HomeMy WebLinkAbout4190 MAIN ST./RTE 6A(BARN.) - Health a
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TOWN.OF BARNSTABLE
LOCATION ; no . '0 "P L &09 SEWAGE i< - S
VILLt1G tY c,�'5 f1(% ASSESSOR'S MAP & LOT36'1
INS'T4Li.ER.'S NAME PRONE NO.Q .�
SEPTIC TANK CAPACITY --
` r
LEACHING FACILITY:(typefl fapAzw!:� (size) f — �7�
NO. OF BEI)RCOMS--PRIVATE WELL OR PUBLIC WATER'
BUILDER OR OWNER Zb�-)0 O'l-oo t,44
DATE PERMIT ISSUED-' IQ - 6` C
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No '�'�
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........T,�A_
..---..OF.......-B..A-P_�T .0 -.:----•------------------•---
Appliration for Dhip ial Warks Tomitrurtion - autit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
........................OTE,.....�A.........
Loc tion-Address or Lot
..........................................
--S-1L�H.IS--- 4�:.-
` qwn dd;s
�? ................ � � ....�LIV.5.....................................
Installer Address
Type of Building Size Lot.....'...................S,-#eet
U Dwelling—No. of Bedrooms_._..................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building ............................ No. of persons-----__•____________________ Showers = Cafeteria
a' Other fixture
---------------------------••-•••-•-•-•••----••-•----------...------••----•-•-••••---------- ._. .
W Design Flow.................. ____.._____________gallons per person per,day. Total daily flow.._................_........_..__...__._gallons.
Septic Tank—Liquid capacity.LI .gallons Length................ Width................ Diameter---------------- Depth................
W . Width..... ........ Total Length Total leaching area.-��� s ft.
x Disposal Trench—No................... g g ___ q.
Seepage Pit No-----------_----- iameter..................... Depth below inlet.................... Total leaching area..................sq. ft.
z Other Distribution box ( Dosing tank ( ) p P 3 g%
~' Percolation Test Results Performed by. A�_+..'�.---......tkk....I.................... Date--�----1,------_.____..._.�_..__ 4-
0`4 T. fl Pit No. 1_..__......s..minutes per inch Depth of Test Pit--------I t...._... Depth to ground water...................
Te'st.Pit No. 2................minutes per inch Depth of Test Pit----_............... Depth to ground water........................
a - -------------------------------------------------•---.-.------------------------------
--------------------•------------.-.-
0 Description of Soil._..... ,p
� �---------�--'------------- -------...........----------------------------------------------------
...............•.....x . �.. � .... :_ 1 _
w --------------------------------------------------------------------........................................----------------------------------- ......................................................
UNature of Repairs or Alterations—Answer when applicable_______________________________________________________•________:_____----------_----------_--.
R --•------------------------•••......--•--•-••---•-•---.-------•-----•--------------......._..------------------------••-•-----••----••---•-••-••••-----••••-•••-•-•-••--••-----•-------......•....---
Agreement:
The undersigned agrees to install the a r scribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Env enta ode—The undersigned further'agrees not to place the
system in operation until a Certificate of Com is ce h s een issued ylthe boar f health.
Signe -----......... - -- ----- -----------............
---.......d/e- ----- :
Dare
Application Approved By ----�:.-- . . . ......... ..... .- ......-- . ---------................ .... '-.
.............. Dace
Application Disapproved for the following reasons: - -------------------------------------------------------------------------------
--------------------------------------------------------------------_..............:------------------------------------------------------------------------................................................... ........-------------------------------
Permit No. ... .. `- ----------- Issued ......
Dare
•4
No......................... YmB..........................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
................ )U1. . ......OF.........
Applira#ion for Bhipos al Works Tonstrnrtinn runfit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:__..Y:� ,� .
....1P:A... Cumloial)!.n. )
Location-Address or Lot No.
......................_.......................................................................... .......------------...................................__......---.................._............--
Owner Address
W
Installer Address
PQ
Is A
V Type of Building Size Lot-___--'------__..�
-------Sq—feet
Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( )
'k Other—T e of Building No. of persons............................ Showers — Cafeteria
Other dW fixture
�-
Design Flow.................j...... ... gallons per person per day. Total daily flow.........._ ___ v....gallons.
;Se tic Tank—Liuid ca acit . . -_____-___-___ Depth...._...._..._..W
x Disposal Trench—No.......�............. Width.....�.Z......_.. Total Length------7 __0..__. Total leaching area Q ---sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box Dosin tank ( ) 1 l }
Percolation Test Results Performed by._29AVIT?�1-.......................................................� t�l 1 ..
a Test Pit No. 1------7! _.minutes per inch Depth of Test Pit-------- _t.....__. Depth to ground water-------
"".........
(14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a ................................- -•------------------------•-•-••------•-----......................------------•-•------•---•---------.._......--•--
0 Description of Soil..........t7-`7-_.�*"? !4�_+ s ? �.�--�...._
U -------------------------- ---
w
UNature 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 been issued by the board of health.
Signed ......-. ------------------------------------------ ----------------------------------------
�./ Da[e
Application Approved BY ✓ '" : ��- --- ---.f-�--- � �f ..
07
Date
Application Disapproved for the following reasons:
------------------------------------------...............------------------------- ---
/� /Due
Permit No. .......�:.....a ---- ..J--►f------------- Issued ......./�--�. �.
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD
,9F HEALTH
...............To
----- OF ............ --------------------.-...-- --
(Q1,er#tftra e of (ILTumplia ire
THIS IS: ,0 CERr - Y, That t, Individual S wage Isposal S st m constructed ( ) or Repaired
by---- -
.-.... .--------- °- - ----- .......................------------------ ------------------------------------ ------>
4 nstaller
' 1 jar t - .ac .. = " - r �..:r .. ----- --------------------- ----------------------------------------- .
has been installed in accordance with the provisions of TITLE Df he State Environmental Code as described 'n
the application for Disposal Works Construction Permit No. ---- . .... ...., dated ....: �'
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WIL FUNCTION SATISFACTORY.
DATE-----•fe--f..--. ` '..... -------------- ---------- Inspecto :7n.. !!/t
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEALTH
.................. t ...................[.. '1. , #✓...®F.........
ti � .....------.........._...
FEE........................
Rifilloga1 .� s Ton iminm�tt�
Permission is hereby granted...... ............ .... 1............-_....
to Construct ) or Repair ( ) an Indi/vidual Sewagp Disposal System
at No. h / ti--... t'' ` �1 `� " ............ j'lad }. /p ---------- -------------
Street
as shown on the application for Disposal Works Construction Permit No? "'__:"ted.._`j0____`'
--------------------------------------------------------------------------••----------...---....---••-._
Board of Health
DATE................................................................................
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
.- ---=.,T-"06-1994 09:07 FROM ,J"py,� 7 ' �/ ;r TO __7755344 P.02
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