HomeMy WebLinkAbout0070 SCUDDER'S LANE - Health �]C7 Ocmc�ce-1 Lzt1 e Caen �
TOWN OF.BARNSTABLE'
LOCATION 'TO &Coc(1CQ.- SEWAGE
VILLAGE �,���� c ��" ASSESSOR'S MAP Sr LOT
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY B'UL� gVoAov-;,
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e=c�a a Pry'
LEACHING FACILITY:(tYPe) �ieC S (size) 6,c 6 u-
NO° 'bF BEDROOMS j PRIVATE WELL R PUBLIC W R
BUILDER OR OWNER \-\01,)S �A;
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No �-®
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No.-71:329 JP...........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�n c,�e�oopartmant
TOWN OF BARNSTABLE
k- -��
Apphration for Uispui�al orkii Ton triir rrmf am
Application is hereby made for a Permit to Construct ( ) or Repair ( individual Sewage Disposal
System at:
...... _. ............... ............................•
Location-Address or Lot No.
/ ................................•--........ ---.......------------•---•-...................:..................................................
... p
F wner I Add! e
-� /
�. ....
k�.....
Installer Address
UType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms...:._.`d...............................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
< Other 4xtu�s .--•--•......•-•--•-----•----••. . •
W Design Flow........... ....................gallons per person per day. Total dam flow----------S..K0...................gallons.
94 .,: Septic Tank l Liquid capacity10 gallons L 9. .�ength..... ..... Width__. .._..._. Diameter---------------- Depth................
Disposal Trench—No. .j............... Width... _ ......... Total Length......Z'........ 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........................
f� Test Pit No. 2................minutes per inch Depth of.Test Pit---:................ Depth to ground water........................
-------------•--------------•--------------------••------------....-----•-•-•---•----............-•----------.........----------- -------------•-
0 Description of Soil.............................................................................................................................................•--..........-----.---•-
x
U
W
U Nature of Repairs or Alterations—Answer_when p licable____--.14 ------
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 -- oard 'f health—
SiSigned <' 1
gned -------- ---- ------- ...........�
............... .................. ----........------- ........................................
Date
Application Approved BY ......... ----------------- .....
Date
Application Disapproved for the following reasons: .......... . ............................................ ................... ...............................................
----------------------------------------------- -- ---------------- --- --------------------------------- - ----------------------------------- ............................................. .................-----
Date
PermitNo. .....q..:a,..-... - ........................ Issued -----------................................................te
---- ----------
[
14
NO._1--m-m--29 F$s --- 0
THE COMMONWEALTH OF)MASSACHUSETTS
BOARD "OF`-HEALTH
` 'OWN OF BARNSTABLE
t' Appliration for. Disposal Works Tons
*Udig frrmi#
s Application is hereby made for a Permit to Construct ( ) or Repair ( 6) I dividual Sewage Disposal
System at:
Location-Address or Lot No.
�_._.;..�.: _.,�✓ 0A C.t:N-
-------------------------—---------—---- --------------------—----- -'------•---•_ ----- ---------_"""'_ _
Iner Address
a ------------------lz:-- !_P 1—AN-� r-''f' 1 -- _(---------ate.---------�f rn - `r
- -
4 Installer Address
PQ
Type of Building Size Lot-----------_•-----__Sq. feet
U Dwell' No. of Bedrooms--_---�------------------------------Ex anion Attic
a Dwelling— _ p ( ) Garbage Grinder ( )
Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
d Other fixtu s -
W Design Flow------------�_ -------------------gallons per person per day. Total daily flow--__---���------------____--gallons.
9 Septic Tank-V Liquid capacity A Mgallons Length-----9^_----- Width_.__ ------- Diameter----------------Depth----------------
W ► Disposal Trench—No---- --------------- Width_-_.iJ /....... Total Length____-- '....... Total leaching area----------------__sq. ft.
x
Seepage Pit No---------j---------- Diameter-------------------- Depth below inlet-------------------- Total leaching area-----------------sq. ft.
z IQther Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by-------------------------------------------------------------------------- Date----------------------------------------
,.a Test Pit No. 1.................minutes per inch Depth of Test Pit-------------------- Depth to ground-water-__------------------__.
L=. Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------
94 •----- --- ----------------------------------------------------------•-------------------------------------------------------------------------------
0 Description of Soil-----------------------------------------------------------
------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
U Nature of Repairs or Alterations—Answer when applicable-___--'----0-!;;VA,-----X-M.....____ _C---t�,_�_.
---------------'�-_ ta,f � ,�--",- T --�c-------V"1-�-`--- =�w---�.-__-----------------------------_---------------------------_--_
Agreement: v
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 df,health. t _
-�t
Signed.......... -- w -- - ------------------- ---- 4^---------------------------------
Dam
Approved B -c.--- -------------------------------------------------------------- -D /�-----------
Application
PP Y -- 'r
Application Disapproved for the following reasons- --------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------
D.-
Permit No. ------7--?�,' ----------------_--- Issued ------------------------- -
Mace
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
(ger#ifirz& of (gantlatiance
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by = ----r<-----------5 -�--�==-- -----------------------------------------------------------------------------------------------
Iscaller
at ------------------------------------------------------0---------S C_c�cCc_Q v' - C ^--�_ 'I re N. C ctU
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 ------------------------------------------------
-
— a
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE-----------------------
----/ -( �`� Inspector -------------- ------ ^ -
j� THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
`, 9 TOWN OF BARNSTABLE
Disposal Works Tottotrudion rrrmft
Permission is hereby granted____.______G-1-._✓_. _.L A_v� le / C
y - ----
to Construct ( ) or Repair ( an Individual Sea=age Disposal System
at No------------------------------------ /,7 �. - i '/L'tn- %4
- -_.............. ---- .............:---
Street qq�
as shown on the application for Disposal Works Construction Permit No..!_A::375_ Dated-----------------------------------------
..................:......... " -----------------------------------------------------
. Board of Health
DATE................. ,` ----------------------------------------
FORM 36508 HOBBS Q WARREN.INC..PUBLISHERS