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HomeMy WebLinkAbout1319 MARY DUNN ROAD - Health o 1319�1VIA12Y 1SiJN�1 RO , 3A'.F.���,'�,►BI; A= 334 002.006 .. i W s_e +rk "'"T�t• - - - - lrn3'�.�. '3l 'P rl 3' • I' '`F v °r 'r :a W�Rs +h,y Y SUBSURFACE SEWAGE DISPOSAL SY9TEH INSPECTION FORK s Address of _property / y Owner's.,name , �j� tlyDate Fof Inspection , t PART -A J3ti z is CHECKLISTW _ 151C"a F Check if. the following have been done: � x r Pumping information was requested of the owner, occupant, and Board c Health. . -None of the system components have been'. pumped for at �Aeast two week; liar;. and the system has been receiving normal flow rates duringthat period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note =, f, they are no- t available with N/A. .= i The facility or dwelling was '`inspected for signs of sewage back-up. a The site was inspected for signs of breakout. -�L All system components, excluding the SAS, have been located on the site. _ The septic tank manholes were uncovered: opened, and they"interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the SAS on the site has been determined bas f on existing information or approximated by non-intrusive methods. The facility owner (and occupants, if different from ouiner).VV- were provided with information on the proper maintenance of `SSDS. 1 ' 'SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION, FOItM 1� PART B d . SYSTEM INFORMATION i FLOV7 CONDIT1j'6NS If residential number of bedrooms number of current residents i .— garbage grinder, yes or no laundry connected to system, yes or •�td,. . seasonal use, yes or no If nonresidential, calcula ted, ted fl ow:ow: Water. meter readings, if availably: : 93 C /Oj oav 3iwGS 3rno, Last date of occupancy Y 1' GENERPJ., INFORMATION Pumping records and source of infc,Lmation: i System pumped as part of inspectionif yes, volume pumped Y eS or no Reason for pumping: Type of system _ Septic tank/distribution box/soil absorptions ste Single cesspool Y m Overflow cesspool Privy Shared system (yes or no) of yes, attach previous ins ection records, if any) p Other (explain) Approximate age of all components. Date ins,t-alled, if known. Sou information: rce. of S/,5 TXf m .na 5- YO Sewage odors detected when azr.i�ien t the site, es or ��,r" gaam* Y no H . 4 StMSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION 'FO"RM `t, k ,PART B - a ' SYSTEM INFORMATION "'continued SEPTIC TANK: y k (locate on. site plan) L a f depth below grade: L/ cs material of construction x l congrete _ metal FRP =otter'j(explair dimensions• sludge depth d r . moo" distance from top of sludge tci. bottom of outlet tee or 'baffl;e scum thicknessa f _ distance from top of scum to top of outlet tee or baffle " distance from bottom of scum' -to bottom= of outlet tee or .baffle .„ Comments. ; (recommendation for pumping, cond Lion of inlet and out tees...or: baffles i depth. of liquid level in relation to outlet invert, evidence of leakage, recommendation structural 'integrity, s for repairs, etc. ) '' n /iv�.�c°�r`7%ozI ,S� ir.c h� SL/soP!> 2, DISTRIBUTION BOX: (locate on site plan) F' ,= depth of liquid levei'� above outlet invert f Comments: l (note if level and distribution is equal , evidence 'of solids ,Carryover, evidence of leakage into or out of box, recommendation for repairs, etc. ) PUMP CHAMBER: (locate on site plan) pumps in working order, yes or no r ' Comments: . µ ; rt:..(note condition. of pump chamber, condition '- pumps and appurtenances, recommendations for maintenance or' repairs,etc. ) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION 0RM 1 ' 'PART B SY STEM INFORMATION continued SOIL ABSORPTION SYSTEM (SAS) : . ' S'on locate ( on -Site plan, , P if possible ;:; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, .,,-explain: Type leaching pits and number leaching chambers and number leaching galleries and number leaching trenches, number, length a , leaching fields, number, dimensions t overflow cesspool , number Comments: (note condition of soil , , signs of,,hydraulic failure, level