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HomeMy WebLinkAbout0090 CAP'N LIJAH'S ROAD - Health (2) S M E A D KEEPING YOU ORGANIZED No. 12534 2-153LOR OSUSTAINABLE RESM MIN.RECYCLED INITIATIVE CONTENT 10% Certlried iiberSouminp POST-CONSUMER www.snpmgmm.org SR01290 MADE IN USA GET ORGANIZED AT SMEAD.001u L AT ION SEWAGE PERMIT NO. V I L L A G l " oL �� INSTALLER'S NAME & ADDR SS :zt 12 T K) C- B UI'LDE R OR OWNER DATE PERMIT ISSUED (� �6 OAT COMPLIANCE ISSUED �M...-ter`— y� fl.,°�/j f� sal !�",.��;i {� � . $ 30 .00 Fps.............................. APPROVED THE COMMONWEALTH OF MASSACHUSETTS q e St a Conserve Depa ent BOARD OF HEALTH OF BARNSTABLE T - - ' ned Date 01 Appliration for Di!ipwi al Wvrk.5 Cnomitrnr#inn ramit Application is hereby made for a Permit to Construct ( ) or Repair O(X)C an Individual Sewage Disposal System at: at ....................-............................................................................. Location-Address or Lot No. Wiener ......................-.......................................................................... •-•-•-•-----•---...••••--•--•------•-•---•.....-••------••---••--......_.._---------------•--•••-- O,ener Address W J .P .Macomber Jr . Installer Address UType of Building Size Lot............................Sq. feet �.. Dwelling-X- No. of Bedrooms-------------a__---------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons--------------------------- Showers ( ) — Cafeteria ( ) a Other fixtures ------------------------------------------------•----- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity........._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 ( ) � Percolation Test Results Performed by.......................................................................... Date........................................ ,-� Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fs Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ a •---•-----•.................•---••--•--•-•------••----••-•••---•--•------•-•-•••-•............_...-•......................................................... 0 Description of Soil........................................................................................................................................................................ W Sand. & Gravel V ................•••-•---•-•---•--•-•-•.....•-•---••---•-••-•--••-•••-•--•-•---•-•-•••--•-....•--•--•••••••-----.......----•-------••-•---••••----•-•----•--------•---•-•----.........--•................ W UNature of Repairs or Alterations—Answer when applicable._..1-._000 �[a l l on leaching -n i t a d d e e d to existing. tank- p-lt' 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 Complian has be n i ued by the boa p of ealth. Signed ----- - - ..... ............. ................. . ..........5./...6/..9 ..:..--- Due ApplicationApproved By ------------------ ---------- - --------�--- --- .,. �............................. ............................ .---,J��.—`1..-..Q'..��_.. Application Disapproved for the following reasons: .................... ...................... .................. ....................-- ... ...................... .......................................:...................................................................................... .... ..I........ .......................---............ ...........-- ....................................... Dare Permit No. ..........T . . .....(.................... Issued .... Dare ' ` y+' ,..�.._ .,,�..ii'G��;.[kta�F.+F..:^,..tyis.ei,yOrV��.»,�:s`�1�... "..,rya..iy.....-.«2x "r^�...,��j�s+ '`'?!-^"..�.+yos-..w..r-v.•✓....-.r.,.... v.... .avt•.6T..,f� f $ 30.00 _ a* THE COMMONWEALTH OF MASSACHUSETTS r' ,f BOARD OF HEALTH �S�tOWN OF BARNSTABLE r JXppliratiou for Diripoonl Works Tonotrur#'tun Ilermit Application is hereby made for a Permit to Construct ( ) or -Repair (KX): an Individual Sewage Disposal System at: 9�...Gapt�ixi..?.a.�:ar.__G .#;.et•v t .le.................... .................................................................................................. Location-Address or Lot No. W�-ener......-.......................................................................... ---•-•••-••••-------•------•••--•---•.........-------•-•----•---•...----------..........•.....---- Otrner Address a J.P.Macomber Jr. InstatIer Address UType of Building Size Lot............................Sq. feet ,. Dwelling n No. of Bedrooms...........................................Expansion Attic (, ) Garbage Grinder ( ) aOther Other—Type of Building ............................ No. of persons......___._..........__. ^Showers ( ) — Cafeteria fixtures -------------------------------------------------------------------------------------- .............................................................. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Ix Septic Tank—Liquid capacity------------gallons Length________________ Width-______---_..___ Diameter---............. Depth................ 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........................................ W ,.� 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........................ a ODescription of Soil........................................................................................................................................................................ Sand & Gravel V. ..............................................................••-------------------------......----------------........----•----------"----------------------------------------.........-•••-•-•--••--- W UNature of Repairs or Alterations—Answer when applicable.___1-10 0 0 gallon l e a ch i n cr pit a d d ee d .............................t ...t ... . lit k _ . ...................................................................•----............. . 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 ben is ued by the boa d of ealth. ,� R Signed -� �Lf/ �e�.!!. - ............. .........5./.6/9A.......... / Dale Application Approved By ...............Q�. ._ ...... ........._............ ..... .—.aA..-.�t..LC... ..................................... Application Disapproved for the following reasons: .. ........ .................... ... ......... ... ....................................................................... ...................... .. ................................................................................................................................................................................. ........................................ Dare PermitNo. . ....1 s j-.... ..�L...:.................... Issued ................ ............................................... Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE LLPrtifirate of Campliattric THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (XXX) J.P.Macomber Jr . by .................................................................. ..........- - -----------------------.------------------------------------------------------........................................... stall er at .....90....Ca.ptain Li.J.ah...Cente.rville ......... 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. ----- -ri.- ..t✓./.._........ dated ............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.. ... "....1.. �.........., ...... ............ Inspecto -- �� .. ...................... Y THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CILI TOWN OF BARNSTABLE 30.00 NO...... FEE. .................... Dispnoal Workn Tomitrudivit rani# Permission is hereby granted....).P.Macomber._Jr.. to Construct ( ) or Repair,(X)o an Individual Sewage Disposal System at No..90. Captain Li_ah_.Centerville..__.._ Street as shown on the application for Disposal Works Construction Permit No._�W. /f_ Dated___.._,,'?...- �/.r--f7z.f.----...._. (� ------------• ........ -------- ----------------------------•------------•- 4. J / Board of Health DATE....................----------'-- ......................�/--:----=-•---;----�- FORM 36508 HOODS 6 WARREN,INC..PUBLISHERS / y _ TOWN OF BARNSTABLE LOi�TION C1 & e%%,SEWAGE # , VILLAGE e.► ASSESSOR'S MAP & LOT/f INSTALLER'S NAME & PHONE NO. /, jIngrowly- Z SEPTIC TANK CAPACITY LEACHING FACILITY:(type) c Z�r (size) (.O 0 C7 NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER AQ4tTWk OR OWNER ' � P¢� ` { DATE PERMIT ISSUED: ,' DATE 'COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No l_ t } i t i y. No. Fmc....,........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...✓.c'..... ....... OF............ . 116tl.............. Appi ration -fur Uifipuutt1 Workii Tomitrurtiun Prrutit Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: , ----------------- -- Location-Address or Lot No. Owner Address Installer Address Q Type of Building Size Lot_A --_d___ ____Sq. feet U Dwelling—No. of Bedrooms..........= .........................-----Expansion Attic ( ) Garbage Grinder (-v al Other—Type .___.....__ a of Building -Q�.�� No. of persons.......6................. Showers ( ) — Cafeteria ( ) Q Other fixtures --._,�..... ------------ -----•=-•-- W Design Flow...........�!?.......................gallons per person per day. Total daily flow-----------Z_6.!.._.._........_._..gallons. WSeptic Tank—Liquid capacitvA!o! -gallons Length________________ Width--- ......... Diameter---------------- Depth................. xDisposal Trench—No- _________________ Width-------------------- Total Length.................... Total leaching area------_.-_:.........sq. ft. 3 Seepage Pit No.___--- ----------- Diameter---!_e�_-__ Depth below inletsn_._____ __. Total leaching area..---- _--___-sq. ft. Z Other Distribution box (ice-- Dosing tank ( ) ��- ;O✓G - ,{r- /�2,_ 76 Percolation Test Results Performed by------------------------------------------------------------------------ Date--------------------------------------- a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ rX4 Test Pit No. 2----------------minutes per inch Depth of Test Pit------------------- Depth to ground water........................ ----------------�4---------- -----4�kyld&e 2` `-------------- = . w Description of Soil--- ------ % - .