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Home My WebLink About0084 CAP'N LIJAH'S ROAD - Health � qz - �So SMEAD KEEPING YOU ORGANIZED No. 12534 2-153LOR FORS MIN.RECYCLED INITIATIVE CONTENTMAN Corritiae Rbar Sourcing POST-CONSUMER wwwsfiprogrom.org S"IM MADE W USA GET ORGANVED AT SMF_AD.COM 0 L0,CATION Z /,) 41 4 SEWAGE PERMIT NO.. d V.tLLAGE L) _ } Lf RINSTALL R�'S NAME. & ADDRESS thmo 144 B Ul'LDE R OR OWNER DATE PERMIT ISSUED DATE.- z.C .OMPLIANCE ISSUED La `� ll�t9A �"', � I• y THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �/v...`v.`� .... ... OF.............................. ... 0.1.7,...................... .................... ppliration -for 4%ipoottl Works Tomitrurtion Vrrotit Application is hereby made for a Permit to Construct ( 4T"or Repair ( ) an Individual Sewage Disposal System ,Gf �Li✓6i/7` c��cTc' �l v!�-ZL. . --------- ------------•----- ....................... ................................................................................................ Location-Address or Lot No. !� .. ....................... ..................•............ w Owner Address •. ..... --••••!fin:.-•-•- --------------------•----------------•-- Installer Address UType of Building Size Lot__. " ®"....Sq. feet Dwelling—No. of Bedrooms-------cnb"2----------------------------Expansion Atti (�JjG Garbage Grinder aOther—Type of Building ---------------------------- No. of persons..____---___ ___-_--_-_.-- Showers ( ) — Cafeteria ( ) Other,fixtures ......................................................----------........----------------------•-_..... w Design Flow...................$�.U__................gallons per person per day. Total daily flow._...._..�.��............_..........gallons. WSeptic Tank—Liquid capacity/5?egailons Length-______-___--- Widtli................ Diameter---------------- Depth..-.-.--_-.----- x 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 ( ) , Percolation Test Results Performed by---------------------------- ............................................. Date------------------------------------ �, Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (Xq Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water-_.--.-..-_.-_-------- P' -----------• - ------------------------•-._. ......................................................................................................... O Description of Soil --------------------------------------------------------------------------------------- ----- --- -------------- w ------------- tP/�y c 'c_�r VNature 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 NI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued b oard of he� Signed............. ---�•--- ="�-�.�'... ------- � Date Application Approved By---------- - -----------•-------•--•---------------------------= ' Date Application Disapproved for tl.e following reasons---------------------------------------------------------------------------------------------Da•......•--_..... ------------------------------------------------------------------------------------•------------------.I----------------------------------------------------------------------------------------------- f Date PermitNo.----- .............................---.......... Issued........................................................ Date •.....�• THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA R ~ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliratiuu -fur Bhipwittl Workii Tiatuitrurtiuu Vanift Application is hereby made for a Permit to Construct ( 4- ror Repair ( ) an Individual Sewage Disposal System at• _ _ , v / Location-Address or Lot No. ..� _ ---- ...._---•--^............................ .............•-----------•-------••--•-----Address -Owner .................................................................................................. Installer Address �..�� S feet Q Type of Building Size Lot________________________ __ q. U Dwelling—No. of Bedrooms.._____. ._-____________________________-_-Expansion Atti (/�i'f G Garbage Grinder Other—Type of Building ---------------------------- No. of persons-.,......... ........ Showers ( ) — Cafeteria ( ) QOther fixtures -•--- --•--------------------------------------------------------------------------------------•----. ).................................----•---•---. W Design Flow......................._L__.__..._.........gallons per person per day. Total daily flow.................r........_......._..._..._gallons. WSeptic Tank—Liquid capacityye�15�1!?gallons Length---------------- Width................ Diameter_.--_.._..._--_ Depth................ x 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 ( ) W Percolation Test Results Performed by--------------------- ---------------------------------------------------- Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water..-.-.--.----. -------- (14 Test Pit No. 2----------------minutes per inch Depth of Test Pit--------_----------- Depth to ground water........................ a ••-•-•••...•----------------------------•---------------•---------•----••-------•---•------------------- •--------- .-------------------•---•---•---•---•----- ODescription of Soil-----------------------------------------------•----- ---------------------------------------- ---------------------------------------------------------------------- -r W Z -------------------------------------- ----------------------------------------------------------------------------------------------------------------------------.................................. --' U 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,thee board of health— Signed /� .....- i_ / Date ApplicationApproved BY 3----- ---------------------------------------------------------------•-------- ........--•-••----•--•...............•--•-........................... ......._ 1 Date Application Disapproved for the following reasons:..................... ._____ -------------------------•••-•-••-••--•--••-•••-_...-••--------•----•......-•------••-••--••••---••-•----------------•----•------•••----•-------•--•-- ------------------------------------------------- Date Permit No........�. � Issued..... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD. OF HEALTH !..l<. i Trrtifirate of Tuutpliaurr THIS-IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( -)or Repaired ( ) r---� by ....p -f Q"_ . .�.... . -.•-�7 --------Installer f has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.__.-_-_f`l ................ dated------- ..... ................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM VILL FUNCTION SATISFACTORY. 4 DATE...... - r ....... �. Inspector. = .......................... cam= w THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH J ...............G......................OF............`o.---------------.................................... No...... -` •--• FEE..---.................. MnVagal Workii Qluu,itrurtiuu errant Permission is hereby granted................` �_o'�. ._._�U-- -�•- ------ ----------------•-•---- -•--•-•--•--- to Construct (r/)or Repair ( )_an Individual Sewage Disposal System atNo. ---------_------------------- Street as shown on the application for Disposal Works Construction Permit No.---- _..... Dated-------- .....--•-•-••-•--•--•-------•----------•-•-------•---•-•--------••--••---._...--- .....•..... DATE............lZ=•--(f f---74� Board of Health ------- ----------------------------------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 6 TOWN OF BARNSTABLE OFFICE OF t Bsxasraszs $ BOARD OF HEALTH ®° %639. `�� 397 MAIN STREET HYANNIS, MASS. 02601 To : Building Inspector From: Health Department Subject: Test hole and Percolation Test 0 A examination of e soil t ,� (Lot) Vddre s) 04 ( village) was made on and found to be (date) suitable for sub-surface sewage, at site of test hole. Building Permit will not be approved or sewage permit issued until Health Department receives two copies of plan showing building, sewage systems and all other details listed in Board of Health instructions to sewage applicants. This approval does not constitute a final decision concerning the installation of a sewage system. All State and local Health regulations apply to final approval. ' (Signature) C7 6/20/75 .S _ Z6- 76 PLEAcH t''s `M.i C0Att GrZ4 GiZAVEL r I L o 7 30 t7 13 a/LD//VG S ETL3ACk-_ e6QU/,L>E.Me_vT ZO F20N7 /0 5'/DE /0 ' 72E4TE P20;ao SE D -3 BED 2ooM5 SEPT/G 5y5TFM CON57-2UC7'/0N t SHALL CONFa/zA4 TO "ASS . DESrG/l/ FLOW 300 GAL ADtA En/V/2O/vML-NTA[ CoDe- T/7LL Y An/d TOL✓N OF 8, ;oAj_57-A L3LF ,L L-A C Al 2.4 TE -=Z- z M/A/. 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LL G A. - .��/ STEEL 20000 /4 7-02 y LAn/E tiIOT TO BE LOCATEZj '4( O✓E,2 5y57'EM UNLE 55 Al- 20 DES/GA/ Z-0A 4D/A/G /S US&ZD. T CE72 i/Fy TA,A [X/.5T/A) � �j �d v,-j o A -rloAjL O C,q T/On/ /S C 4r�- r yf AL��G� 1✓. G�LdI/c/ C3 7 J C -}G E G.T .�.� �H�7 t.,,,j/l/ �n,l i7 C C�t�./�4Ts�✓tl.� >.,; WITH 'THE auIC.,z:>//.✓G S'ETaACR e6_ Q cJ/Ta6146 N i S 0,= T/yE 7_000 A., 0Z 6,4;2/V•5T-4 8 L.G. L7 A TC- 11 1-315 �� . :� � � �� l� �� l�✓�J3� 3