of -pondiiig, condition of vegetation, recommendations for maintenance or repairs,etc. ) CESSPOOLS (locate on site plan) : number and configuration depth-top of liquid to inlet invert depth of solids layer depth of scum layer _ dimensions of cesspool materials of construction indication of groundwater —~ inflow , (Cesspool must be pumped as part of inspection) Comments: (note condition of soil , signs of;.,.hydraulic failure, level 'of ponding, condition of vegetation,g recommendations fir mainten ance or repairs,etc. ) PRIVY: (locate on site plan) materials of construction dimensions depth of solids Comments: Y (note condition of soil , signs 017 nydrauli& failure, level of ponding, condition of vegetation, recommendations fc�r maintenance or repairs,etc. ) rt SUBSURFACE -SEWAGE DISPOSAL SYSTEM INSPECTION BORM PART C FAILURE CRITERIA Indicate yes, no, or not• determind (Y N 4 determination in all instances. sIf. "not determined"Deexplainbwhys of not) .Backup of sewage into facility? r Discharge or ponding `of efflLuent to the surface of the gz•ound or surface waters? ' Static aiquid level in the distribution box above outlet i-' nvert? �W Liquid depth in cesspool <61, below flow? invert or available volume< 1 2 d Y Required pumping 4 times or more in the last ear? number of times pumped y 77- Septic tank is metal? cracked'? structurally infiltration? substantial exf �ltration? tankuns failure imminent?al Is any portion of the SAS , cesspool or below the high privy: g groundwater elevation? y within 50 feet of a surface '_water? ti within . loo feet of a surfaca.:water su water supply. pply or tributary to a surface fU ��within a Zone I of a public well? { within 50 feet of a "borderin" . ve e (cesspools and privies onl g hated wetland or salt marsh y, "-riot the SAS) ?. within 50 feet of a private water supply well'7 less than 100• feet but greater `g ter than 50 feet from a' private -wate.r supply well with no 'acceptable water quality analysi has been analyzed to be acceptable, attach co py for coliform bacteria, volatile, organic compoundsf ammoniatnitrogensi s?7 If the well and nitrate nitrogen. t r •i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION PORK PART B SYSTEM INFORMATION continued SKETCH. OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent refero.ences landmarks or benchmarks locate all wells within 100 ' u i /Z UH 13 3� �✓ O 33 i 4. DEPTH TO GROUNDWATER �y/ depth to groundwater method of determination or approxi.m{at on: fi r d r L, SUBSURFACE SEWAGE DhSPOSAL SYSTEX INSPECTION 4 j t BORX` PART D CERTIFICATION Name of Inspector ZLby0J. P y C Name ��GL�S om an Company Address 2,34?% Certification Statement x I certify. that I have personally Tnspecteci `the sewage disposal system at this -address and that the informaaion reputed is true, accur8te 8nd • complete as of the time of inspection. The inspection was- performed and any recommendations regarding upgrade maintenance consistent with my training and e`,cperience inthe and repair are. manitenance of on-site sewage disposaly.�tems s Proper function and Check one: I have not found any information whir--,.I indicates that the system fa: to adequately protect public .hea�,.th o the environment as defined ii 310 CMR 15 . 303 . Any failure-. criteria not evaluated are as stated ii the FAILURE CRITERIA sectior, of this ,+form. I have determined that the system fails to protect ublic helth the environment as defined in . -,,10 CMF' 15. 303 . The basis fora this an( determination is provided in the FAILURE C TERIA section of this form. Inspector' s Signature ;av Date �S f<` Original to system owner x.s, Copies to: xj Buyer (if applicable) ;;. Approving authority 33.,•s map and lot -Z.- . Sewage Permit number ..09..�7�•.•. ....... EPTIC WP�O ro`o SYSTEM MUST Be d . House. number INSTALLED . ../ IN COMPLIANCE MST �. . WITH ARTICLE 'II STA-M '� �r SANITARY CODE AND 1 TOWN OF BAR T1 ���AYa, BUILDING 'IN SPEOOR APPLICATION FOR PERMIT TO ... .��� ..