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 aI 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. Sig h .JJ � /� 'd -----r c_!_f e_ `�..... C at Application Approved By----- 1 �� ............. Date Application Disapproved for the following reasons___________________________________________________________________________________________________________ ,l -•-••--•----•-------•--.._.-----•----------------------------- •-----..._----------------------------•..._-----••--------•-••--•----•---------------------------•---•-----•-----•-----...-------- ------ Date PermitNo......................................................... Issued-....................................................... Date -- ------------------- rp— THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......................................... ...................................................................................... Aff Tntifirate of Tom�rfi��cre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (— ) or Repaired ( ) - -.---- - ------------ Installer has been installed in actor ante with the p�r`ovisions of art' e X o The State Sanitary Code as descriUed An the application for Disposal Works Construction Permit No_________ ____�_---j ...... dated.-.._/�:-�.�`__ v THE ISSUANCE OF THIS CERTIFICATE SHALL OT BE CONSTRUE© AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY.DATI � cr Inspector *�-rt. .................................... ......................... ............... -. _ THE COMMONWEALTH OF MASSACHUSETTS 1 BOARD OF HEALTH 7 O F N FEE Binvjj�, r TTlamitrurthin Vamit Permission is reb ranted_..___ Y g - -- - --------------• ( ...--- ----------------------------------- ............. to Cons ( ) �. Rep it7 ( ) /I di ual Se age Dispo l�ystem at No.. .e ft -� �L Street as shown on the application for Disposal Works Construction etrr it No __ _%__. Dated--------- _'. ______.... �- -------------- ........................ -........-•-•..................... .Board of Health DATE...................... . - . FORM 1255 HOSES & WARREN. INC.. PUBLISHERS - THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA 14)............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1- Appliratinn -for Diripwial Workii Towitrurtiou Vinuid Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System/at: _ / Location.Address or Lot No. Owner Address Installer Address Type of Building Size Lot-j-- _--__-`'.--.---_-_-Sq. feet ,- Dwelling—No. of Bedrooms................__---_--.-__--_-_.-_-_-_Expansion Attic ( ) Garbage Grinder (, ) Other—Type of Building ........... No. of persons_____--_---------------- Showers ( ) — Cafeteria ( ) dOther fixtures ----•--------•--••----------------------------------- ------------------•- •---------------------------•---•---•-•----------••--- W Design Flow..............'.`�_-_---__.___-_--___--.gallons per person per -Total daily flow_-----_--4'�_�:.'.._..._..-_..__.._._gallons. V4 Septic Tank—Liquid capacity_/_.J'-)_gallons Length-----------_... Width____--_----._ Diameter................ Depth.--.--.---._..-. xDisposal Trench—No- -------------------- Width---_--------------- Total Length-------------------- Total leaching area--------------------sq. ft. 3 Seepage Pit No..................... Diameter------__-------------- Depth beloNt inlets_...?.__ .__.: . Total leaching area-----_--------..sq. ft. Z Other Distribution box (: ) Dosing tank ( ) �jV' /" (�' ` 76 aPercolation Test Results Performed bY----------- ------•- ----------------------------------------------- Date---------------------------------- Test Pit No. 1...............`minutes per inch Depth of Test Pit-.----_----.--_..._. Depth to ground water.-___-----_.-_----- f4 Test Pit No. 2................minutes per inch Depth of 'Pest Pit..............------ Depth to ground water-_....._____.___.__._... .^ ............................ Description of Soil '.. !k!' ±-�--a- ---- r x ----------------------------21--------�------ .....5-'� Cr -• --9----pe....... .... w 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 the board of health. 411- S 1'Sig e ate Application Approved BY -- . -GG %GC -- G �... ..�_ . Date Application Disapproved for the following reasons------------------------------------- --------------_------ ................................................... -------------------------------------------------------------------------------------------------------------------------------------------------------•------------------------------------------------ Date PermitNo........................................................ Issued........................................................ Date ' r _ ,r �• � � r:�a L:o'r 31 , + A 1* eµ ta +�• OW3 ,` '� •�• - V!s/q..t - _ �_ ,�„A:,m� 3 u/L Z7I/L!G S ETOAC • '.EQU/;t E:N1E•l/T N' t , 20N77- /u S ,• OAIA-f y r GoD TirT SUE 5 i G N G:a�V A .a�. & ANd TOwN OF"+ ! % G E A G/W a2.4 TE ',- ;. //1✓i;�/ f TOP A4EAG7"/�I E6lJLA Ti.C�/V5 !VG/y ' �`o un>'�ArioN , . " . • �2 a�0 5�F7~ L E �4�zr/` .mil�C E�4 •:; s� '�/ ' ai � r/•�� c,a. i ,.1. 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