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HomeMy WebLinkAbout0372 CAP'N LIJAH'S ROAD - Health (2) 3-1-z cotpT ' &&At ry i i ll v SMEADO No.2.153LY UPC 12934 smead.cam • Made in USA OSUSTAINABLE FORESTRY INITIATIVE Certified Rber Sourcing wwwAprogram.org I I I �i 7 N-OF BARNSTABLE c LOCATION SEWAGE # VILLAGE Cer-, @ A c J ASSESSOR'S MAP & LOT 9—/ " INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type (size) NO. OF BEDROOMS 5 PRIVATE WELL OR PUBLIC WATER G�l� 53REDOR OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No l/ 1 d zz 2 A ` 6-0 $. a-e �a 9 ' ,3 7 l� No... t' :. Fa$....... .Ce'. .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE tration for Diri.pitial Wurk,i Towitrnrtinn runfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: g74E A_ . 1� Lo'ation-Ads css or Lot No. ' ... -----•-•-------------•--------------•---------- -•---•••••....•••---•--•------•---•---•••.....--•----•••-••-••••_.........._...................... ,cner Address W Installer Address UType of Building Size Lot............................Sq. feet �-, Dwelling—No. of Bedrooms.--3-...........-----------------------Expansion Attic'( ) Garbage Grinder ( ) 04 Other—Type of Building ---------------------------- No. of persons---------.------.------.---- Showers ( ) — Cafeteria ( ) 04 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 ( ) 0.4 Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. L...............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 •---•••••----•--------------•••••-••-•••-•-•-•----------•••-•-•-•--•-•-••---........-•---•-•••........_.........••--••...-•--•-.....................•••...... 0 Description of Soil.........................--•------•---------------------------•-•--------------------...-------------•--------•--------- .............................................. w U Nature of Repairs or Alterations—Answer when applicable.------.--.C&4---. /--..•-��-------------------------------------- --•-•---.....--•-----•-•---•..............•-•---------•----•------•---•••-••••••---.....--•--------•---•----•••----------------------•••••-••--••-•-••-------•--••••••••••••••••••-•--•-................ 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 Complia V_AA� has bee ss y the board of health. Signed `7T.. X- ....... Dare ApplicationApproved By ............. ..... ­ > . ............................................ ........................... .....f................................ Dare Application Disapproved for the following reasons: .... ...................................................... ......................... ......---............... ...................... ........................................................ ...... ... ..... ................................ .. ..... . . ............................. .. . ........................................ Dare Permit No. ......... `..'..... .. ..a ................... Issued ............ � Dace G �''.��'— (� �� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE -- - Teztifirate of CITomylianre - s THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaid ( ) by .... ....... . p..... - -1- ---- ------.-----..------.............................................................. ................. Inswllcr at ..........� 4 r.....,.. ...( ..... ... .. -------... s ..... !.................. - has been installed In accordance the provi 'ons of TITI,E 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ...-..`7.+- _,----4..6..$....... dated ........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE i SYSTEM WILL FUNCTION SAT-SFACTORY. DATE.......... ..~cT-,/..... Insp crdr...-.... -'� �. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No. C��y.-'._1�g FEE......Inin..... Disposal Workii (9,amitr ion Vrrmit Permissionis hereby granted......................................................................................................................... .................... to Construct ) or Repair ( ) an Individual Sewage Disposal System at No.............. � ------1 LT IS Cam='--. . v.. -�a . - - Wi ...................... Street as shown on the application for Disposal Works Construction Permit No. Dated....................................... Board of Health f DATE.......------ ............................. FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS ✓ w.,; a v V V vw Ll Fim THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Z� TOWN OF BARNSTABLE XPVP ration for Di►i.poott1 Wi ork.6 Tonotrnrt"tun Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at -74E �. _ s::A. Location-:49< css or Lot No. � • ------------------------------------------ •----•-•-•-••••-••-•••••......-•---•••........-- ••--------•-.............--------........----•- Owner Address W Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.__-3-----------------------------------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. 3 Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a .....------•-----------------------•-----------------------•---...-•----.........--•---•-•-----...-•......................................................... 