�.. TYPE OF CONSTRUCTION ......................... !r� ................................................. fr'1 �_•�•. ................................... ......... .. ..... .........2j.....,9...2 TO THE INSPECTOR OF eviLo,rvc�s: . The undersigned hereby applies for a permit according to the following,information: - Location ....,rC..4.. ............... .................... /VS ProposedUse ......C/4r.��/lam• . ........................................ .............. .... ...................................................... Zoning District ... /� lv,v� �C......v.�l..............................:Fire District 1few•............ .�%:l•�n.....:(� ..�,s.�..c�v� ....................Q................. Name of Owner . ... .C..:.�..............Address ......1...�.1.�...ir,���:':r•/....��I.1!!.k .�1� Name of Builder ... 1.!`o.ri...i�+r.... c Ic o / •. ,........... lC:..............:Address Name of Architect ... :F:,. ................................. ............ Address Numberof Rooms ...... ....... ........... .................................................... Fc�;ndation ...:. f.-CA.C.,a fig.............. Exterior ......k ./ ..Gr�i� ' ........................ r... Roofing ......�•.•...... .�1k..}' ................ Floors ...... .. .. .....�t'".....��.�.`�........ ....................... • Inte!ior S.l�e.e7.r' �?.5... .................. Heating ...............f�! o o ........................ Fireplace ..........hc?.�1 . ................... .................................. -)proximate Cast a............... J,y, .......... Definitive Plan Approved by Plannin Board • ••... 9 19 Diagram of Lot and Building --- - -- Area ........Q„qf f.. . ' g with Dimensions � Fee �` (n SUBJECT TO APPROVAL """'�"" '••••••••••OF BOARD """"""""•' OF HEALTH �- C�/� 71 r� i•ti - Y. Q` • 710 f: `• _GOT �.� — � _ C O qo o ram- be%rn9 LOT CJ � Pcz 9 -¢`j Of ', .:: NG�CG:Qy CG'C7"/�Y TNFaT T�-IG ©'C//LD/•Vfr { �, �'S •� :VA.1 O.1/ r"IC o04�UA/ IC 40CA7-&D %OA/ Ti-M` f73 :JNOwA/ KCQCoA./ LJ.VD T.4/�iT �T �O p;^i{r: Go T '•.. TO TNG =OA-eN:... i a7Y��.AQWO o.� rAVL-- 72�w.v CF F',A��' �`i PL E. 'dPub.t rr ..� L/p.va Ct/vVVYoo� i ��'/ /'1S C-L�/1'C.+� t'�:''•:L•!'r..:.', .Q494. 4AAJa. A7V& FILE # D5367 _ CENSUS TRACT # CLIENT: AttorneyR.ich.'rd S: Dubin DEED BOOK 2753 PAGE 348 / OWNER: Ruth B. Wilcox : PLAN BOOK 324 43 LOT APPLICANT: Kenneth Feller ASSESSORS PLAN PLOT MORTGAGE I' NSPEC' T I0N PLAN of LAND I N BARNS ,TADLE . SCALE: 1"= 80' JANUARY 22, 1986 20,89' 195,50' 17,44' TLOT g I Z I 'f Y +1LU � LOT 10 to I W 0EK f LOT 7 t NI a Q 1 LU �M LOT 9 W 0 4 1ti� M A R Y D U N N ROAD 1 CF.RT:FY TO A T T iR rE PiQIAR'D S, 11,Ur3IN!, Ll!iHK Or' NEW ENGLAND, il,A, AN); ITS TITLE INSURANCE COMPANY, 4AT THEERE AR_. i'G VISIBLE ENCROACHMENTS OR EASEMENTS !_X'.'EPT AS SII40NN A:iTj THIAT H S PLAN ;''AS PIREPARED UNDER MY IYMEI)IATE Sit)P':R`,iS'_0`I, 1HE LOCATIO:' OF Tk'= :;v?L 4S Sy HEREON IS IN i;Oh':PL is\I';C_ T ;_ 'OCAL AP^!2'CASL BY- .A14S DIME^ISIONAL REQUIREM!_=NTS, .'J' '.':., c, iNE D!9ELLI :i. S ;GWN t':!.R'_ .: :ES r10 F!.'L;_' !1Ty1N A SPECIAL Fi_)OD i!?7AR.ii ' ZQN'r= AS .!i'.._I ';`: A! _'D h t G.N. A .MAP F CiMmu-NiTY #250001C :SAT_.' 8/19/85 � BY T!,E F , I .A 1 i Land Surveyors Civil Engineers (gibe�Vzto t Pita pjurUeg (g0.,�nr. 1� 172 Pilliam St. Ntfu �tbforb, 0,1 02740 GENERAL- NOTES: (1) The declaration^ made above are on the basis of my knowledge, information, and belief as the result. of a mortgage plot plan Lapejsurvey inspection made to the normal standard of care of registered land surveyors practicing in Massachusetts. (2) Dec 1arat;ons are made to the above named client only as of this date. (3) This plan was not made fo,• recording purposes, for use in preparing deed descriptions or for con— structions. (4) Verifications of property line dimer;ions, building offsets, fences, or lot configuration may be accomplished only by an accurate*instrument survey. f L 0•C'k T`1'O It SEWAGE PERMIT N 0... 40 S ` ��HRV P✓NN (lc/. VILLAGE. -. - INS :LLER'S NAME ADDRESS s B U I.L.10-t. `:R OR OWNER 'd 77 /1 Ir 6 .. X DAT ' .'`.: PERMIT ISSUED DATE .'; COMPLIANCE 1SS0E.D • - •X • .af ••tltt tip•'•••+• /B oO. ... ..r .. _ T/O`N V A-F T. FL oW SCNGO.40 P✓.G. OG (ra-. air %• an oos l EQt/gL,TO SEPTIC _ '•r• P �' / Z'.of Is'- YE' c.