HomeMy WebLinkAbout0059 BAY LANE - Health (2) -qLzLnc,
IN I SMEAD
KEEPING YOU ORGANIZED
No. 12534
2-153LOR
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FOR aE"W"" MIN.RECYCLED
1 INITIATIVE CONTENT 0
Cerlified Fiber Sourcing pOST-CONSUMER
www4fipropramorp
SFW1290
WDEINUSA
GET ORGANIZED AT SDEAMM
L0CAT10N SEWAGE PERMIT NO.
./-C7' /w y/ v 83 - 76
VILLAGE
CS'sV7_11z ill A-4- l Q SHI iLZLS
I N S T A LLER'S NAME ADDRESS
Ill UILDE R OR OWNER
DATE PERMIT ISSUED
.DAT E COMPLIANCE ISSUED � �� 0
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Dr . "Barry J. Benjamin o O .L
Bay,, Lane
Centerville ,Mass .
02632
790-4324
1-1000 gallon septic tank
1-Distribution box.
2-Flow Diffussors
Packed in 3 ' of stone .
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� THE COMMONWEALTH OF MASSACHUSETTS
CD[ BOARD OF HEALTH
..----.....Town.................OF....Barnstable.....
Vp iration for Uhipostti Works Tonotrnrtion ramit
Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal
System at:
---.-•_._ Bay__Lane-,.. .................. _.Lot 4Q;...Aaaj ssorl s Map 1.86.Fareel 7!L
Location.Address or Lot No.
Cornerstone Enterprises fi0�. Mai,n_-St.,,,Centervlle,xP2A.0262
.................- _ ........... .............I.... ..............-- ...
wner Address
W
a ..... ..........•-•.
� Installer Address
U Type of Building Size Lot32_s22.9 ........_..Sq. feet
Dwelling X No. of Bedrooms-__.L....................................Expansion Attic ( ) Garbage Grinder (11o)
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures -------------•. •-••-......._.....•-••----••---•---•----..............---•--.....---------•----•---....
Design Flowl.1.0...ggl/bedrO9T4..gallons per person per day. Total daily flow......) ,.0.__.GPD__...............gallons.
W Septic Tanker Liquidcapacity�_250.g g Width.5..... Diameter................ Depth. ._f •..
__. allons Len th 10--,f t. f t,.--
Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
x Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area...b1.2......sq. ft.
Z Other Distribution box ( X) Dosing tank ( )
'-' Percolation Test Results Performed b ......9K._( j-nj-ellerllnc_,_•--_ - Date......2/2 /�
a Y -•-------•-• �•-••-• -- ..........
„-a Test Pit Noftf,•• '-_....2 minutes per inch Depth of Test Pit...._.6._.f t__ Depth to ground water....................•
(i, Test Pit Nc"�`:...............minutes per inch Depth of Test Pit.__.... Q.�_ __ Depth to ground water..na--Water
No• 14 ft. no Crater
--•-•------------------- -----------------------•-•-..........- ....
O Description of SPiI Medium to e_ arse sand - 02•�..................
x ��------� .6.......................................................
---------------------------------------------------------------------------
w
x .......
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
---- --------------------------•----------•----•-••-----•-•--••--•-•---•----••---••.....---••--•............--------------•...------•-------------•-•---•--•------•-----••--•-•--•-•-•----------•••••.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
I the provisions of TITLE 5 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 th b rd of Health.
Sin... . .................. 0/29/8 3
I_ Koiv , Engineer Date
Application Approved B �� 6
Da e
�0-- '
Applica i n Disapprover he following reasons:----•-------•-------------------•-•-------------------.....---•-•-----------•..................................
Date
Permit No................................................... ._ Issued..........
---- - ----- -- -- ----------
D�
"..........— -- - --
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
��* ��
A VVfira *� ��� ��m� hipasaK� Workii Tomitmartimn Vrrmit
Applicationis hereby made for u Permit to Construct 3� or Repair an Individual Sewage
Disposal
System at: '
�
��
� '~° �
e ss or Lot No.
......ad,�A_ XIA ----X61 A, 3. --
Owner Address
-----'- -------------------'------ ''
�a� AddressTyyenfDoJ6'ng Size Iu . feet
D~eDiog-X-No. of Bc6roonoo-.Ji-.--------------..}Ixpaoxioo Attic ( ) Garbage Grinder (*n)
Other—Type of Building ............................ No. ofye,avoy----------- S6o~ccu ( ) -- Cafeteria { )
04 Other fixtures
^� -.-_--------.-_-----..-.-.-..----.-.-.----.-_-,----------_-'_---------
Design flon4.l[1..pcL�/ �u looxyccp�cxouperdu�. Total daily ��-.
Septic Tzok�-Liquid 2.50-gallouo Leocth'1.0...;ft"Widt6.5..f!_. Diamcter-----.. D°°'h.5...ft4'
Ciopnou 'Trench--No. ............... Width.................... Total Length.................... Total leaching area....................sq. 8.
> Seepage Pit DJu----'--. Diameter.................... Depth below inlet.................... Total leaching area...Al2......sq. ft.
Z Other Distribution box Dosing tank ( \
� Percolation Test Results I&0_W �,_
Test Pit NqRZ-7�;X-----2--..minutes per inch Depth of Test Depth to ground water.......
C�I minutes per *inch Depth of Test Pit........I Depth to ground water..AP..X4.tjPX1
94 -'-'-----------------'----------'7- -I]��'-----4-------------2X�.-�l4t��,
u D�o��o � S�� t ) �� / ) -
__--. --------..---_-------.---_--------------------------------
�i ............--- ..................................................................................................................................................................................
L) Nature of Repairs or Alterations--Answer when applicable...............................................................................................
'----------''-------'`-----'----'---'--''-'---''--'------'-------'—''--'-----'-----
| Agreement:
| The undersigned agrees to install the aforedescribed Individual Sewage System io accordance with
the provisions ofZ[TIL4 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
' operation until a Certificate of Compliance ku
5qg ,&Deens,.,e,l Dy
--________ _ ������� �
An� ----' o-��-
Application Disapproved /- -'��,�lowing '--~~~'-'--''--~~--'----------'—''--'-'-----'--`--------' �
-`--`----`--``---`--`---''---------'---------------------------`--`------`--`-------
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THE COMMONWEALTH OF wAssACHussTrs
'?
� BOARD
�
......�-�--�--�.............OF....... �����������I'���..-....l'...........................
THIS IS TO CERTIFY, That the Individual ewage Disposal System constructed or Repaired
cv� _44_ -----------a!.....................................
has
- been installed_ in accordance- -ith- the provisions of ----_ ~ _ The State_ Sanitary- -(Ide as-de cribed 4n the '
application for Disposal Works Construction Permit No......................................... dated----+��7< .........
E ISSUANCE
SYSTEM WILrU
,,./rTION- SATIkFACTORY.
THE COMMONWEALTH ormAseAo*ussrrs
� BOARDOF ��
/
-� ' .OF...� -- -
Permission is hereby __--_-----__-__.-'.-_.-_-_...__-_-''-_-.--_-''__._________ `
to Construct r Repair an Indiv*.dual wage Disposal System
as'show
n on roe, *~ p~- pocs000ucNe"� � ocu___--'-- uutcu--at N �.. _----
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.��'��
' ^ ' Board of Health
DATE.................................................. ....'..............'........
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