0 Description of Soil........................................................................................................................................................................ x U ...-•••-•-••---......-•-••-•••••••-••----•-••••••••••••••••••---••••••••--------•--•--•............•-••••••-•---•--•--••----...•-•-•-....•-••-•--••••••-••••-•----•..............•...............-••.... w x •-••-------••---....----•---•------•----•--••••-••••.--••-.._.....-•-•--••-•-----------•-••--••••--•----•-----••-------------------••--•----•••••-•••---•--••---•--•••-••--•-•-••••-•••.........----•••- UNature of Repairs or Alterations—Answer when applicable-----------j.9"d... '__---.ka6.%-„-------------------------------------- -•---•---------•-----------------•--•-•...........-•-•-•....-----...--------------•-........-•------------------------------------------............................................................... 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 bee i'ssu di y the board of health. h Signed .... - 11. �....................... ......... ... ..... �. Date Application Approved B ' PP PP Y ............. ..... - �--'.. ............................ ......................................... ..................... . .................. Dare Application Disapproved for the following reasons: .... ........ ... .......................................-- ............ ................ ................... ................ ........................................................................... ............................................................................................................ ........................................ Date Permit No. ....... .��/..`....... ..i3-- -- Issued ..........................-- .................................... Date No.. ...���.. Fps....�v...�...�.... THE COMMONWEALTH OF MASSACHUSETTS _ BOAR® OF HEALTH / Ltd /v ..OF..... 73,.1.4 t'I1�..5�7��...�c..77._-......................... Applira#ion for Uiipuiial Workii Tnnitrurtiun rantit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: V. 0- 5 ........................................... Locajon-Address or Lot No. ..................•.................. � --•-----..............................•.. --------------------- ------------•---------._.------ O er Address a > r'1 .. Install Address QType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms........._�........................Expansion Attic ( ) Garbage Grinder (Q)) per, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures d ------------------------------------------•--•-----•--...-----•-•------------••-••---•----...........------------• W Design Flow......... .........................gallons per person ejr day. Total dai� flow__._.._Zo.__..__.._....__.........gaJlons. WSeptic Tank—Liquid'capacity,er® _gallons Length.... .......... Width..../........ Diameter................ Depth_.__._Y.:_... xDisposal Trench—No..................... Width.....,..4-.-------- Total Length........... ...... Total leaching area....................sq. ft. Seepage Pit No......./............ Diameter.._.[ ..... Depth below inlet........[.._........ Total leaching Other Distribution box (JO Dosing tank ( _ '-' Percolation Test Results Performed b 1-G'k-- •- -��� ._ A_C-'..._.... Date.... _`1� y.................. 4 ._........_._........._.. aTest Pit No. 1__:L Z-_-_-minutes per inch Depth of Test Pit.....IY ....... Depth to ground water__"-0.7......��Ay Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground wateni�ggP�T6R. a -------------------••------•--•••----••------------•----------- O Description of Soil �� R '- �.. _0.....................................---••--•-•------••---••-•. x U 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 TITi:,,,. 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b is e y the bo d health (� l� d Signed- - •- •-- ------•----- •- •-------- ---- ...................... _1 '3� ................. Application Approved By...................... ...... �P:_.__._... Date Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------------------- •---------•-----------------------------------------------------------------------------------------------••---•----•---•---•--•---•-------•-----•--------•----......----•------------------ I......... Date PermitNo------------- >.._ _...... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........... ..' r...........OF.77 ::...:....�� ..U......... 05rrfifiratr of Tampfittnrr THIS IS TO CERTIFY, T at the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by---------------------7--- _4 • --------------------------•-- -- -•-----•------------•--•--------....._......_.....--•-...........--•• Insta I at - � ---- ....-- .......................... has been installed in accordance wit t t,e provisions of T I 5 of The State Sanitary Code des ibfee in the application for Disposal Works Construction Permit No......__. - . .__. dated_:.---�rANTEE . ............. PP P �-°°�-- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUJA THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... ANN THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................OF. .................... Appliration for Uiopooal Works Tumtraartion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: _. `r ....!f_ h.