_-__1A-j f_ b
7 L - �r ` _------------------------------------- ---- -
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 Com fiance has been issued by the board.-f-heatt..
a Signed" ------ ---- - r�-
r' ��-- .Dare
Application Approved By ----------- -
Dare
Application Disapproved for the following reasons- --------------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------q-------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------_-------
Permit No. l - �- Issued --------------------------------------------------------Da.
r Dare
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
GPr#tftctt#e of (gompliance
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (
by (21 �A- ------- e---------------------------------------------------------------------------------------------------------------
r
- - � 0 � n
- - - T7 at --------------t� ti ------------2 - --------------------------------------------------
has
been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No- ___; -__579.�____________ dated _______________________-__-_________-_
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE---------------------------�--------------1� -- tJ77------------------------------- Inspector = -------------------------------------------------------------
- -'
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Disposal loorkii Tonstrudiatt f rrmit
Permission is hereby granted------------sC1 le �=y�1 c 6�- `( -= _-_-
----
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
atNo-------------------------------------------q l/_�tO-------['�-'----e-�"-----------------------------------------------------------------------------------
Street 5�
as shown on the application for Disposal Works Construction Permit No. 2_'____Q!__- Dated------------------------------------------
k
- - - -`-�'-' - - ------------------------_
-— Board of Health
DATE °� -------------------------------
FORM 3830E HOBBS Q WARREN.IMC_PUBLISHERS