Loading...
HomeMy WebLinkAbout0148 ELIJAH CHILDS LANE - Health ,, 1 1+3 ELIJAH CHILDS :LN, CENTERV, E A 171-21 t; t No. 42101/3 ORA ESSELTE 10% o © 0 0 ram+ w _. ._.. Fss........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Apphration for Uhrip wial lV ark.6 Towitrnrtilan ramit Application is hereby made for a Permit to Construct ( ) or Repair (t/) an Individual Sewage Disposal S stem at: e Location-Address or Lot No. .......................•--- _-•-Addres c Installer Address UType of Building Size Lot.................... Sq. feet �t Dwelling— No. of Bedrooms------ -------------------------------Expansion Attic ( ) Garbage Grinder (l� aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) d Other fixtures ----------------------------------------------- ----- W Design Flow.................................... allons per person per day. Total daily flow.....................................,------gallons. W Septic Tank—Liquid Li uid ca acity...� Ions Length Width--___._.__----._ Diameter._._ . P 9 P` g - ---------- Depth................ 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 ( ) .-4 Percolation Test Results Performed by............ ------------------------------------------------------------- Date........................................ 1 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........................ 04 ._...---•--------------------------------------------------••--•••-'-------•••......--•-••......----......................................................... 0 Description of Soil........................................................................................................................................................................ U ---••-•••---•-••••-•----••----••-'•---••-•--•--•-•--------------•-'-'------•-•----•---------'-'-----'----.......----'---'-"-------•----•-------•--•----•- ---------------............................. ----------------------------------------------------------------------------------------------------------- U Na e of Repairs. Alterations—Answer when applicable.__/'�.C1.. .____..1...- ��. jC.6. . 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 Comph ce has been is oard of health. / Signed ` - _ .......... .�............................. Date Application.Approved By ----- ---- ------ -------- --- ------- - -- G- Dare Application.Disapproved for the following rear s: ----............... ..................................................... ---------...---......--------------------._--------- -- / --------------------------------------- ----._._......--- --------- - QF Date ................. Permit No. ......I.. --- ........ Issued ...... at ------ ————----------- --------J mac, No.- ;:; FEB.............................. K THE COMMONWEALTH OF MASSACHUSETTS ` BOARD OF HEALTH TOWN OF BARNSTABLE Appliratioii for Dijapniul Works Towitrurtion 11trwit Application is hereby made for a Permit to Construct ( ) or Repair (Van Individual Sewage Disposal System at: G� l6n✓f��//�_.. .��,G- ..... .......... lc� ------- n Location-Address or Lot No. .yc;IA.. via = ....................................................,,,,.,k- ---.......--•-•-------•--•-----------------•--- caner -Add" e a ._... -r�.h -----------------------------------------•---- l rh_:. ... .....� Installer ' -. Address UType of Building Size Lot....................______..Sq. feet g— P� ( ) Garbage Grinder (Aif Dwelling No. of Bedrooms.______. _- ____Ex Expansion Attic `4 e of Building a Other—Type g --------•------------------ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) d Other fixtures ----------------------------------------------------- Desi n Flow_____________________________________ _ _ allons per person per day. Total daily flow...--.--------__----_-------. W g ' P P P Y• Y - --------------gallons. WSeptic Tank—Liquid capacity___ 1_ allons Length________________ Width---------------- Diameter................ Depth-----______-.._. x Disposal Trench—No. .................... Width-------------------- Total Length-------------------- Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY-------- ------------------•-••••-•----......--------•----•--------------• Date........................................ 1.4 Test Pit No. I.