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HomeMy WebLinkAbout0212 SALT ROCK ROAD - Health 212 SALT ROCK AD, BARNSTABLE A= 316-018 S u i I f F j (/ TOWN OF BARNSTABLE LOCATION 4A' -D SEWAGE # O V VILLAGE s Lam- ASSESSOR'S MAP & LOT3/6 'U INSTALLER'S NAME PHONE NO. SEPTIC TANK CAPACITY /el'o-O LEACHING FACILITY:(type) /A/F7,v/Z4W-.J' r Asize) -71'X Vb S-' NO. OF BEDROOMS 7 PRIVATE WELL O PUBLIC WATER BUILDER O OWNE - le--U t,C i,'J 07 DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes -No j ti a Cal C3q` e � d\ � V No............ w / FEs....-- 0............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABL.E Appliration for Dinpnial Warkii C owitrurtion. ramit Application is hereby made for a Permit to Construct. ( ) or Repair (D/,) an.Individual Sewage Disposal System at: ,—_> �,_4-L:i .........................................•-----•-------�--�=1.2-------....... 3�i�d L� Location-Ad ess or Ownc Address W ........l.. -- -- �.. ..... .1=..........................................,........ Installer Address UType of Building Size Lot............................Sq. feet ., Dwelling—No. of Bedrooms------------------/_-.�j-_-_---.-----_.----.-.Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures _.. W Design Flow......................JJ----_- .......__._gallons per person per day. Total daily flow----------------- .................gallons. WSeptic Tank—Liquid capacity-/lOPO_gallons Length---------------- Width..--.-.-.------. Diameter..--............ Depth................ 7/x Disposal Trench—No- -----_---_ ....... Width....... .-.--- Total Length.-.-_-�i.�'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........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ----------------------------------------------------------------------------------------------------......................................................... 0 Description of Soil........................................................................................................................................................................ x U •-•-----------------------------------------------------------------------------------------------------------------------------------------------------------------------•-•--------------------------. w ----x --------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------•--------•---- U Nature of Repairs or Alterations—Answ when applicable.--.-._ . -:.. - ._.__ ----.--__'Z___. --------- 1� .............................. 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 Complian has been issu b e board of health. Signed ...... _...-. �_� g r .. ............ ------- Applicaiion.Approved By ------------------------------------ .? 95 Application Disapproved for the following reasons- ---------- ----------------------------------------------------------------------------------------------------------------------- ........:...................... . ................. ................_ Dare ---- .......... Permit No. 9-:5----�0..7.�......... ........ Issued . � 7/915Z Dare No�. ..!_ (✓ / / Fps....- �.............. w THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABL.E Appliration for Di-nipniul Works Towitrurtinn rantit Application is hereby made for a Permit to Construct ( ) or Repair (V,) an Individual Sewage Disposal System at --------•-------------------------- .....(------..................................................................................... Location-:\d ess or Lot o Owner Address •-- PPI Installer Address UType of Building U Size Lot............................Sq. feet _, Dwelling— No. of Bedrooms----------------__/--__._____________-____Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures ___________________________ _ _ �/ W Design Flow-------------------�J-----------------gallons per person per day. Total daily flow................1__�Q..........._-----gallons. fs: Septic Tank—Liquid capacity.oP.Q.galIons Length---------------- Width---------------- Diameter................ Depth................ W x Disposal Trench—No. ---------- Width....... ...... Total Length____..,�j.•��_��.__ 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........................................ a Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water_..__._._..______._-_--. Gz, Test Pit No. 2................minutes per inch Depth of Test Pit_................. Depth to ground water........................ ------------ ----------------------------------------------------------------------------------•--..............------•----•---------------------...--..---- ODescription of Soil........................................................................................................................................................................ x U -•--------------------------•-•--•------------------------•-------•--••----------•-•---------••-----•---••-----------------•---•--------•......•-----•-----------------------------•----••---------•---- W ------------------------------------------- ----------------------•---- ------._....--• --------------------------------------...--•-------------•••--•------------------------------------------•--- VNature of Repairs or Alterations—Answ r-when applicable.. N--_`-� �___..� ......... ..�. ... 1 J / - --- --•�-�-...----....�: .....3...�..... ....�!....1AJ�.=_(_t, ✓ )------- 1.. -- ZN`C .............................. 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 b e board of health. �--- - > � ;.Signed -- --------------- - � Application.Approved BY ..........................�.�� - -� - ...7 9"5........._...._..... _..._........ _.. Dare Application Disapproved for the following reafonr: ...................... ------------------------------------.....------------...........--------------------------------------- - -..... ..------------------------------------------------------------------------------------ -- ---------------- Dare Permit No. ........9-:�5---r 7.4�----------------- Issued .....3. ­2�7/�5-------------------- Date THE COMMONWEALTH OFMASSACHUSETTS ���� _ 3�6 `©� BOARD OF HEALTH TOWN OF BARNSTABLE ' Gelrtificttte of Compliance THIS IS TO CERTIFY, ` v the Individual Sewage Disposal System constructed ( ) or Repaired (�) at ------- -------------------------------------- oZ- .._ �----'i /t-P/U�2- - ----------- ----/-------- � -A- I--E.-.......... 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. ... .-�.�P_ _ ......... dated .. ..2_79..a-..-.... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WIL CTION SATISFACTORY. ��� .--, DATE -,--------------------- �...._.`-- ..-..... Inspec r - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7q TOWN OF BARNSTABLE 3r-- FEE.................. Riip on1 Workii �T;�—umitrur##ion "Vrrntit Permission is hereby granted.................... ---------- ...........................N------._..........--- to Construct ( ) or Repair (p-�-an Individual Sewage Disposal System at No.----•-----------------------•----------------15�4jY Ls ----- ---- f----` IZNs-- -.-------_- Street as shown on the application for Disposal Works Construction Permit-No--------------- Dated______ `7 �.5_._._-._. ......................................��---------------- ...............-........................... �� � Board of Health DATE----•-------- ------•---•- ----•-------........................................ ~� FORM 36508 HOBBS&WARREN,INC.,PUBLISHERS