+n sired Sto..! Tgn/K T- _ / Q /000 6/94 $G-TIC Tq NK of�� /�• 6' LEAGI-✓ P/T i /32 52, U - .. / _._ - .-' �' '--- � ,. s'6 O.e00M HOUSE .. _•. -. OFiTE: S 7$ I 3 �� TEST a`s: A,e.�/e �1 vJFiCA �rro d.'sposer� owe cca/as e..q:neerin9 n, gTG- _/ M/N.IivCH N//TNESS: P UL U.e,Ef? a end' .e qr-- 3o GgLS./aowY oATuM M.SL.Y Ba.�nstab/e Bd ea/ TEST HOLE�/ TE 5T HOLE 'µZ ' Se•PT/G TANK .330 .. /.S• -¢95 ' VS�:.1000 GAG.TjgNAlf /oarn LCf7GN P/T: S'vl,So;/� / 36 e/ /.83./ � �-". $/06LVq LL • '"/�yS.F. �Z.S-): S�� 8 GALS�OAY B4-� BOTTOM• ;�.e S.F _-'-': _ �>. e Sew✓ - Gina••^ I i TOTAL ;s ' th G T/ON VE,e T. -o—o—e— pro Posed 9rour�d, Profi/e. N' FL o w SCIIBO.40 P.✓.C. oG TANK ' _/N _ _ / /' •3- �� t mot 7 sox of3Yf - = / Q /000 6/94. Strr/G TA NK A° w.sA ad s rase vex � �O - 43B•9/' i - i �?� c /�_ _ �k TE St � � T i !, dwa//.'n9 SZ$ \ PE.eC.A A9r �P of-A:;-,-' . OATUM M.S L S a �/90 9 y � FLOW..eATF 330 6ALS.�O�iY P V Q TEST HC o - n,�(� .c/.-840 or ` .�/�-�/� tisB•:.(000 6AL.Tf)ti/.e /oam o �t\ - ' -• �/ �Q tip v�Q � �•� BFF OepT/I '.o t�' �' - —. —LOT 8 O� $/GGWALL • '.i7-yS.F. �Z.S 1 4'7�y"B 6AL S� OiGa /-58 /9C.CE5 . .6J 80TTOM �S alai✓. .'�' _ �.'s:.:c GAY TOTAL 6ALS.�OAy L T TRD 7 Snpr`h, a+, .'�''.��t "lt ,r5i t 'r5 �� SETT �� - �Y' , H .Ya 'v �; s iea a,�5 r n7 t eKq -..' �+IASSA I"I T® N OF BARNSTABLE µ'- k' &r#tft.zt#e of;Cum ltttxc ce' r 5: TH O ERT That the I ividual S wage Disposal System„constructed ` b mod_ ).or Repaired`( ) .................................................. at -------- �.,daric installe ....................... ....... .........has been installed m ac with the provisions of TITLE of The St' Environmental Co as described i the application for Disposal Works Construction Permit No. . ��'�y . ......_-- dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR SYSTEM WILL FUNCTION SATISFACTO UED AS A GUARANTEE THAT THE ^ = I DATE 5�.-..-------- ..----------------------------- Inspecto o z m X: v r o -,I I ;a m m o E o ;0 c) z m z 1 r v •. -� ;0 I � (n rn -•i •-• v I -+ O z m z a (A v oo z a �+ c-) -o r w rn -� = m m a rn cn I c1) 3 --t W rn . O -i rn '-' LO z m r _.. r m _ O rn r c 3 co v 3 c m 3. CA / r v o c� o W v -; c -.. N U \ C I ( ~ rn •.., s m n c� /lid v\ w 3 m O -0 3 • . Old rn Z v c� O O Zrn (A '} V) (A o Q�k rn 11 n 3. ., I oil TOWN OF BARNSTABLE LOCATION 13 - 19 MARY DUN ROAD SEWAGE # 9� 5 �3 VI LAGE CUMMAQUID/BARNSTABLE ASSESSOR'S_ MAP & LOT,; . - ei� as, y INSTALLER'S NAME & PHONE NOELLIS BROTHE-RS�CONST. CO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) —1600 NO. OF BEDROOMS PRIVATE WELL OR PLUBLIC WATER v (, BUILDER OR OWNER�'' fL��/� DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No' -� -- - - - - r , G ti a � ��� I `t , + O • n� - _ __ � _ te. .., �, J c7[ /� 3 �� � �� � �r i. .. o No.---••_�°'_.._.::. � PARCEL b�3 ors Fes$............._............ . THE COMMONWEA BOAR® OF HEALTH TOWN OF BARNSTABLE Appliratiun for lh"aa al Morkii Tomitrurtiurt Frrutit Application is hereby made for a Permit to Construct ( ) or Repair (/an Individual Sewage Disposal System at: ............ 1 .... ._.:..... .. .. ....._�.,� 1)4A .....................•-•------••--........---- tion ress or Lot No. � .... .. - __ -----•- ........... -........ -^ ion.. � s - - .Ac es W ---•--..... .. 'r'�.......:.....................���--- ----•- - ----- .... - -- - � --.. Y... a � Installer Address Type of Building ize Lot............................Sq. feet Dwelling—No. of Bedrooms___....-.._.�_ ____________________Expansion Attic ( ) Garbage Grinder ( '4 Other—Type of Building No. of persons............................ Showers — Cafeteria P, 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.:.`_4s..........._.. Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No...........::'•s:._. Diameter--_-____•___-___-__ Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ ,.� Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ f� Test Pit No. 2................minutes per inch Depth of.Test Pit---:................ Depth to ground water........................ Q+' •---••-•--•-----------------•---•-•-•-•-•-••--•-----•••-••-•---•---•-....•••--•----••--•-•-•--_••••.._....._.................-••........--•-----------•_•---- 0 Description of Soil........................................................................................................................................................................ x .------. . -a ._ __. . U Nature of Repairs or Alterations—Answer when applicable_ ___________. !. . -- . . . Agreement: The undersigned agrees to install the aforedescribed idual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmenta —The undersigned further agrees not to place the system in operation until a Certificate of Comp an een issued b t board of health. SDate B " 49- - � ............ - - .... .....APPlication Approved �, . . 'ign l Date Application Disapproved for the following reasons- ------------------------ ----------------------------------------------------------------------------------------------------------- ........................................... ........................................................................ .... . ....... ............................................................... ........................................ 5­1ate Permit No. � � .----... Issued .....-------- . Date i 1 33 No........ ...t`.'/ LiU pc� Fmc....��•�(� } S THE COMMONWEALTH OF MASSACHUSETTS R' BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diipooal Workii Tontitrur ion Vamit Application is hereby made for a Permit to Construct ( ) or Repair (V j) an Individual Sewage Disposal System at ........... ./..r / �... ....:. ,! .r�-1?� ................................................. ......_... Flr ' ' . ` ca*tion ss or Lot No. -� i -- W ..................................................................... (/V J��` , r / _ e ....................................................................................... .... . •-- -- �.-�--- I Instaaer 1 { },.. ddress r• t ` J Type.of Building Size Lot................ Sq. feet Dwelling—No. of Bedrooms .... f.'...............................Expansion Attic ( ) Garbage Grinder ( �V p, 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I-----------_....minutes per inch Depth of Test Pit.................... Depth to ground water........................ GX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -------------------------------------------------- .----------------•------------ ...... ---------------------------------- •-•------------------- -......... 0 Description of Soil-•-----------•-•.................................................•---------•-••------------------------•--------------•-•. ............................................ x c., -------- - x .. -gin•. . - ,_____ ,. Nature of Repairs or Alterations—Answer when a hcable__ t/f//�l� J �� - /�Cf��� U P PP7 ... ----••-••-•••-•••--•--•-•••...............•---- Agreement: The undersigned agrees to install the aforedescribedj4vidual Sewage Disposal System in,accordance with the provisions of TITLE 5 of the State Environment o•e—The undersigned further agrees not to place the system in operation until a Certificate of Coin lian '�een issued b�tboard of health. Sig — 1 r--------- --- . y� ) f Date ' Application Approved By v......,�' " ... /....�----. Date Application Disapproved for the following reasons- ......................................................... --- ....----------. --------........----------........------------------ Date Permit No. � � ...----- Issued �z-" Date e -------------------------------- ------------------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (9rdiftra e of Cfoutlalttxrtre a THIS4S TO CERTI Y, That the ndividual Sewage Disposal System constructed ( ) or Repaired( ' ) by ..................... . ' --............... ,1� • Installe £ -----....... �yv� } s at . -/ ........ .. �G�.-:_........................ .............. -�i'��'f%�lf .:1l :........ - ----...-.. has been installed in accordancwith the provisions of TITLE of The State Environmental Code as described in� the application for Disposal Works Construction Permit No. dated ..