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Home My WebLink About0066 SHEAFFER ROAD - Health No....... ------- Finc .................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...........OF............................................................... - -- Apphralilan -for Di!ipmal Workii Towitrurtion Pprutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Location-Address or Lot No. c4 � ' C�.. ,13.t�'.rY. .D.E�r�/..................... ...t1'Ai��c.,A'pk 1 -...✓�'��t� A.00A._ _'041A 'F Owner Address alrv,--- ------ 4 ----------------------------•------------ ------. -�-------- 1-3-j6.......� ��....-14,2ArX, Insta er Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.....- .. ..-.-----.Expansion Attic ( ) Garbage Grinder ( ) �+ per, Other—Type of Building ............................ No. of persons-----.--------------..------ Showers ( ) — Cafeteria ( ) W Other fixtures ------------------------------------------------------ W Design Flow--------------------------------------------gallons per person per day. Total daily flow............................................gallons. P4 Septic Tank—Liquid capacity------------gallons Length---------------- Width_ _-.-----.-_-- Diameter--..-----_--.- Depth..-.. --------- xDisposal Trench—No. .................... Width.............------- Total Length-------------------. Total leaching area.-------------------sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet--------:-...... .DTotal leaching area------------------Sq. It. Z Other Distribution box ( ) Dosing tank ( ) - d,0e - J_'z ;1 `7,� aPercolation Test Results Performed by---------- ............................................................... Date-------•-------------------------------- ,a Test Pit No. 1----------------minutes per inch Depth of "Pest Pit...-.--.-------_--- Depth to ground water_---------------------- LT. Test Pit No. 2.......:........minutes per inch Depth of Test Pit................---. Depth to ground water.------..----------.-... ----------- ------ -- ------------ Description ofDkoil------ - -- �-`---- ------� - - -4R ------------------- W V Nature 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 Article XI 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. Stgn � l9� s' 7 S' Date Application Approved By---- .. - ---------------- �..'.�.P...� 5 Date Application Disapproved for the following reasons-------------------------------------------------------------------•-•--•--------•--•------ •--------•-•------ --••••-•---•--•-•-••-------•-----•--•-------•----•--•- ------------------------------------------------------------ -----------•-•--......--...----------------•--------••--•......-----•------••----... q.f Date PermitNo......................................................... Issued--•• .................................................. Date 1J No...... ... FRs.. ......�..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ . .. ._ _................OF.............................I............................ ApV iraflun -for M-4puiittl lVarkii Tottfitrurtiott Vrrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ........_ .�F _v� c��'j r -------.................lJ / �/ ------------ ----------- -- Location.Address or Lot No. _t?`7,�,�..................... tl l r . z------• Owner Address ----------------------------------------- Instiller Address UType of Building Size Lot............................Sq. feet �-, Dwelling—No. of Bedrooms-----k,-?----------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Otherfixtures -----------•...•--------------------------------•---- W Design Flow............................................gallons per person per day. Total daily flow---------------------------------------.....gallons. G; Septic Tank—Liquid capacity------------gallons Length................ Width---------------- Diameter-----_.-------- Depth.--.---__-.--_. Disposal Trench—No.---_______________ Width-------------------- Total Length_._______-..._-_--_ Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet...... ....-__ T _ _otal leaching area---------------- ft. Z Other Distribution box ( ) Dosing tank ( ) v�_ �___.Z I _ S- " ?- 71— aPercolation 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....................... - •---f --- escription ofoil.. ,/1 x ------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------- V Nature 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 Article XI 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. Sign ,1. ✓�i / j"-�-t � .... ...3�.7 S ---- Date Application Approved BY . ••-•----------•-•--- •- Date Application Disapproved for the following reasons:................................................................................................................ ..••-•--•••--••--•---•-•--•-••--••----------•-----••••-------••-•--------•--•----•-------------------------------------•-•--------------•-----•----•---------•-••-----------•-•-------••••-•---•-----•.. 7 Date Permit No.---------.............................................. Issued--------fC_.'_..1. ...."..7 1..__. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH ...............OF..... .. ... . .................. ........ If Qwrtifiratr of f�lImphtturr TH S O CERTI Th t Individual Sewage Disposal System constructed ( ) or Repaired ( ) by S at...m... ....... - ----- . . ....................... ................................................................... ................�e has been installed in a cordance with the rovisions of Article XI of The State Sanitary e as described imthe application for Disposal Works Construction Permit No.-------Y,?---r__________________ dated...._:--3_.._.. � J THE ISSUANCE OF THIS CERTIFICATE SHALE, NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM VPLL FUNCTION SATISFACTORY. -DATE...... ! Inspector -......... ....•--- ` THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTFJ. No. 1- ......OF.--..... . -- . .. ...... /� FEE./L!............... � �t iutt �rrtnit �i� Permission i hereby granted.-- N__. _ --------- -----•-- --- ---- -- ---- -- •........................................................ Construct or Repair (I') an ndivid 1 ewag i posaI em v` -----------•----- Street /' as shown on the application for Disposal Works Construction er it __------- ADaatted_-!J._.v- .7 _ •-_--•-.._- �X t•-- }-----•-----------•-- 7 � DATE.....-- - -------------------/2-------------------------------------------•-- oard of Health FORM 1255 HOB & WARREN. INC.. PUBLISHERS t c. W ��o goo s E o 3 (3�BED E1o�on f 00 N \ h a (IF 144. 1.3 7 8� �- �`� may. oZ JAMES GJ, JO o A �Y v Is �fsS100%. PLOT PLAN SHOWING PROPOSED CONST T 1 0 �4 S A L E /' _ ��"' ' DAT E �`: G L ,, N D S U R V E Y O R DEFERENCE Z G A E OF Alq 7-/2y Z / C� �— 3 Z_ JOSEPH M. i o MONAHAN,JR. ti v BARNSTABLE SURVEY CONSULTANTS , INC . �F ° STE�,�O� R E G I STE RED ENGINE ER 5 rl LAND 5 U R VE YORS �NpSURV� WEST YA R M O U T H MASS Z61� / s� (Alooll, LOCATIOKA ' SEW&C;E PERMIT--MO.- -YV VILLAGE IWSTQLLER S 1J&ME ADDRESS '- -BUILDER 'S DINTE -PERMIT ISSUED DATE COMPLI &KICE ISSUED : � �. i --�, �, ,�: � p � u ! /)/ 4��.. \ �' .i� Qr+�� II �� I I '� � �� - t� � 1' \��' �.�, I t ""�• �� . \� s ,, �� z �s �� f ;, �� . f�.. __ .. __ _ .:.i. �'� ,