------_____-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........................ , -_--------•------------ --------•---...........-•----------•-••-•-------------•-----------••------•-------•----•-------------= ... ``. Description of Soil--------------------------------------------------------------------•-•--••------------. U ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- w ---------------------------- - _ _ _: -•--� .._. -- -------- ---- U Na pipe of Repairs or Alterations—Answer when applicable_._._ 41!�� ,.__... _ -.A ;-� Agreement: The undersigned agrees to install the aforedescribed Individual Sewage-Disposal System in accordance with the provisions of TITLE S of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compha11 ,h s been is u d kry the board of health. 1, Signed ... :' , ... .... �w Spa"f r✓�c?�./. �J--- f - 't Application.Approved By . .d.. - .......................... - Dace Application.Disapproved for the following real, f. ............----- ---------------------------- .......... -------------------------------------- .......---------- -------------------------......- ------ = N, Permit No. ..... .... ------------- Issued ...... J .:. "f.y .........-e.._.. ace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Te>r#ifi ak, of Tamplianee THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ✓) by ............. s l,C� . � t v 1—ah" at .......c:_l.. .......... .�.. .- - ..�.� s..._......�. - has been en installed in accordance with the provisions of TITI IF, ,o The to e .nvironmental Code as described in the application for Disposal Works Construction Permit No. ... ..... ._"". ........ .._...._. dated .................._------.................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT CO S RU A AS A GUARANTEE THAT THE = SYSTEM WILL FUNCTION SATISFACTORY. . DATE-------- "..�T.. ..... -...�� - - Inspectar� .ioll_ . 4-'�.� .�1� ''' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � / TOWN OF.BARNSTABLE No....I. FEE.... .. ............. t �i��oott1 ork� �u�totri�tifrn On.erutit Permission is hereby granted '---------------•-----------------------------------:........................ to Construct ( ) or Repair ( ) an Individual. Sewage Disposal System ` Cif c at No................1.i-r c'........... ,�t eet i as shown on the application for Disposal Works Construction Permit N �;1_.--_ ated+ ^ " . Board of Heai'�h-� � DATES --- •---------------•--------------•--••----•-----•-------- l . FORM 36508 HOBBS&WARREN.INC..PUBLISHERS /•y TOWN OF BARNS-TABLE _ LOCATION r y lk�G� C�,i\d S C.c,,t, SEWAGE # VILLAGE C"r-V\�SIC ASSESSOR'S MAP&LOT - INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY \Qt >Q0 &Cf` LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER �cJnj!Acl PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: 1lll q;� (® Maximum Adjusted Groundwater Table and Bottom of Leaching Facility V"�`^��d`r � O Fe t Private Water Supply Well and Leaching Facility (If any wells exist A on site or within 200 feet of leaching facility) /y&\ C Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) �I1/J"e Feet Furnished by Nr Ao O E3o x 0? P��S 573 C t3 P� 3d NM L�6 nLr-n 7 5 2-3 ew S. I t i SEA 2 d 3? v��16t�1 ya-r-A. a t c la tL-I) II u0 G.artanGS b21+.tn / �; Flow = 110 +� 3 • 33b G•P•D. I t. �EQT-1r- TA+-•tK. s 33ov Irio °I• • 495 6-P.D.. ' M us+✓- %o00 6A.L. -12ISPOs AL PIT • USE. t OCxo GoL. c-UXWALL AZeA - 150 ',.F'. ISc�> -,,F 2.S • 7S G.R.D. tjul�D, 'p Uzrrro" AoEA• So ST. TcrrAL -veS.16W ,- .425 G.P.D. gooc- Tt>T&L. 1:>QI L-( FLow = 330 6 FID. SrPr?e, . �`v� pis!' 1 y : PM- COLQTIOt.I SZI�TE : �..lu 2�4ttu�02 L�S/s. (T- G14$ea-w l u H le tJ 1 �,�y�traf. �.►'''`� of � I r A,)Or tz BAN r n t Nk t: t Tor F'iaa L`D.o 57, carom � eve I oao i ':� sUC�ul� 4rpvt- VKf. IW GAL. r '8ox sill Sepnc 10 4 v . TANK N 10A0O •b INV, S y LsAco P�T I vW v rtt , WASWILD IF . C-EIZTIFIELD PLO r-'L.A ." LC— .pAT� V) CGtZTjp q TE-1AT Tt4r-- �V-Et.1GC-- ;? %4Z.Z(=oiJ Gcx4vlPLIeS W I-Ct-I TNT 51DE.u►-•1E-- �' Q.ut� SE-TL'tAG1G S'G4u(�Etitt:}-(TS of TNC. -Town or- ►; i OSTE�V1Lt_G o t1rCAS5� TINS C7LA�-! IS UoT ZASCv ova AN ItJ r('C'cJMitJ i t=`( TtaG UFC;�T�, it�GWLD /LNPt_t GA.1-JT �(�� _) r%�✓�� _I- 1 I�;�<-