-. �- ------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. <�-!,,, DATE ----... 'l, .. .... .............................. -- , Inspector. '-- - ,..... ................................... THE COMMONWEALTH OF MASSACHUSETTS i BOARD OF HEALTH �' TOWN OF BARNSTABLE CD No.---.:2................. ! FEE.----.....-..e.......... Disposal Workv TiomAr iort an it Permission is hereby granted = 10............'--•---•"•`••---•............••'---••-•---•--•--••-••••••-•......-••-••.................------ vidual Sevt r to Construct �) or Repair ( an I rage Dispo� System-�� at No 1... - ._ '....:v1 ... A.Lt (/Nitl /�f�> .ter` 4 11>. S t :. _ Street as shown on the application for Disposal Works Construction Permit � __'14' ,-�ted.._ �� �^J -------------- ------- oaard-df Healt h DATE----•---•---------•----_...•---------�-------------- ----- FORM 36608 HOBBS Q WARREN.INC.,PUBLISHERS LO;CATION SEWAGE PERMIT NO. �;o/ 9 ` �l HRY Rd, VILIAGE INST:A LLER'S NAME & ADDRESS x A®C �s 8 UIIDE R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED � � �,, __ 1' �v vS ..�� ,� .. {� vim. �; �� No........... ...................7 .......2..:s.. THE COMMONWEALTH OF MASSACHUSETTS BOAR® O HE L H Appliration for Bi-qpoiial Works Tnni$rnrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: e .......L T 7�1....�1�._.. .. ...e --------- ----------------------------------------------•...------------------------------------.......-- / Location. do ss or Lot No. .. ..... ...�"�� �............................. ................ a Owner Address ....... 6h.n.ea......................................................... ...........-.------•----•--.-.'_..••---.•-- --...............-------------------------- Installer Address Type of Building Size Lot............................Sq. felt awellin —No. of Bedrooms............................................Expansion Attic (--I Garbage Grinder ( 0 p,, Other—Type of Building ............................ No. of persons....-__�............... Showers (/ ) — Cafeteria ( ) a Other tomes ......................... d ------------------------------------------------ W Design Flow......... .. gallons p er person per day.. Total daily flow_._..... .3._D.....................gallons. WSeptic Tank—Liquid capacity/.On�allons Length................ Width----------------- Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....._ ........... Diameter:./r?.X-6... Depth below inlet......... ...... T eaching area.�� ....sq. ft. Z Other Distribution box ( ) Dosing tank ~ Percolation Test Results Performed by................( Q� 'L.... Q -------- f Date___._ _._......._...._.......__.._. a4 Test 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........................ O Description of Soil Q S� ... ..................................../ ---- x w - ----------.................................. U Nature of Repairs or A terations-Answer when applicable_______________________________________________________________________________________________ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iIT :;. p S 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. ned...... _... = Date Application Approved By. ---•- ..-•----- •------- (��2 '---- ..' Date Application Disapproved for the following reasons-----------------------•-----•---•-.. --------------•-•••----••-••••-•-----•----•--------- --•--------•-_...-- ...................................................... ......................................... ......... --- ---•-•--- .. -•......•----------•------. �--•- ---••----'--Date-------- PermitNo......................................................... ssu •----.......-----------•---------••-------------------. Date _ �' No..................`....: � �x$....!�.�.... _ THE COMMONWEALTH OF MASSACHUSETTS J/ BOARD O HE L Hr _;.J-... .....OF............ - .tl.. . ......................... Allp iratiopt for Bi ipoiial Vorkii Towitrurtiou rvrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at .. .'..AMP..PKI........ ..............•••---•--•......