-......-•---•................................ ............... 1 - •- Loca ion-Address or Lot No. ._.......... ................ ........................................... ----•.....----••............................ • •.•-•••---••.....................•............ er Address �. . - --- -------------------------------------•- Install Address Type of Building ../ _ Size Lot............................Sq. feet Dwelling—No. of Bedrooms..........+1=*"" ........................Expansion Attic ( ) Garbage Grinder (/V0) '4 Other—T e of Building No. of persons............................ Showers — Cafeteria a Other 62itures --------------------------- W Design Flow - -------------------............gallons per person per day. Total c��i)1y flow----------------------- --------------------g9 ..... or s. WSeptic Tank—Liquid'capacity,© • ..--gallons Length.. __....... Width----........... Diameter________________ Del ... x Disposal Trench—No. .................... Width....t---------- Total Length........�../..`...... Total leaching area....................sq. ft. Seepage Pit No______ ____________ Diameter____, Z�_:-------- Depth below inlet..._.._!_.._........ Total leaching area.,57C.. . C & Z Other Distribution box ( ) Dosing t�nk Percolation Test Results Performed by........ ' .__ ___�..�jc"�.. .. _'..._..__ Date____. '..... M T as Test Pit No. L.t.k_._.__minutes per inch Depth of'Test Pit.....IY5 o..... Depth to ground water._' 7_-.....erA) " Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water 4p!?..... ODescription of Soil � 1 - ....................................................................................................... W .............---.........................................----•--••----•-•---•-...----•-•---•------•---•••---------...---••-........................................................................... UNature 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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b i e y;th5D healthi...Signed---------- --�-' --•------- ----•-- ••------ "`=-------------------- -�..----- .................. Application Approved BY- '`° "A' ,t .... .......•................................... ...../ Date Application Disapproved for the following reasons:................................................................................................................ ......----•--------•---...---•------------------•------•--•--•-•-•--------••----...---•-•--•------------•-----•--•-•------•--------••--•----•------------•------•--•••----•--•----•-----------------••-- Fl Date PermitNo........... ................ Issued-------------------------------------------------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH C�rrtif iraU of TompliFanrr THIS IS TO CERTIFY, T at the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by-------------------- --- - --------- ------------................--------------- Inst 1 .. at ` r 1 .:..r"°y... 4 . .....------..f.-.'°° ---------------------•-----...-------•---•--.....---•---------------- has been installed in accordance wi i tie provisions of Tl`iLE 5 of The State Sanitary Code ,, de b in the application for Disposal Works Construction Permit No----`� _ �'� ---- dated-------1 P --------... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUAkANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...............................•------..............-----.......------.......... Inspector--•------------------------------------------••----............................---- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No............. `�.J FEE........................ �io�ol.. /�o,.,.r o �onotraar�ion rraatit Permission is hereby granted...... _...,,,a +.r1 s :. to Construct ) Repair ( ) an Individual �r e Disposal System �. at No.--- -------=- ---------- - . ........... } . ..•--.-=� � ....... �s --- � -� " Stree �++ •. as shown on the application for Disposal Works Construction Permit No' ?__ ___ Zted..__ >d "^ Board of Health DATE ........ ' . h� FORM 1255 HOBBS & WARREN. INC., PUBLISHERS 4 a CATION a. / �' NO. - O / LLAGE _ DATE PLICANT �ccG ,/ FEE ZY' DRESSZy3 �`�"� /�� ��'9iyl ✓�� ���'%��'�� "TELEPHONE NO. (Non-refundable) GINEER d ! TELEPHONE NO. kTE SCHEDULED -3 (Applicant' s signature) SOIL LOG B-DIVISION NAME ��� `�'' /LL �i9.5-7' DATE TIME J % PANSION AREA: YES/-ENO _G >.,c� s' ,L^c.c�?z, ��/c, ENGINEER.N- WN WATER-L,�RIVATE WELL BOARD OF HEALTH EXCAVATOR TCH: (Street name,etc. ,dimensions of lot, exact location of test holes and percolation tests, locate wetlands in proximity to test holes) NOTES : L�JA/J S f At Cis- /g v7C_7_/Z'i c � SSE•-�a,,-7 RCOLATION RATE: ST HOLE NO: ELEVATION: TEST HOLE NO: ELEVATION: • 3 ?a 4 .. 3 4 4 - 5 5 6 6 7 ,. 7 8 n.� �- 8 9 10 10 11 11 12 /y�' ~ 12 13 13 14 14 1515 16 16 ITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD LEACHING PITS G LEACHING TRENCHES SUITABLE FOR SUB-SURFACE SEWAGE. REASONS: TE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION IGINAL: COMPLETED IN ENTIRETY BY P . E . AND RETURNED TO BOARD OF HEALTH PY: RETAINED BY APPLICANT f,f