HomeMy WebLinkAbout0062 SALT ROCK ROAD - Health i
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eLq� TOWN OF BARNSTABLE? ` 0
LOCATION Lim JAI%-06 (20,40 . SEWAGE #
VILLAGE ASSESSOR'S MAP & LOP 2 i 7
INSTALLER'S NAME & PHONE NO. Vo'�OW/� C4J 5 i �'d-PFUG
SEPTIC TANK CAPACITY Ayo pa
LEACHING FACILITY:(type) r7— C / (size-V 10
NO.-OF BEDROOMS PRIVATE WELL OE,(]�BLIC WATER
BUILDER OR<ZW E �/JOt,1 SJ'►�t
DATE PERMIT ISSUED: 3ZL1`/�''
DATE COMPLIANCE ISSUED:
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VARIANCE GRANTED: Yes "No
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No....[•..?�: .....................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Application is hereby made for a Permit to Construct ( ) or Repair (p4 an Individual Sewage Disposal
System at:
- ....
/�/� A/���g Location-Add ress or LotCI4 N
------------- ..........................................................
owner Address
a � U...u.f� Cad_% �l.� �/�+►2.�Y �c�
------------- ........................... .,..._. -�
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 ( )
Other fixtures ............................... ..d
W Desi n Flow.................... gallons per person per day.. Total daily flow-.-_.-._--__-...��0____.___..........gallons.
g a�----------------g� P P P Y• Y -
fs: Septic Tank—Liquid capa6ty/0M---gallons Length---------------- Width---------------- Diameter--___--.-.__-- Depth____-_-__-_-----
W Disposal Trench—No_ -------------------- Width........r............ Total Length--------------r.... Total leaching area....................sq. ft.
x
Seepage Pit No---------l........ Diameter------/U-------- Depth below inlet........ .._...._. Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed bY-------- ----------------------------------------------------------------- Date........................................
,4 Test Pit No. I................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........................
W -------------------------------------------------------------------------------------------•--------.........................................................
0 Description of Soil........................................................................................................................................................................
W
x ----------•----- -------------------------------------------------------------------------------------------------------------------------•-••-----------. -----
U Na re of Repairs or Alterations—Answer when applicable._____A..0_--._-4:__.__....aG o.__ -------i$..._.....
...�NT----- �Tb�J.--------------------------------------------- --------------------------------------------------------------••----..........
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 as been iss b e board of health.
��_ 3 � /�
• Signed - .. ^ .-. ..:.. _ . ... -- �....................:......
Date
Application.Approved By .. ............ .............. . .-...................----------------------------------- ----------------------------------------
Date
Application Disapproved for the following reafonf- -------------------------- -- ------------------------------------------------------------------------------------------------
..__------------------------------------------ -- ---_-----------------------------------._.. - ........................................
Permit No. c
J..-". �( ---------------- te
Issued J� = �1�'cJ
Date
��._---_---_—
No.. `1�: y Fmc.............................
THE COMMONWEALTH OF MASSACHUSETTS
�rl BOARD OF, HEALTH
d- TOWN OF BARNSTABLE �.
Appliratiou for Bi-nVo!3al lVor1w Towitrur#iou ramit
Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal
System at:
Location-Address
� c,� 4 or Lot N;M c /1AjT .----------. . ..__._ � - ........................................................
owner �_ Address
W OY vu'r� G vi s`-------------------74-.�---------- w�r.�-%--`------- ............. ..... --/...... ....................
Installer Address
d Type of Building Size Lot............................Sq. feet
U
Dwelling—No. of Bedrooms----------------1,_7.__._-_:__-.---_.--_Expansion Attic ( ) Garbage Grinder
aOther—Type of Building --------------------- ----- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Otherfixtures ---------- ---------------- \---------------------------------_---------------------- --------------•-----•-------------•-----------•.............
W Design Flow.................._ -----------gallons per person per day. Total daily flow-------------. 7 11------------------gallons.
WSeptic Tank—Liquid capacity/_C!&___gallons Length__---=......`__ Width________________ Diameter---------------- Depth................
x Disposal Trench—No_ _________________ _ Width------------------/Total Length--___-______-_(---- Total leaching area....................sq. ft.
Seepage Pit No........../........ Diameter:___../CI...__.__ 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........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---------...............
R+ --------------------------------------------------------------------------------•-•--------------.--.........................................................
0 Description of Soil........................................................................................................................................................................
,x
U •-------------------------------------------------------•---------------------------------------------------------------------•-----....---------•-------••-------------------------•---------•........
---------------------- - ---------------------------------------------------------------------------------------------------------------------------•-------------------------•........................
U Na re of Repairs/ __or Alterations—Answer when applicable..__. D------_A----------6GGy-_ -�, ........ 4.._.._...
- -
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 as been iss by',t�'ie board of health.
/ --- i i 11
Signed ------------------ ---- ----�-� - - ----- ......................------ �------- Dare�V---'---'
Application.Approved By ..---------------------------------------------------------_-------------- ..----------------------------.._------_....... - - -
Dare
Application Disapproved for the following reasons- --------------------- ---------_ -------------------------........_..............__ .....................................
------...-._............................. ........ _--------------------------------------------...._... .._--------------------------------.._----------- --------------------------------------
Dare
Permit No. - ... '..�. --- ...Issued .............. � �GJ
Dace
THE COMMONWEALTH OF MASSACHUSETTS 1-7
BOARD OF HEALTH
,. TOWN OF BARNSTABLE
Certiftra e of C omptianre
THIS IS TO CERTIFY t the Individual Sewage Disposal System constructed ( ) or Repaired (� )
W(„"Z�t-0 � CC v�� %w-�-Tc--vJ
--------------------------------- --
by ............_............._..............._........._.... Installer
at -----------------------------------...._------------ ------------------------------------L-------- --------'t-----------A-----.-------1�/--- ----------------------------------------------
has been installed in accordance with the provisions of TI fI E of The State° nvironmental Code as described in
the application for Disposal Works Construction Permit No.,/ � . dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOBE CONSTRCIED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE---- .. - -.., ...... ------ Inspect r1
----.----------,- ------- --_-- -------_,---_.-_---_ ---- --1------ __-_ w
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
5-�L FEE........................
�)
Permission is hereby granted..........................................................
to Construct ( ) or Repair O an Individual Sewage Disposal System
atNo--------------------------------------------------- ' ..................................... ------
Streett !` _
as shown on the application for Disposal Works Construction Permit No./ _ 7�" Dated.__.. -^ _= `7_.._........
•--------•--•-••-••---••••-- ]r�z o --alth----------------------------------
�,. Bf He
DATE.............. - �� ................................
FORM 36508 HCBBS 6 WARREN,INC..PUBLISHERS