--•••-------. . ..................................... •. Location- dIl ss .....or Lot No. .... _ Owner Address ------ -------------------------------------------- -----------------------------------•...------...--------•-.....-----------------•.......-......... Installer Address Type of Building Size Lot............................Sq. fegt wellin —No. of Bedrooms..........:....•............................Expansion Attic (" Garbage Grinder ( 3 Other—Type of Building ............................ No. of persons_....................... Showers Cafeteria ( ) a Other fM,,xf tVes --------------- ---------- WDesign Flow......... _.............................gallons per person per day. Total daily flow........., ._ .. ?.....................gallons. WSeptic Tank—Liquid capacity/Q 'Lkallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. ............. Width.................... Total Length......-............. Total leaching area....................sq. ft. Seepage Pit No-----Y_'...........- Diameter /P.X_ _. Depth below inlet..... .... Ching area. q...sq. ft. z Other Distribution box ( ) Dosing tank Percolation Test Results Performed by................. 0' -... ....___::.__:.. :� Date........................................ aTest Pit No. I................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........................ x .........•-• 1 f O Description of Soil _..:: _ `? "` �"� r • � x . U •--------------- ,; ,� G . .. .,..""" UNature of Repairs or A terations— nswer when applicable _-_-.:..._- ... ....................................................................... I r .t ......................................._....................................._..m:...............y...,_,.._...........----------._..__._.._............................................................. Agreement: ^ F ,• The undersigned -agrees to install the ,aforedescrilied*Indivr�ival Sewage Disposal System;in accordance with the provisions of T IT i E 5 of the State Sanitary Code—The undersigned further,agrees notao place the system in operation until a Certificate of Compliance has been issued by the'boarch;of healtl; �„ Sed.._. ! .. ------------ ---------------------•------------- ................................ / � Date f �// Application Approved BY_...'..._.._.�"�C."��?.-;9..._..,r�:'....f. ... --j, _ : ::___.__ .. d Date ` Application Disapproved for the following reasons:............. ..���� ;.:_____.._._..---_- ............ Date p. Permit No................................................. *A Issued.... f`. Date THE COMMONWEALTH OF MASSACHUSETTS ~� BOARD OF EALTH o' O F............�..........�r'`"u j " '1 �(„ 'L:.......................................... (IrdifirFatr of Toattlifitta a TH ISITO gC� RT Y That the Individual Sewage Disposal System constructed ( ) or Repaired..�.. ° • •--• • `......................... •-- -•--••-----............ - `. . 7 I Ins ller -------------------------------------------------------------------------- has been installed in accord ce with the provisions of TIE'¢ 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.-_ -.___-•-__1.. ----------- dated---- ................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUEIYAS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......................•-••-•-----•---..................._.........---------•-_. Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF I HEALTH cr 0F. —6" No._.__....:T............. ...•.-...-•. FEE...---...__............. �tu�rouatl u 1� �ratr�aon rrattt� . Permission ' reby gran ... - .._.... G. �'Z- __'........--•-•-................................................ to Construct ( ' or Repair I Y an Individual r ge Disposs ll Syst ' Street as shown on the application for Disposal Works Construction Permit! o.-.__._ :: %� ted._._ *Z .. _`._..__ �Ly7 C r. - k , !! ' Board of Health �. DATE................................................................................ FORM 1255 _HOBBS & WARREN. INC.. PUBLISHERS a MSL t iTOP OF 94 -71 BS67 o0 %gaO t- - - - - - - G-Oo Prod; /G H Grou �r-ofi /P D E'% Z. 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